Alternative antibacterial therapy of Methicillin-resistant Staphylococcus aureusin patients with diabetic foot and sepsis

Abstract

A total of 210 patients with diabetic foot and sepsis who were treated in the purulent-septic center of Zaporizhzhya, Ukraine, were examined for the period of 2007–2020. All patients had type II diabetes mellitus, with a duration of 12.6 ± 2.7 years and an age of 56.8 ± 2.5 years. The diagnosis of sepsis is established according to the criteria of Sepsis-3 (2016). The complex of therapeutic measures included the mandatory use of antibacterial drugs, which was preceded by a microbiological study of biological material (blood and wound discharge). Gram-positive flora was detected in 118 (56.2%) patients and prevailed over gram-negative 81 (38.6%), anaerobes were detected in six (2, 8%) patients, and fungal flora in five (2.4%). Among patients diagnosed with Staphylococcus aureus 52 (100%), Methicillin-resistant Staphylococcus aureus (MRSA) prevailed with 38 (73.0%) (p < 0.05). We have identified a pattern that allowed us to categorize patients with MRSA into four groups according to similar sensitivity to antibacterial drugs, which received the conventional designations MRSA type 1; MRSA type 2; MRSA type 3; MRSA type 4. Moreover, MRSA type 4–3 (7, 9%) of the patient is pan-resistant. The most universal drugs in the presence of MRSA in patients with sepsis caused by complicated DFS are daptomycin, linezolid, teicoplanin, vancomycin, and tigecycline. In patients with MRSA type 1 and MRSA type 2, except standard anti - MRSA antibiotics, aminoglycosides, fluoroquinolones and macrolides can be effectively used as first-line drugs.