Level of Empathy among Medical Students in Kuwait University,Kuwait

Objectives

To evaluate the level of empathy among medical students in Kuwait University Medical School and its association with sociodemographic factors, stress levels and personality.

Subjects and Methods

A cross-sectional survey of 264 medical students was conducted in the Faculty of Medicine, Kuwait University. Empathy levels were measured using the Jefferson Scale, personality was assessed using the Zuckerman-Kuhlman Personality Scale and the Perceived Stress Scale was used to measure stress levels. Factors associated with empathy were evaluated using t test/ANOVA for categorical variables and correlation for continuous predictors.

Results

Mean empathy score was 104.6 ± 16.3. Empathy scores were significantly associated with gender, year of study, mother''s level of education, household income, satisfactory relationship with the mother and stress levels. Male medical students in their clinical years also had significantly lower empathy levels. However, factors such as grade point average, desired specialty, marital status of parents, father''s educational level and relationship with father were not significantly (p > 0.05) associated with levels of empathy. Stress scores were significantly and positively associated with empathy (r = 0.13; p = 0.041).

Conclusion

Medical students in Kuwait University had low empathy level and this may be a cause for concern; as such we suggest a possible inclusion of emphasis on empathy in the curriculum.Key Words: Empathy, Medical Students, Kuwait, Sociodemographic factors, Personality, Stress     

Prevalence and Factors Associated with the Use of Illicit Substances among Male University Students in Kuwait

Objectives

To estimate the prevalence of illicit use of substances and identify the factors associated with illicit drug use among male students in the state-run Kuwait University and private universities in Kuwait.

Subjects and Methods

The study was a cross-sectional survey with a sample of 1,587 male students from both private universities (n = 869) and the public (n = 718) Kuwait University in Kuwait. A self-administered questionnaire was used to collect data. Overall lifetime prevalence of substance use was computed with 95% confidence interval. Logistic regression was used to identify the factors influencing substance use, which was adjusted for potential confounders.

Results

The total lifetime prevalence of illicit drug use was 14.4% and the most frequently used illicit substance was marijuana (11%). The substance use in general varied significantly (p ≤ 0.001) between private (18%) and public (10%) universities. Multivariate logistic regression model revealed that drug use was positively associated with age, poor academic performance, high family income, being an only child, divorced parents, and graduation from a private high school.

Conclusion

Drug use among male university students in Kuwait was high and requires attention and appropriate intervention. The factors identified with drug use in this study could be utilized to develop appropriate public health policies and preventive measures that may improve the health status of the student population.Key Words: Prevalence, Illicit stimulants, Substance abuse, College students     

Smoking Cessation Practices in Kuwaiti General Dental Clinics

Objectives

This study aimed to determine the degree of involvement of general dental practitioners working in primary health care centers of the Ministry of Health (MOH) of Kuwait in tobacco cessation activities.

Subjects and Methods

A survey questionnaire composed of 48 structured multiple choice questions aimed at assessing practitioner knowledge, attitudes, perceived expectations, confidence, and perceived barriers preventing them from performing these activities was distributed to 150 general dentists working in MOH dental clinics.

Results

One hundred forty-five dentists responded to the survey questionnaire. Twelve (12%) surveyed practitioners always or almost always incorporated overall tobacco cessation activities into their practice. Forty-one (3%) of the respondents felt that they had excellent cessation knowledge. One (1%) felt barriers prohibited their performance of cessation activities. One hundred (76%) participants strongly agreed that there was an expectation for them to perform cessation activities in their clinics. Fourteen (10%) respondents felt very confident about their cessation counseling skills.

Conclusions

Findings showed that smoking cessation practices are not performed on a routine basis in MOH dental clinics. Practitioner knowledge and confidence showed the most significant association with the performance of cessation activities.Key Words: Kuwait, Dentists, Smoking, Cessation, activities, General dental practice     

Emergence of Methicillin-Resistant Staphylococcus aureus in the Maternity Hospital,Kuwait

Objective

To establish the relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Maternity Hospital, Kuwait.

Materials and Methods

A total of 22 MRSA were isolated from 20 neonates and 1 mother in the Special Care Unit, Maternity Hospital, Kuwait. They were characterized using antibiogram, pulsed-field gel electrophoresis (PFGE), SCCmec typing, spa typing and multi locus sequence typing (MLST), and were screened for genes encoding Panton Valentine leukocidin (PVL) and capsular polysaccharide types 5 and 8.

Results

The isolates were resistant to cadmium acetate (n = 22 or 100%), trimethoprim (n = 13 or 59.1%), gentamicin (n = 7 or 31.8%), ciprofloxacin (n = 5 or 22.7%), erythromycin and clindamycin (n = 2 or 9.1%), tetracycline (n = 2 or 9.1%) and fusidic acid (n = 2 or 9.1%). Eight isolates contained genes for PVL while 15 and 6 carried genes for types 5 and 8 capsular polysaccharide, respectively. Molecular typing distinguished 12 clones. Ten of these clones consisted of 20 isolates belonging to ST60-SCCmec-IV-t3935 (5 isolates), ST6-SCCmec-IV-t6269 (4 isolates), ST194-SCCmec-IV-t6892 (3 isolates), ST1-SCCmec-V-t2962 (2 isolates) and 1 isolate each of ST77-SCCmec-IV-t339, ST935-SCCmec-V-t1084, ST1317-SCCmec-V-t1548, ST9-SCCmec-V-t5801, ST627-SCCmec-IV-t1340 and ST2148-SCCmec-IV-t2810.

Conclusion

The study demonstrated the emergence of MRSA including novel ST60 and ST194 clones at the Maternity Hospital in Kuwait.Key Words: Methicillin-resistant Staphylococcus aureus, Neonates, Molecular typing     

Occupational Injuries Prone to Infectious Risks amongst Healthcare Personnel in Kuwait: A Retrospective Study

Objective

The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials (OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the factors associated with these incidents.

Subjects and Methods

An epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included.

Results

The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7s% of the HCP at risk. Their mean age was 32.31 ± 6.98 years. The majority were nurses: 166 (66.7s%), followed by doctors: 35 (14.1s%), technicians: 26 (10.4s%) and housekeeping personnel: 22 (8.8s%). Needle stick injury was the most common type of exposure, in 189 (75.9s%), followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7s%), were caused by hollow-bore needles. Exposure to blood represented 96.8s%, mostly during drawing blood and the insertion or removal of needles from patients [88 (35.4s%)] and when performing surgical interventions [56 (22.6s%)]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 (9.6s%)] and garbage collection [21 (8.4s%)] were reported. Exposures mainly occurred in the inpatient wards [75 (30.1s%)] and operating theaters [56 (22.6s%)]. Among the exposed HCP, 130 (52.2s%) had been fully vaccinated against hepatitis B virus (HBV).

Conclusion

Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete.Key Words: Occupational exposure, Blood-borne viruses, Healthcare personnel, Kuwait     

The Cost of Asthma in Kuwait

Objective

To evaluate the direct costs of treating asthma in Kuwait.

Materials and Methods

Population figures were obtained from the 2005 census and projected to 2008. Treatment profiles were obtained from the Asthma Insights and Reality for the Gulf and Near East (AIRGNE) study. Asthma prevalence and unit cost estimates were based on results from a Delphi technique. These estimates were applied to the total Kuwaiti population aged 5 years and over to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise and the AIRGNE results were used to determine the number of asthma patients managed in government facilities. Direct drug costs were provided by the Ministry of Health. Treatment costs (Kuwaiti dinars, KD) were also calculated using the Delphi exercise and the AIRGNE data.

Results

The prevalence of asthma was estimated to be 15% of adults and 18% of children (93,923 adults; 70,158 children). Of these, 84,530 (90%) adults and 58,932 (84.0%) children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest portion of total direct costs (43%), followed by emergency room visits (29%), outpatient visits (21%) and medications (7%). The annual cost of treatment, excluding medications, was KD 29,946,776 (USD 107,076,063) for adults and KD 24,295,439 (USD 86,869,450) for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over KD 58 million (USD 207 million).

Conclusions

Asthma costs Kuwait a huge sum of money, though the estimates were conservative because only Kuwaiti nationals were included. Given the high medical expenditures associated with emergency room and inpatient visits, relative to lower medication costs, efforts should be focused on improving asthma control rather than reducing expenditure on procurement of medication.Key Words: Asthma, Cost, Gulf, Kuwait, Delphi method     

Restorative Treatment Thresholds: Factors Influencing the Treatment Thresholds and Modalities of General Dentists in Kuwait

Objectives

This study investigated the thresholds at which general dentists in Kuwait would restore approximal and occlusal carious lesions and examined the demographic characteristics of the dentists in relation to their decision making.

Subjects and Methods

The study population consisted of a random sample of 185 general dentists practicing in the Ministry of Health of Kuwait. A survey questionnaire was administered. The questionnaire presented different stages and locations of carious lesions; the participants were asked to identify the stage at which a restoration is required under different conditions, the preparation technique, and their choice of restorative material.

Results

For approximal carious lesions, 74 (40%) of the participants reported that they would restoratively intervene when the carious lesion reached the outer third of the dentin. A total of 91 (49.2%) reported the use of traditional class II restorations. For occlusal carious lesions, 128 (69.2%) said they would intervene when lesions reached the middle third of the dentin. 146 (78.9%) said they would remove the carious tissue only in their preparation. For both approximal and occlusal lesions, the participants preferred resin composite as the material for restoration.

Conclusions

The respondents tended to delay restorative intervention until dentinal penetration of the caries. Resin restorative materials were used in conservatively prepared cavities. Participants chose a conservative approach for occlusal lesions but still believed in a traditional approach when it concerned approximal lesions. Experience, university dental education, and participation in continuous education courses were most significantly related to restorative treatment.Key Words: Restorative treatment, Dentistry, Decisions, Operative intervention     

The Rising Tide of Overweight among Kuwaiti Children: Study from Al-Adan Hospital,Kuwait

Objective

This study was designed to screen patients who sought medical services in the Pediatric Outpatient Department, Al-Adan Hospital, Kuwait for overweight.

Subjects and Methods

Body mass index (BMI) was used to screen 361 children (≤10 years old) for risk of overweight and overweight (BMI between 85th and 94th, and ≥95th percentile, respectively). Overweight children were fully examined and abdominal ultrasound was done for each of them.

Results

Of the 361 children, 52 (14.41%) and 77 (21.33%) were at risk of overweight and overweight, respectively. There was a slight male predominance for overweight (40 males, 51.95%, compared to 37 females, 48.05%) and within the overweight category; 28 males (70%) and 26 females (70.27%) were above 6 years of age. In overweight children over 6 years, 4 (7.41%) had hepatomegaly with fatty changes and 3 (5.56%) had blood pressure above the 95th percentile for age and sex.

Conclusion

Childhood overweight at Al-Adan Hospital was high and increased with age. Hence childhood screening for overweight is recommended at an early age because it is an important risk factor of chronic diseases.Key Words: Body mass index, Child health, Overweight     

Expression of the Renin-Angiotensin System in a Human Placental Cell Line

Background

The renin-angiotensin system (RAS) is present in human placental tissue and participates in regulation of maternal-fetal blood flow during pregnancy. RAS expression in placental tissue is regulated by various hormones and is altered in various disease conditions. An in vitro system is needed to further investigate regulation of the placental RAS. To this end, we studied RAS expression in the human placenta-derived cell line, CRL-7548.

Methods

CRL-7548 cells were cultured in plastic plates. Total RNA was extracted, reverse transcribed, and amplified by polymerase chain reaction (PCR) with specific primers. Angiotensin II peptide in the culture media was measured by radioimmunoassay. Renin activity was detected by radioimmunoassay measuring angiotensin I generated. Angiotensin receptor type I was detected by Western blot.

Results

Specific mRNA for angiotensin, renin, angiotensin converting enzyme, and angiotensin receptor type I was detected by real-time PCR. Renin activity was detected in the placental cell lysate, and angiotensin II peptide, the final product of the RAS system, was detected in cell culture media by radioimmunoassay. Angiotensin receptor type I was identified as a 41 kDa protein in cell lysates by Western blot.

Conclusions

These results demonstrate that all necessary components of the classic RAS are expressed in the human placental cell line CRL-7548. This cell line may prove useful as an in vitro system for studying RAS regulation in the placenta.     

Safety and Viability of Microencapsulated Human Islets Transplanted Into Diabetic Humans

OBJECTIVE

Transplantation of insulin-producing cells placed inside microcapsules is being trialled to overcome the need for immunosuppressive therapy.

RESEARCH DESIGN AND METHODS

Four type 1 diabetic patients with no detectable C-peptide received an intraperitoneal infusion of islets inside microcapsules of barium alginate (mean 178,200 islet equivalents on each of eight occasions).

RESULTS

C-peptide was detected on day 1 post-transplantation, and blood glucose levels and insulin requirements decreased. C-peptide was undetectable by 1–4 weeks. In a multi-islet recipient, C-peptide was detected at 6 weeks after the third infusion and remains detectable at 2.5 years. Neither insulin requirements nor glycemic control was affected. Capsules recovered at 16 months were surrounded by fibrous tissue and contained necrotic islets. No major side effects or infection occurred.

CONCLUSIONS

While allografting of encapsulated human islets is safe, efficacy of the cells needs to improve for the therapy to make an impact on the clinical scene.Transplantation of insulin-producing cells placed inside capsules is a strategy that is being trialled to overcome the need for immunosuppressive therapy in insulin-dependent diabetic people (1). We have made microcapsules of barium alginate and shown that insulin-producing porcine cells can function as efficiently inside such capsules as when nonencapsulated (2). Moreover, human islets placed in these capsules normalize blood glucose levels when engrafted in diabetic mice (3,4). In the current study, we transplanted four type 1 diabetic humans with encapsulated human islets.     

Establishing physician advocates for human papillomavirus vaccination in British Columbia

Objective

To survey general practitioners in oncology (GPOs) in British Columbia (BC) to identify opportunities for them to serve as public supporters of human papillomavirus (HPV) vaccination.

Design

A mailed or online survey.

Setting

British Columbia.

Participants

Forty-two GPOs who worked in the community in BC.

Main outcome measures

Current practices, knowledge, and resource needs concerning HPV, the vaccine, and the HPV immunization program, and the willingness of respondents to be contacted to participate in stated public HPV vaccine supporter activities.

Results

The survey found that 42% of surveyed GPOs were willing to act as public supporters of the HPV vaccine. The survey also identified education needs among GPOs concerning HPV, the vaccine, and the HPV immunization program in BC.

Conclusion

This study found that GPOs in BC are willing to publicly support the HPV immunization program. This study shows that involving physicians in the promotion of public health programs is a viable option that should be further explored and evaluated.     

Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: compliance with national guidelines

Objective

To examine antibiotic prescribing in nursing homes and determine to what degree the prescribing was in accordance with the national guidelines for antibiotic prescribing.

Design

Retrospective examination of patients’ records who were prescribed antibiotics in the period 1 March 2007 to 28 February 2008.

Setting and patients

Patients residing in the nursing homes of Arendal, Norway.

Main outcome measures

Choice of antibiotic in respect of the recommendations in the national guidelines for antibiotic prescribing.

Results

A total of 714 antibiotic courses were prescribed to 327 patients yielding a prevalence of 6.6%. Compliant prescribing was 77% for urinary tract infections (UTI), 79% for respiratory tract infections (RTI), and 76% for skin and soft tissue infections (SSTI). Ciprofloxacin was responsible for 63% of non-compliant prescribing. On the respite wards there was a higher rate of total prescribing, non-compliant prescribing, and prescribing by physicians employed at the local hospital.

Conclusion

Guidelines for antibiotic use must be implemented actively and efforts to improve antibiotic prescribing in nursing homes must be aimed at both nursing home and hospital physicians.Key Words: Anti-bacterial agents, antibiotic resistance, compliance, geriatrics, infection, nursing homesThe geriatric population has a relatively high use of antibiotics, but few studies document compliance with national guidelines when prescribing antibiotics.

• Compliance with guidelines for urinary tract, respiratory tract, and soft tissue infections was about 80%.
• Ciprofloxacin is the antibiotic responsible for the majority of non-compliant prescribing.
• Non-compliant prescribing and prescribing by physicians not employed at the nursing home is higher on respite wards than on the long-term wards.

     

Immunonutrition in critical illness: still fishing for the truth

Citation

Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature. Intensive Care Med 2008;34:1980–1990 [1].

Background

The role of immuno-modulating diets (IMD''s) in critically ill patients is controversial.

Methods

Objective

The goal of this meta-analysis was to determine the impact of IMD''s on hospital mortality, nosocomial infections and length of stay (LOS) in critically ill patients. Outcome was stratified according to type of IMD and patient setting.

Data Sources

MEDLINE, Embase, Cochrane Register of Controlled Trials.

Study Selection

RCT''s that compared the outcome of critically ill patients randomized to an IMD or a control diet.

Data Synthesis

Twenty-four studies (with a total of 3013 patients) were included in the meta-analysis; 12 studies included ICU patients, 5 burn patients and 7 trauma patients. Four of the studies used formulas supplemented with arginine, two with arginine and glutamine, nine with arginine and fish oil (FO), two with arginine, glutamine and FO, six with glutamine alone and three studies used a formula supplemented with FO alone. Overall IMD''s had no effect on mortality or LOS, but reduced the number of infections (OR 0.63; 95% CI 0.47–0.86, P = 0.004, I² = 49%). Mortality, infections and LOS were significantly lower only in the ICU patients receiving the FO IMD (OR 0.42, 95% CI 0.26–0.68; OR 0.45, 95% CI 0.25–0.79 and WMD -6.28 days, 95% CI -9.92 to -2.64, respectively).

Conclusion

An IMD supplemented with FO improved the outcome of medical ICU patients (with SIRS/sepsis/ARDS). IMD''s supplemented with arginine with/without additional glutamine or FO do not appear to offer an advantage over standard enteral formulas in ICU, trauma and burn patients.     

Physical activity in youth: Prevalence, risk indicators, and solutions

Objective

To determine the unadjusted and adjusted associations between developmental, environmental, psychological, social, or demographic factors and meeting the Health Canada physical activity standard.

Design

Survey.

Setting

Saskatoon, Sask.

Participants

Every student in grades 5 to 8 in Saskatoon was asked to complete the Saskatoon School Health Survey; 4197 students did so.

Main outcome measures

Whether students met the Health Canada standard for daily physical activity and associated risk factors for not meeting the standard.

Results

Among the 4197 youth who participated in the survey, only 7% met the Health Canada standard of daily physical activity longer than 1 hour of somewhat hard intensity or higher. Although there were 23 unadjusted factors associated with youth meeting the Health Canada standard, only 5 were significant after multivariate adjustment: 1) their fathers were employed (odds ratio [OR] 2.29, P = .027), 2) their parents watched them participate in physical activities or sports every day (OR 1.23, P < .001), 3) their friends encouraged them to do physical activities or sports every day (OR 1.19, P < .001), 4) their friends or classmates did not tease them for not doing well at physical activities or sports every day (OR 1.20, P = .001), and 5) they played sports or physical activities with coaches or instructors more than 4 times a week (OR 1.44, P < .001).

Conclusion

Given the low rates of physical activity among youth, we believe that a reduced list of independent risk indicators is required to focus our limited human and financial resources for successful intervention in the community.     

Knowledge,Attitudes and Practices of Caregivers in Relation to Oral Health of Preschool Children

Objective

To assess the knowledge, attitudes and practices of caregivers in Kuwait in relation to the oral health of preschool children.

Subjects and Methods

Questionnaires with multiple-choice questions were distributed to 334 caregivers of children under the age of 6 years attending vaccination centers in Kuwait. For each question, one of the multiple-choice answers was consistent with the consensus in the pediatric dental literature in relation to early childhood caries prevention, and was considered to be correct. The χ² test, independent t test, ANOVA, and stepwise linear regression were used to assess the associations between the variables in question and p ≤ 0.05 was accepted as statistically significant.

Results

Of the 334 participants, 234 (70%) were between 20 and 40 years of age with a high school diploma or higher degree and had between 2 and 5 children. The mean knowledge score was 4.68 ± 1.87, the mean attitude score was 4.34 ± 0.88 and the mean practice score was 2.45 ± 0.99. Major weaknesses were reported in infant oral health-related concepts. Mothers had better knowledge than other caregivers (p < 0.001). Higher education was significantly associated with better knowledge (p = 0.003) and better practices (p = 0.017). In addition, knowledge, attitude and level of education were positively and significantly associated with practices (p < 0.005).

Conclusions

Our study showed that caregivers had weak knowledge and practice in relation to the oral health of preschool children. Mothers and caregivers with higher education had better knowledge and practices. Education and attitude appeared to be favorable indicators of the caregivers’ practices with regard to the oral health of their preschool children.Key Words: Knowledge, Attitude, Practice, Children, Early childhood caries, Infant oral health     

Differences in Rat and Human Erythrocytes Following Blood Component Manufacturing: The Effect of Additive Solutions

Background

Small animal models have been previously used in transfusion medicine studies to evaluate the safety of blood transfusion products. Although there are multiple studies on the effects of blood banking practices on human red blood cells (RBCs), little is known about the effect of blood component manufacturing on the quality of rat RBCs.

Methods

Blood from Sprague-Dawley rats and human volunteers (n = 6) was collected in CPD anticoagulant, resuspended in SAGM or AS3, and leukoreduced. In vitro quality was analyzed, including deformability, aggregation, microvesiculation, phosphatidylserine (PS) expression, percent hemolysis, ATP, 2,3-DPG, osmotic fragility, and potassium concentrations.

Results

Compared to human RBCs, rat RBCs had decreased deformability, membrane rigidity, aggregability, and microvesiculation after component manufacturing process. Rat RBCs in SAGM showed higher hemolysis compared to human RBCs in SAGM (rat 4.70 ± 0.83% vs. human 0.34 ± 0.07%; p = 0.002). Rat RBCs in AS3 had greater deformability and rigidity than in SAGM. The number of microparticles/µl and the percentage PS expression were lower in rat RBCs in AS3 than in rat RBCs in SAGM. Hemolysis was also significantly lower in AS3 compared to SAGM (2.21 ± 0.68% vs. 0.87 ± 0.39%; p = 0.028).

Conclusion

Rat RBCs significantly differ from human RBCs in metabolic and membrane-related aspects. SAGM, which is commonly used for human RBC banking, causes high hemolysis and is not compatible with rat RBCs.Key Words: Red blood cells, Additive solutions, Blood manufacturing, Blood banking     

Human papillomavirus vaccination for boys

Question

In Canada, generally provincial human papillomavirus (HPV) vaccination programs exist for only the female population. What should I recommend when parents and teenage boys ask about male HPV vaccination?

Answer

The quadrivalent HPV vaccine is effective and will reduce the incidence of disease in boys and girls. The quadrivalent HPV vaccination is approved and recommended for both boys and girls in Canada. Public funding for male vaccination is available in Prince Edward Island and Alberta. The remaining provinces and territories will need to consider cost-effectiveness analyses before expanding their female-only vaccination programs to include the male population.     

Wound Chronicity, Inpatient Care, and Chronic Kidney Disease Predispose to MRSA Infection in Diabetic Foot Ulcers

OBJECTIVE

To determine the microbiological profile of diabetes-related foot infections (DRFIs) and the impact of wound duration, inpatient treatment, and chronic kidney disease (CKD).

RESEARCH DESIGN AND METHODS

Postdebridement microbiological samples were collected from individuals presenting with DRFIs from 1 January 2005 to 31 December 2007.

RESULTS

A total of 653 specimens were collected from 379 individuals with 36% identifying only one isolate. Of the total isolates, 77% were gram-positive bacteria (staphylococci 43%, streptococci 13%). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 23%; risk factors for MRSA included prolonged wound duration (odds ratio 2.31), inpatient management (2.19), and CKD (OR 1.49). Gram-negative infections were more prevalent with inpatient management (P = 0.002) and prolonged wound duration (P < 0.001). Pseudomonal isolates were more common in chronic wounds (P < 0.001).

CONCLUSIONS

DRFIs are predominantly due to gram-positive aerobes but are usually polymicrobial and increase in complexity with inpatient care and ulcer duration. In the presence of prolonged duration, inpatient management, or CKD, empiric MRSA antibiotic cover should be considered.This study was undertaken to evaluate microbiological specimens collected from patients with diabetes-related foot infections (DRFIs) and managed by a multidisciplinary diabetic foot unit (DFU). The primary aim was to determine the prevalence of bacterial isolates including methicillin-resistant Staphylococcus aureus (MRSA). The secondary aim was to characterize the effect of wound duration, inpatient treatment, and chronic kidney disease (CKD) on the microbiological profile.