1534. The Detection of Methicillin-sensitive Staphylococcus aureus from Ulcer Is a Risk Factor of Amputation in Foot Infection with Critical Limb Ischemia after Revascularization
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDweek 2015 one poster.pdf (327.0 kB)
  • Background: Foot infection with critical limb ischemia (CLI) required amputation occasionally. The aim of this study is to determine the most common organisms involved in foot infection with CLI and to investigate the risk of amputation after revascularization.

    Methods: We retrospectively reviewed 64 patients who suffered from Fontaine classification stage IV of CLI and were hospitalized at our hospital to perform revascularization during two years from 2012 to 2014. We collected data of isolated microorganism (>104 cfu/ml) from surface or biopsy sample, the Society for Vascular Surgery lower extremity threatened limb (SVS WIfI) classification associated with wound, ischemia, and foot infection, and outcome.

    Results: The rate of severe grade of wound and ischemia before revascularization was 7.8% (5 cases) and 39.1% (25 cases), respectively. There was no case of severe grade of infection with the sign of SIRS. The number of the cases with high risk of amputation by the SVS WIfI classification after revascularization was significantly lower than that before revascularization (16/64, 25.0% vs. 30/64, 55.6%; p<0.001). Amputation was performed for 15 patients (23.4%) (at toes, 10 cases; below the knee, 3 case; above the knee, 2 cases). A total of 92 bacterial strains were isolated from ulcer of 42 patients . The most common isolate is Staphylococcus aureus (27 strains, 29.3%): 12 strains (13.0%) of methicillin-sensitive S. aureus (MSSA) and 15 strains (16.3%) of methicillin-resistant S. aureus(MRSA). There was no difference of the rate of severe grade of ischemia after revascularization between the case with MSSA detection and the case without MSSA detection (8.3%, 1/12 vs. 7.7%, 4/52; p=0.45); however there was a significant difference of the rate of severe grade of wound between two groups (25.0%, 3/12 vs. 3.8%, 2/52; p=0.04). The detection of MSSA was a significant risk factor for amputation (50.0%, 6/12 vs. 9/52, 17.3%; p=0.03). There was no relation between MRSA detection and the rate of severe grade of wound (6.7%, 1/15 vs. 8.2%, 4/49; p=0.46) or the rate of case required amputation (26.6%. 4/15 vs. 16.3%, 8/19; p=0.74).

    Conclusion: Foot infection with CLI caused by MSSA was associated with the severity of wound and one of risk factors of amputation after revascularization.

    Hideki Kawamura, MD, PhD1, Kenichi Arata, MD, PhD2, Itsumi Imagama, MD2, Toyoyasu Koriyama, MT1, Tsuyoshi Kojyo, MT1, Akari Shigemi, MSc1, Koichi Tokuda, MD, PhD, MPH1, Yutaka Imoto, MD, PhD2 and Junichiro Nishi, MD, PhD1, (1)Department of Infection Control and Prevention, Division of Medical and Environmental Safety, Kagoshima University Hospital, Kagoshima, Japan, (2)Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Disclosures:

    H. Kawamura, None

    K. Arata, None

    I. Imagama, None

    T. Koriyama, None

    T. Kojyo, None

    A. Shigemi, None

    K. Tokuda, None

    Y. Imoto, None

    J. Nishi, None

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