The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decades
Objectives: To investigate the microbiological trends of community-acquired diabetic foot osteomyelitis (DFO) over the past two decades in specialized academic centres in Switzerland, Spain, and Turkey. Methods: A retrospective analysis of DFO cohorts (2000-2019) from five centres (Geneva, Zurich, L...
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Elsevier
2025-05-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971225000669 |
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| author | Laura Soldevila-Boixader Oscar Murillo Felix W.A. Waibel Madlaina Schöni Javier Aragón-Sánchez Karim Gariani Dan Lebowitz Bülent Ertuğrul Benjamin A. Lipsky Ilker Uçkay |
| author_facet | Laura Soldevila-Boixader Oscar Murillo Felix W.A. Waibel Madlaina Schöni Javier Aragón-Sánchez Karim Gariani Dan Lebowitz Bülent Ertuğrul Benjamin A. Lipsky Ilker Uçkay |
| author_sort | Laura Soldevila-Boixader |
| collection | DOAJ |
| description | Objectives: To investigate the microbiological trends of community-acquired diabetic foot osteomyelitis (DFO) over the past two decades in specialized academic centres in Switzerland, Spain, and Turkey. Methods: A retrospective analysis of DFO cohorts (2000-2019) from five centres (Geneva, Zurich, Las Palmas, Barcelona, Istanbul) stratified into four periods (P1-P4) to assess microbiological changes. Results: Among 1379 DFO episodes (76% male, median age 67 years; 90% type 2 diabetes, median duration 17 years), gram-positive bacteria were identified in 82%, including Staphylococcus aureus (47%). Methicillin-resistant S. aureus (MRSA) was more prevalent in Barcelona (36%), Las Palmas (24%), and Geneva (29%) than in Zurich (7%). Over time, gram-positive bacteria remained stable or decreased, particularly in Las Palmas (83% to 65%, P = 0.03). The proportion of MRSA decreased in Geneva (39% to 16%) and Las Palmas (37% to 9%), but remained stable in Barcelona. Enterobacteriaceae prevalence increased, notably in Geneva (16% to 39%, P < 0.01) and Las Palmas (27% to 41%, P < 0.01). Among gram-negative pathogens quinolone resistance was 12.5%. Enterobacteriaceae-DFO was associated with ischemic necrosis (OR 1.65), Las Palmas cohort (OR 3.14), and 2016-2019 period (OR 2.68). Conclusions: A significant increase in Enterobacteriaceae-related DFOs was observed from 2016 to 2019, particularly in Mediterranean Europe. |
| format | Article |
| id | doaj-art-29cf432cbbb4468cbcb94732f79b63d3 |
| institution | DOAJ |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | International Journal of Infectious Diseases |
| spelling | doaj-art-29cf432cbbb4468cbcb94732f79b63d32025-08-20T03:06:25ZengElsevierInternational Journal of Infectious Diseases1201-97122025-05-0115410784310.1016/j.ijid.2025.107843The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decadesLaura Soldevila-Boixader0Oscar Murillo1Felix W.A. Waibel2Madlaina Schöni3Javier Aragón-Sánchez4Karim Gariani5Dan Lebowitz6Bülent Ertuğrul7Benjamin A. Lipsky8Ilker Uçkay9Department of Infectiology, Balgrist University Hospital, Zurich, Switzerland; Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Internal Medicine, Infectious Diseases Unit, Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, SpainDepartment of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; CIBERINFEC (Centro de Investigación Biomédica en Red en Enfermedades Infecciosas), Instituto de Salud Carlos III, Madrid, Spain; Corresponding author. Oscar Murillo, Department of Infectious Diseases, Bellvitge University Hospital Hospitalet de Llobregat, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, SpainDepartment of Orthopedic Surgery, Balgrist University Hospital, Zurich, SwitzerlandDepartment of Orthopedic Surgery, Balgrist University Hospital, Zurich, SwitzerlandDepartment of Surgery and Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, SpainDivision of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, Geneva University Hospitals, Geneva, SwitzerlandService of Infectious Diseases, Geneva University Hospitals, Geneva, SwitzerlandUnit for Diabetic Foot and Chronic Wounds, Service of Infectious Diseases and Clinical Microbiology, GEDA Clinic, Izmir, Turkiye; Service of Infectious Diseases and Clinical Microbiology, REYAP Clinic, Istanbul, TurkiyeDepartment of Medicine, University of Washington, Seattle, Washington, USADepartment of Infectiology, Balgrist University Hospital, Zurich, Switzerland; Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, SwitzerlandObjectives: To investigate the microbiological trends of community-acquired diabetic foot osteomyelitis (DFO) over the past two decades in specialized academic centres in Switzerland, Spain, and Turkey. Methods: A retrospective analysis of DFO cohorts (2000-2019) from five centres (Geneva, Zurich, Las Palmas, Barcelona, Istanbul) stratified into four periods (P1-P4) to assess microbiological changes. Results: Among 1379 DFO episodes (76% male, median age 67 years; 90% type 2 diabetes, median duration 17 years), gram-positive bacteria were identified in 82%, including Staphylococcus aureus (47%). Methicillin-resistant S. aureus (MRSA) was more prevalent in Barcelona (36%), Las Palmas (24%), and Geneva (29%) than in Zurich (7%). Over time, gram-positive bacteria remained stable or decreased, particularly in Las Palmas (83% to 65%, P = 0.03). The proportion of MRSA decreased in Geneva (39% to 16%) and Las Palmas (37% to 9%), but remained stable in Barcelona. Enterobacteriaceae prevalence increased, notably in Geneva (16% to 39%, P < 0.01) and Las Palmas (27% to 41%, P < 0.01). Among gram-negative pathogens quinolone resistance was 12.5%. Enterobacteriaceae-DFO was associated with ischemic necrosis (OR 1.65), Las Palmas cohort (OR 3.14), and 2016-2019 period (OR 2.68). Conclusions: A significant increase in Enterobacteriaceae-related DFOs was observed from 2016 to 2019, particularly in Mediterranean Europe.http://www.sciencedirect.com/science/article/pii/S1201971225000669Diabetic foot osteomyelitisMulticentre cohortGram-negative rodsEnterobacteriaceaeMRSA |
| spellingShingle | Laura Soldevila-Boixader Oscar Murillo Felix W.A. Waibel Madlaina Schöni Javier Aragón-Sánchez Karim Gariani Dan Lebowitz Bülent Ertuğrul Benjamin A. Lipsky Ilker Uçkay The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decades International Journal of Infectious Diseases Diabetic foot osteomyelitis Multicentre cohort Gram-negative rods Enterobacteriaceae MRSA |
| title | The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decades |
| title_full | The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decades |
| title_fullStr | The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decades |
| title_full_unstemmed | The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decades |
| title_short | The increasing prevalence of Enterobacteriaceae as pathogens of diabetic foot osteomyelitis: A multicentre European cohort over two decades |
| title_sort | increasing prevalence of enterobacteriaceae as pathogens of diabetic foot osteomyelitis a multicentre european cohort over two decades |
| topic | Diabetic foot osteomyelitis Multicentre cohort Gram-negative rods Enterobacteriaceae MRSA |
| url | http://www.sciencedirect.com/science/article/pii/S1201971225000669 |
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