The comparison of imipenem/cilastatin and piperacillin/tazobactam regimens for the treatment of moderate to severe diabetic foot infections: A prospective, randomized study

Foot infections are frequent causes of substantial morbidity and mortality in the diabeticpopulation. Appropiate clinical assesment and culturing of infections are critical in establishingthe presence and severity of infection. Following necessary debridement and other surgicalinterventions, appropriate antibiotic therapy is a cornerstone of managing the infected diabeticfoot.In the prospective, randomised, clinical trial of comparing the effectiveness and sideeffects of two antibiotic regimens, we assessed the patients with diabetic foot infections whoseinfection grade is between Wagner 2 and 4. Of 62 patients enrolled the study, we randomlyassigned patients Piperacillin / tazobactam or İmipenem / cilastatin. A total of 89 organisms wereisolated from 62 patients. Infections were polimycrobial in 40,3 % of patients while 21 % had nobacterial growth on culture. Of the microorganisms isolated, 42,7 % were gram positive while57,3 % were gram negative. Nearly 66 % of the patients had previous antibiotic therapy and 40 %had a hospitalisation history within 3 weeks of the study. The frequency of the microorganismsisolated from each therapy group was similar and the most commonly isolated pathogens werePseudomonas aeruginosa, Staphylococcus spp, Streptococcus spp and Enterobacteriacea spp.The presence of ESBL among the Enterebacteriacea isolates was 40 % while the methicillinresistance among Staphylococcus species was 75 %.Of the patients in Piperacillin / Tazobactam group, 60 % had undergone an amputationwhile the 68,8 % of the patients in the Imipenem / cilastatin group had. Most of the amputations (63,6 %) which were done as a consequence of infection, were among the patients whose infectiongrade was Wagner 3.Cure rates for the two treatment groups were similar when compared by clinical response.The side effects were more common in the Piperacillin / Tazobactam group and the most frequentones were nephrotoxicity, hepatotoxicity, and the haematological effects, respectively.As a result, because of the broad antibacterial spectrum and their relatively high cost, bothof Piperacillin / Tazobactam and Imipenem / cilastatin should be used for the empirical treatmentof diabetic foot infections primarily for those severe, and polymicrobial and/or caused by resistantorganisms. When their relatively low frequency of side effect kept in mind, they can be used withconfidence.Key words: Diabetes, diabetic foot, infection, therapy.IX