Preprint Article Version 2 Preserved in Portico This version is not peer-reviewed

The Influence of Skin Commensals on the Therapeutic Outcomes of Surgically-Debrided Diabetic Foot Infections – A Large Retro-Spective Comparative Study

Version 1 : Received: 20 December 2022 / Approved: 21 December 2022 / Online: 21 December 2022 (09:23:20 CET)
Version 2 : Received: 19 January 2023 / Approved: 20 January 2023 / Online: 20 January 2023 (15:13:51 CET)

A peer-reviewed article of this Preprint also exists.

Uçkay, I.; Lebowitz, D.; Kressmann, B.; Lipsky, B.A.; Gariani, K. Influence of Skin Commensals on Therapeutic Outcomes of Surgically Debrided Diabetic Foot Infections—A Large Retrospective Comparative Study. Antibiotics 2023, 12, 316. Uçkay, I.; Lebowitz, D.; Kressmann, B.; Lipsky, B.A.; Gariani, K. Influence of Skin Commensals on Therapeutic Outcomes of Surgically Debrided Diabetic Foot Infections—A Large Retrospective Comparative Study. Antibiotics 2023, 12, 316.

Abstract

In diabetic foot infections (DFI), the clinically virulence of skin commensals are generally pre-sumed to be of low virulence. In this single-center study, we divided the wound isolates into two groups: skin commensals (coagulase-negative staphylococci, micrococci, corynebacteria, cutibacteria); and, pyogenicpathogenic pathogens, and followed the patients for ≥ 6 months. In this retrospective study among 1,018 DFI episodes (392 [39%] with osteomyelitis), we identified skin commensals as the sole culture isolates (without accompanying pyogenicpathogenic patho-gens) in 54 cases (5%). After treatment (antibiotic therapy [median of 20 days], hyperbaric oxy-gen in 98 cases [10%]), 251 episodes (25%) were clinical failures. Group comparisons between those growing only skin commensals and controls found no difference in clinical failure (17% vs 24 %, p=0.23) or microbiological recurrence (11% vs 17 %, p=0.23). The skin commensals were mostly treated with non-beta-lactam oral antibiotics. In multivariate logistic regression analysis, isolation of only skin commensals was not associated with failure (odds ratio 0.4, 95% confi-dence interval 0.1-3.8). Clinicians might wish to consider these isolates as potential pathogens when selecting a targeted antibiotic regimen, which may equally base on oral non-beta-lactam antibiotic agents susceptible to the corresponding skin pathogens.

Keywords

antibiotic therapy; diabetic foot infections; non-beta-lactam antibiotics; skin commensals; treatemet failures; associations with treatment failures

Subject

Medicine and Pharmacology, Surgery

Comments (1)

Comment 1
Received: 20 January 2023
Commenter: Ilker Uçkay
Commenter's Conflict of Interests: Author
Comment: -
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