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Evidence of the Month

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Evidence of the Month

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    1. Evidence of the Month Comment on: Miniaturized oligonucleotide arrays: a new tool for discriminating colonization from infection due to Staphylococcus aureus in diabetic foot ulcers

    2. Methods

    3. Results S aureus isolated in 72 patients: 35 MRSA; 37 methicillin sensitive All recurring wounds MRSA; only 1 new foot ulcer MRSA 50 patients had clinical signs of infection; 22 patients were clinically uninfected MRSA was more prevalent in infected than in uninfected wounds Virulence genes were present in 98% of infected wounds and 9% of uninfected wounds

    4. Results Uninfected wounds in 22 patients not initially treated with antibiotics 8 healed and 14 developed clinical infection (2 within 10 days and 12 more than 3 weeks after initial presentation) In these 2 patients, virulence genes with the same S aureus genotype were present in the wound sample and at follow-up In the majority of the 14 patients, virulence genes appeared at follow-up, and S aureus was again isolated but with a different genotype from baseline

    5. Clinical implications About half of patients with diabetic foot ulcers have signs of infection at presentation, and several with uninfected wounds will develop an infection during follow-up Study by Sotto et al highlights the problems of diagnosing/treating diabetic foot ulcers Recurrent foot ulcer wounds often positive for MRSA due to previous antibiotic treatment Both virulence and resistance factors appeared more frequently in clinically infected wounds Isolation of S aureus from a clinically uninfected wound but with unfavourable resistance and virulence profile associated with rapid onset of infection in some patients

    6. Clinical implications New, faster approaches are needed to identify S aureus infections in diabetic foot ulcers If well replicated in future studies, DNA arrays may help to detect more virulent colonisers and/or early infection before clinical signs are present Already possible with PCR methods to identify gram-negative antibiotic-resistant micro-organisms Only with new approaches can we stem the growing epidemic of multi-resistant micro-organisms

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