Faculty Collaboration Database

Comparison of serum and tissue antibiotic levels in diabetes-related foot infections. Surgery 1991 Oct;110(4):671-6; discussion 676-7

Date

10/01/1991

Pubmed ID

1925956

Scopus ID

2-s2.0-0025952746 (requires institutional sign-in at Scopus site)   44 Citations

Abstract

Parenteral antibiotics are used as an adjunct to amputation or operative debridement for patients with diabetes who require emergency surgery for a septic foot. In 26 patients with a diabetes-related foot infection, one dose of various intravenous antibiotic regimens (gentamicin and clindamycin, ticarcillin/clavulanate, ampicillin/sulbactam) was administered during the hour before the procedure, and assays were performed to measure the antibiotic serum and tissue levels at the time of surgical debridement. Aerobic and anaerobic cultures were performed on infected tissue. The 172 bacterial isolates, including 95 aerobes and 77 anaerobes, (6.6 isolates per patient) underwent antibiotic susceptibility testing. Antibiotic levels were calculated by biologic assay from serum and tissue biopsies from the viable margins of the surgical site, which subsequently healed primarily or supported a split-thickness skin graft. Sixteen of the patients achieved therapeutic serum levels, and therapeutic tissue levels were reached in six patients at the time of surgery. A significantly lower number of patients had therapeutic tissue levels compared to serum levels (p less than 0.01, chi square). Initial intravenous antibiotic administration provides inadequate tissue concentrations for treating foot infections in patients with diabetes. Adequate serum antibiotic levels do not reflect therapeutic tissue antibiotic levels at the surgical margins in this group of patients.

Author List

Seabrook GR, Edmiston CE, Schmitt DD, Krepel C, Bandyk DF, Towne JB

MESH terms used to index this publication - Major topics in bold

Anti-Bacterial Agents
Bacterial Infections
Diabetes Complications
Diabetes Mellitus
Foot Diseases
Humans