Enterococci in Diabetic Foot Infections: Prevalence, Clinical Characteristics, and Outcomes

• Published in: Open forum infectious diseases Vol. 10; no. 5; p. ofad238
• Main Authors: Perzon, Ofer, Cahn, Avivit, Gellman, Yechiel N, Leibovitch, Michal, Peled, Shahar, Elishoov, Ofer, Haze, Amir, Olshtain-Pops, Karen, Elinav, Hila
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.05.2023
• Subjects: Major; amputation; diabetic foot infection; enterococci
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad238

Abstract Background Diabetic foot infections (DFIs) are frequently polymicrobial, yet the relevance of each isolated pathogen, remains ill-defined. Specifically, the prevalence and pathogenicity of enterococcal DFIs and the impact of targeted antienterococcal treatment remain elusive. Methods We collected demographic, clinical, and outcome-related data on patients admitted with DFIs to the Hadassah Medical Center diabetic foot unit between 2014 and 2019. The primary outcome was a composite of in-hospital death or major amputation. Secondary outcomes included any amputation, major amputation, length of stay (LOS), and 1-year major amputation or mortality rate. Results Enterococci were isolated in 35% of 537 eligible DFI case patients, who were notable for a higher prevalence of peripheral vascular disease, increased levels of C-reactive protein, and higher Wagner scores. Infection in enterococci-positive individuals was mostly polymicrobial (96.8% vs 61.0% in non–enterococci-infected patients; P < .001). Enterococci-infected patients were more likely to undergo amputation (72.3% vs 50.1%; P < .001) and had longer hospital stays (median LOS, 22.5 vs 17 days; P < .001), but the primary end point of major amputation or in-hospital death did not differ between groups (25.5% vs 21.0%; P = .26). Appropriate antienterococcal antibiotics were used in 78.1% of enterococci-infected patients and, compared with results in untreated patients, were associated with a trend toward a lower rate of major amputations (20.4% vs 34.1%; P = .06) but longer hospitalization (median LOS, 24 vs 18 days; P = .07). Conclusions Enterococci are common in DFIs and associated with higher rates of amputation and longer hospitalization. A reduction in major amputation rates with appropriate enterococci treatment is suggested retrospectively, meriting validation by future prospective studies.