{"id":116037,"date":"2014-08-07T00:00:00","date_gmt":"2014-08-07T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/infecciones-en-ulceras-de-pie-diabetico-epidemiologia-factores-predictivos-de-multirresistencia-y-pronosticos-asociados-con-amputacion-estudio-prospectivo-2008-2012\/"},"modified":"2014-08-07T00:00:00","modified_gmt":"2014-08-07T00:00:00","slug":"infecciones-en-ulceras-de-pie-diabetico-epidemiologia-factores-predictivos-de-multirresistencia-y-pronosticos-asociados-con-amputacion-estudio-prospectivo-2008-2012","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/medicina-interna\/infecciones-en-ulceras-de-pie-diabetico-epidemiologia-factores-predictivos-de-multirresistencia-y-pronosticos-asociados-con-amputacion-estudio-prospectivo-2008-2012\/","title":{"rendered":"Infecciones en ulceras de pie diabetico: epidemiolog\u00eda, factores predictivos de multirresistencia y pronosticos asociados con amputacion. estudio prospectivo 2008-2012"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Mar\u00eda  Victoria Garcia Zafra <\/strong><\/h2>\n<p>Objetivos: estudio descriptivo de las infecciones de pie diab\u00e9tico en nuestro \u00e1mbito, identificaci\u00f3n de aquellos factores predictivos de infecciones multirresistentes y valoraci\u00f3n de los factores pron\u00f3sticos asociados con la amputaci\u00f3n.  pacientes y m\u00e9todo: hemos estudiado 167 pacientes con infecciones de \u00falceras de pie diab\u00e9tico ingresados en el hospital cl\u00ednico universitario virgen de la arrixaca (murcia; espa\u00f1a) durante los a\u00f1os 2008 a 2012. Las infecciones se clasificaron de acuerdo con la escala de severidad de idsa, y la metodolog\u00eda microbiol\u00f3gica seg\u00fan los criterios de gorbach. Todos los datos epidemiol\u00f3gicos se recogieron durante la hospitalizaci\u00f3n de una forma protocolizada. Se analiz\u00f3 la epidemiolog\u00eda, los factores de riesgo asociados al staphylococcus aureus meticilin resistente (samr), a bacilos gram negativos productores de betalactamasas de espectro extendido (blee) y los factores pron\u00f3sticos de amputaci\u00f3n.  resultados: de la muestra de 167 pacientes, 79% fueron hombres, con una edad media de 62 a\u00f1os y una historia de diabetes de m\u00e1s de 20 a\u00f1os de evoluci\u00f3n. La estancia media hospitalaria fue de 17 d\u00edas (rango 7-21 d\u00edas. Los pacientes ten\u00edan mayoritariamente diabetes tipo 2 (89%), mal control metab\u00f3lico (66%), hipertensi\u00f3n (89%), exceso de peso (80%) y eran fumadores (50%). Las \u00falceras eran digitales (73%), mayores de 2 cm. (57%) y profundas (85,6%). Casi el 40% de las \u00falceras presentaba afectaci\u00f3n \u00f3sea. En las \u00falceras m\u00e1s graves (idsa) (34%) el microorganismo m\u00e1s frecuente fue samr. La mitad de los cultivos fueron monomicrobianos. El microorganismo m\u00e1s frecuentemente aislado fue s. Aureus (36%) seguido de e. Coli (17%) y p. Aeruginosa (5%). De las 82 infecciones de pie diabetico causadas por cocos gram positivos, (47 -28%- samr); y 85 por bacilos gram negativos (68 -40%- productores de blee). El an\u00e1lisis multivariante mostr\u00f3 que la vasculopat\u00eda perif\u00e9rica [or 2,47; ic 95% (1.068-4.727)], el uso previo de fluorquinolonas [or 2,78; ic 95% (1,156-6,685)] y la profundidad [or 8,563; ic 95% (1,068-4,727)] permiten explicar el 71,8 % de las infecciones por staphylococcus aureus meticilin resistentes. En el caso de los bacilos gram negativos productores de blee, el an\u00e1lisis multivariante mostr\u00f3 que la osteomielitis [or 6,351; ic 95% (1,609-25,068)] y el uso previo de cefalosporinas [or 5,824; ic 95% (1,517-22,361)] permiten explicar el 80,9% de las infecciones. Respecto a las amputaciones, el estudio multivariante mostr\u00f3 que la vasculopat\u00eda grave [or 2,7; ic 95%(1,142-6,377)] y la supuraci\u00f3n [or 3,4; ic 95% (1,331-8,642)] permiten explicar el 70,7 % de las amputaciones. conclusiones: hemos estudiado 167 pacientes por infecciones de \u00falcera de pie diab\u00e9tico con una edad media de 62 a\u00f1os y con diabetes tipo 2 mayoritariamente. Las \u00falceras m\u00e1s frecuentes son cr\u00f3nicas, de m\u00e1s de 2 cm de di\u00e1metro y profundas, en las cuales el microorganismo m\u00e1s frecuentemente hallado es s. Aureus seguido de e. Coli y p. Aeruginosa en las m\u00e1s graves. como factores predictivos asociados de forma independiente a las infecciones por s. Aureus meticilin resistente encontramos la vasculopat\u00eda perif\u00e9rica, el uso previo de antibi\u00f3tico y las \u00falceras profundas. En el caso de los bacilos gram negativos productores de blee, encontramos asociados de forma independiente la afectaci\u00f3n \u00f3sea y el uso previo de antibi\u00f3ticos.  como factores pron\u00f3sticos asociados de forma independiente a la amputaci\u00f3n encontramos la vasculopat\u00eda grave y la supuraci\u00f3n prolongada de la \u00falcera.   objectives: to evaluate the diabetic foot infections epidemiology, factors associated to mdro-dfi and amputation prognostic factors in our hospital.   patients and methods: 167 patients with dfi and hospitalized at hospital cl\u00ednico universitario virgen de la arrixaca (murcia; spain) were prospectively studied from 2008 to 2012. Infections were diagnosed according to the idsa severity score. The microbiological methodology was adjusted to gorbach criteria. All epidemiologic and clinical data were collected during hospitalization according to a standard protocol. Epidemiology, risk factors for methicillin resistant staphylococcus aureus (mrsa), extended spectrum producing beta-lactamases enterobacteria (esbl-producing bacteria) and amputation dfi were analyzed.  results: out of 167 patients, 79% were males, with an average age of 62 and diabetes history of 20 years. The average length of stay was 17 days (7-21 range). Our patients had type 2 diabetes (89%), poor metabolic control (66%), hypertension (89%), overweight (80%) and were smokers (50%). The ulcers were digitals (73%), bigger than 2 cm. (57%) and deep (85,6%). Almost 40% of them had bone infection. The ulcers were severe (idsa) in 34% and in those the microorganism more frequently obtained was mrsa. Half of the samples had just one microorganism isolated, most frequent was s. Aureus (36%) followed by e. Coli (17%) and p. Aeruginosa (5%). 82 dfi were considered to be caused by gram-positive cocci (47 -28%- mrsa); and 85 by gram-negative bacilli (68 -40%- esbl-producing bacteria). In multivariate analyses, statistically significant independent factors for mrsa infections included: wound depth (or 8.563, 95%ci 1.097-66.842), peripheral vasculopathy (or 2.247, 95%ci 1.068-4.727) and fluoroquinolon previous use (or 2.78, 95%ci 1.156-6.685); independent factors for esbl-producing bacteria dfi were osteomyelitis (or 6.351, 95%ci 1.609-25.068) and previous cephalosporin administration (3 months before)  (or 5.824, 95% ci 1.517-22.361); independent factors associated with amputation were severe vasculopathy [or 2,7; ic 95%(1,142-6,377)]  and long ulcer discharge[or 3,4; ic 95% (1,331-8,642)]. conclusions: we have studied 167 patients for dfi, almost all of them had type 2 diabetes and an average age of 62 years. The more frequent ulcers are chronic, bigger than 2 cm and deep, in which the main microorganism isolated was s. Aureus and in those severe samr followed by e. Coli and p. Aeruginosa. Our study detects an association in patients with dfi between mrsa infection and wound depth, peripheral vasculopathy and previous fluoroquinolon use; esbl-producing bacterial infection is associated to osteomyelitis and previous cephalosporin treatment.  We found as prognostic factors of amputation severe vasculopathy and long ulcer discharge.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Infecciones en ulceras de pie diabetico: epidemiolog\u00eda, factores predictivos de multirresistencia y pronosticos asociados con amputacion. estudio prospectivo 2008-2012<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Infecciones en ulceras de pie diabetico: epidemiolog\u00eda, factores predictivos de multirresistencia y pronosticos asociados con amputacion. estudio prospectivo 2008-2012 <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Mar\u00eda  Victoria Garcia Zafra <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 08\/07\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Francisco Javier Tebar Masso<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: jos\u00e9 Barber\u00e1n l\u00f3pez <\/li>\n<li>elisa Garcia vazquez (vocal)<\/li>\n<li>\u00ed\u00a0lex Soriano viladomiu (vocal)<\/li>\n<li>Jorge Parra ruiz (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Mar\u00eda Victoria Garcia Zafra Objetivos: estudio descriptivo de las infecciones de pie diab\u00e9tico en nuestro \u00e1mbito, identificaci\u00f3n [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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