Abstract
Eradication of bacterial flora from the foot, especially the nailfolds and toe webspaces,
through surgical preparation remains a challenge. All previous studies have involved
healthy patients undergoing elective foot and ankle surgery or healthy volunteers.
However, the patient with diabetes is considered an immunocompromised host with decreased
ability to combat invasive bacterial infections. The use of an efficacious surgical
preparation is therefore of paramount importance. The author conducted a prospective
study involving patients with diabetes with and without ulceration who underwent the
current “best evidence available” surgical preparation (i.e., chlorhexidine gluconate
[4%] scrub followed by alcohol impregnated with iodine [1%] solution). Qualitative
aerobic cultures before and after completion of this surgical preparation technique
were obtained from the hallux nailfold; second, third, and fourth toe webspaces (as
one culture); and distal anterior tibia. A total of 120 organisms were cultured before
surgical preparation with 64 in the elective group and 56 in the ulcerated group.
The most commonly isolated organism was methicillin-resistant Staphylococcus epidermidis,
which was identified in 46 pre-preparation cultures (38.3%). This was followed by
methicillin-sensitive S. epidermidis (16.7%) and “other” organisms (10.0%). There
was a significant reduction for both numbers of organisms identified and positive
cultures for the 3 most commonly isolated organisms after surgical preparation. Based
on the results of this study, the surgical preparation used here appears to be an
efficacious surgical preparation technique for eradicating aerobic bacterial pathogens
from the foot in patients with diabetes both with and without ulceration. The high
incidence of methicillin-sensitive and methicillin-resistant S. epidermidis found
in this patient population is a cause for concern, especially when metallic fixation
is intended to be implanted.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Disclaimer: Research conducted while Chief, Limb Preservation Service, Vascular/Endovascular Service, Department of Surgery, Madigan Army Medical Center, Tacoma, WA. The opinions or assertions contained herein are the private view of the author and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Financial Disclosure: This study was the recipient of the American College of Foot and Ankle Surgeons 2006 Annual Scientific Research Grant.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
