Investigation of methicillin resistant S.aureus carriage among the patients with diabetic foot infection by using molecular diagnostic methods background-objective

Foot infections lengthen the duration ofhospitalization stay and increase the risk of amputation and major medical, social and economic complication for patients with diabetes. In this study, we have investigated the prevalence of MRSA carriage in diabetic patients, risk factors, agents for diabetic foot infections and we have explored the relationship between nasal carriage and foot infection.Material-Method: The present study was conducted at Düzce School of Medicine and Izzet Baysal Hospital in Bolu between March 2007 and July 2007 on 250 patients who were diagnosed with type1 and type 2 diabetes. Forty-seven patients with diabetic foot ulcers were included in this study. The ulcer and nasal samples were evaluated by using standard microbiolocigal techniques. The samples of patients whose were positive for MRSA tested for the presence of nuc, mecA and PVL genes by PCR and gel electrophoresis.Results: Nasal MRSA carriage was obtained from %10.4 of the 250 patients. The most common isolate from foot infections was S.aureus (%25.6) as 8.9% MRSA and 16.8% MSSA. 55.5%of the patients who had MRSA isolation from their diabetic foot ulcer were nasal MRSA carrier.The antimicrobial resistance patterns were similar 22.2% of these samples. Nuc and mecA genes were found positive for all MRSA isolates obtained from foot and nasal samples; while PVL genes were positive is 1.5% associated with foot infections.Conclusion: This study showed that, the increase in the nasal MRSA carriage in diabetic patients and the risk factor for foot ulcer infections. The nasal and foot ulcer isolates showed that fenotpying demonstrated but found positive PVL genes in the foot ulcer isolates different from those of the nasal isolates of samples even if there is a need of an filogenetic analysis in order to prove that the source of MRSA isolated from diabetic foot infections in nasal carriage. Nasal carriage is always a risk factor for infections in diabetic patients and necessary precautionsKey Words: Diabetic foot, MRSA, nasal carriage, mecA, PVL