What is it about?
Infected leg and foot ulcers in people with diabetes are a frequent and serious problem. A review on lower-extremity ulcers published in the New England Journal of Medicine mentioned linezolid alone as a possible antibiotic to cover all the bacteria involved. In this letter we point out that linezolid, although it penetrates skin and soft tissue very well and may reduce bacterial toxin production, acts mainly against Gram-positive bacteria and anaerobes, and is much less active against Gram-negative bacteria. Severe diabetic foot infections are often polymicrobial and frequently involve Gram-negative bacteria, especially Pseudomonas aeruginosa. We therefore suggest adding an anti-Gram-negative agent when linezolid is used as empirical therapy in these patients. The authors of the review agreed that severe infections require broad-spectrum coverage.
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Why is it important?
Choosing an empirical antibiotic regimen that does not cover the likely bacteria can lead to treatment failure, worsening infection and amputation. This letter helps clinicians tailor empirical therapy for severe diabetic foot infections to their typical polymicrobial nature.
Perspectives
Diabetic foot infections are among the most common reasons we are consulted in the hospital, and the microbiological spectrum matters. Writing to the NEJM with my colleagues in Trieste was a way to make sure that a widely read review would not lead to undertreatment of Gram-negative bacteria.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Evaluation and Management of Lower-Extremity Ulcers, The New England Journal of Medicine and Surgery and the Collateral Branches of Science, January 2018, New England Journal of Medicine (NEJM/MMS),
DOI: 10.1056/nejmc1715237.
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