Choice of Empirical Treatment in Patients With Wound Infection

Year 2024, , 604 - 610, 30.09.2024

Hülya Duran , Nihan Ceken , Tuğba Kula Atik , Esma Yeniiz

https://doi.org/10.33808/clinexphealthsci.1093150

Abstract

Objective: We aimed to determine the distribution of infectious agents in wound culture specimens, their resistance rates, and to evaluate empirical treatment choices in wound infections.
Methods: Wound culture results of adult patients between 2016-2020 were retrospectively investigated. Determination of bacteria and antibiotic sensitivity tests were done using conventional methods and automatized systems.
Results: A total of 2576 wound specimens were sent, and significant bacterial growth was detected in 1254 (48.7%). Most frequently isolated agent was Escherichia coli (E.coli) (24.2%), followed by Staphylococcus aureus (S.aureus) (16.8%). The highest rate of resistance in Enterobacterales species was against amoxicillin-clavulanate (AMC), except Proteus mirabilis. Antibiotics that Enterobacterales species were most sensitive were amikacin and carbapenems, while it was trimethoprim – sulfamethoxazole (TMP-SXT) for Acinetobacter baumannii, and amikacin for Pseudomonas aeruginosa. The highest rate of resistance in S.aureus strains was against penicillin, with a methicillin resistance rate of 22.9%, while no resistance was found against vancomycin.
Conclusion: Initial treatment in wound infections is empirical, and the range of treatment is narrowed when results of culture and sensitivity tests are obtained. Clindamycin, AMC, TMP – SXT and ciprofloxacin seem to be appropriate for outpatients, while TMP-SXT or vancomycin for gram-positive cocci, and TMP-SXT and amikacin combination for gram – negatives, and carbapenems as a last resort.

Keywords

Wound infection, empirical treatment, antibiotic resistance

References

• Ramakrishnan K, Salinas RC, Higuita NIA. Skin and soft tissue infections. Am Fam Physician 2015;92(6):474-483.
• Negut I, Grumezescu V, Grumezescu AM. Treatment strategies for infected wounds. Molecules 2018;23(9):2392. DOI:10.3390/molecules23092392
• Mohanty S, Mahapatra A. In vitro activity of tigecycline against multidrug-resistant Enterobacteriaceae isolates from skin and soft tissue infections. Ann Med Surg (Lond). 2021;62:228-230. DOI: 10.1016/j.amsu.2021.01.010.
• Leong HN, Kurup A, Tan MY, Kwa ALH, Liau KH, Wilcox MH. Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics. Infect Drug Resist. 2018;11:1959-1974. DOI: 10.2147/IDR.S172366.
• Bessa LJ, Fazii P, Giulio MD, Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection. Int Wound J 2015;12(1):47-52. DOI:10.1111/iwj.12049
• TC Sağlık Bakanlığı, Türkiye Akılcı İlaç Kullanımı Bülteni 2017;4(1):1-13.(Turkish)
• The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters, Version 10.0.2020. http://www.eucast.org.
• Sisay M, Worku T, Edessa D. Microbial epidemiology and antimicrobial resistance patterns of wound infection in Ethiopia: A meta-analysis of laboratory-based cross-sectional studies. BMC Pharmacol Toxicol 2019;20(1):35-54. DOI:10.1186/s40360.019.0315-9
• Marques SA, Abbade LPF. Severe bacterial skin infections. An Bras Dermatol 2020;95(4):407-417. DOI:10.1016/j. abd.2020.04.003
• Bouza E, Burillo A. Current international and national guidelines for managing skin and soft tissue infections. Curr Opin Infect Dis. 2022;35(2):61-71. DOI: 10.1097/QCO.000.000.0000000814. PMID: 35067522.
• Klinik Örnekten Sonuç Raporuna Uygulama Rehberi, Deri, Deri Ekleri, Yumuşak Doku Örnekleri-Göz Örnekleri, KLİMUD, 2015 Ankara, p.11-18. (Turkish)
• Stieferman AE, Mazi P, Burnham JP. Severe skin and soft-tissue infections. Semin Respir Crit Care Med. 2022;43(1):3-9. DOI:10.1055/s-0041.174.0974
• Russo A, Concia E, Cristini F, De Rosa FG, Esposito S, Menichetti F, Petrosillo N, Tumbarello M, Venditti M, Viale P, Viscoli C, Bassetti M. Current and future trends in antibiotic therapy of acute bacterial skin andskin-structure infections. Clin Microbiol Infect 2016;22(2):27-36. DOI:10.1016/S1198-743X(16)30095-7
• Avcıoğlu F, Behçet M, Karabörk Ş, Kurtoğlu MG. Antimicrobial resistance rates of microorganisms isolated from wound specimens-three year evaluation. J DU Health Sci Inst 2019;9(3):110-114. DOI: 10.33631/duzcesbed.538681
• Eren F, Öngün G, Ural O, Öztürk Ş. Hospital infection rates in a neurology intensive care unit in a one-year period: Pathogenic and clinical evaluation. Turk J Neurol 2017;23:205-210. DOI:10.4274/tnd.59002
• Tanrıverdi Çaycı Y, Torun EG, Bilgin K, Birinci A. Microorganisms isolated from wound specimens and antibiotic resistance profiles. J DU Health Sci Inst 2021;11(2):123-128. DOI:10.33631/duzcesbed.562187
• Çöplü N, Çağatay M, Aygün Ünal N, Singer Ş, Öcal D. Approach to surgical wound infections from the perspective of antibiotic control team. Türk Mikrobiyol Cem Derg 2016;46(3):128-134. DOI:10.5222/TMCD.2016.128
• Burnham JP, Kollef MH. Treatment of severe skin and soft tissue infections: A review. Curr Opin Infect Dis. 2018;31(2):113-119. DOI:10.1097/QCO.000.000.0000000431. PMID: 29278528; PMCID: PMC6200137.
• Christaki E, Marcou M, Tofarides A. Antimicrobial resistance in bacteria: Mechanisms, evolution, and persistence. J Mol Evol. 2020;88(1):26-40. DOI:10.1007/s00239.019.09914-3.
• Turhanoğlu NM, Koyuncu E, Bayındır Bilman F. Microorganisms and antibiotic resistances isolated from wound cultures, 2010-2015. Turk Hij Den Biyol Derg 2018;75(2):183-194. DOI:10.5505/TurkHijyen.2018.56338
• Köse E, Çalışkan E, Memiş N, Dönmez B, Duran P. Microorganisms isolated from wound samples and theirantibiotic resistance rates. ANKEM Derg 2021;35(1):14-21. DOI:10.5222/ankem.2021.014
• Yerlikaya H, Kirişci Ö, Çilburunoğlu M, Uğurlu H, Aral M, Muratdağı G. Microorganisms isolated from wound cultures and their antibiotic susceptibilities. Sakarya Tıp Derg 2021;11(1):170-176. DOI:10.31832/smj.824924
• Agarwal R, Bartsch SM, Kelly BJ, Prewitt M, Liu Y, Chen Y, Umscheid CA. Newer glycopeptide antibiotics for treatment of complicated skin and soft tissue infections: A systematic review, network metaanalysis and cost analysis. Clin Microbiol Infect 2018;24(4):361-368. DOI:10.1016/j.cmi.2017.08.028
• Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America 2022 Guidance on the treatment of extended-spectrum β-lactamase producing enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). Clin Infect Dis. 2022;75(2):187-212. DOI:10.1093/cid/ciac268.
• Central Asian and Eastern European Surveillance of Antimicrobial Resistance, Annual report 2016 https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial – resistance/publications/2017/central-asianand-eastern-european-surveillance-of – antimicrobialresistance.- annual-report-2016
• Central Asian and European Surveillance of Antimicrobial Resistance, Annual report 2020https://www.euro.who. int/ data/assets/pdf_file/0003/469200/Central-Asian-and –European-Surveillance-of-Antimicrobial-Resistance.-Annualreport-2020-eng.pdf
• Nordmann P, Poirel L. Epidemiology and diagnostics of carbapenem resistance in gram-negative bacteria. Clin Infect Dis. 2019;69(7):521-528. DOI:10.1093/cid/ciz824