Randomized controlled trial of topical hyperbaric oxygen for treatment of diabetic foot ulcers.

The effect of 2 wk of topical hyperbaric oxygen (THO) treatment on the healing of diabetic foot ulcers without associated gangrene was evaluated in a prospective, controlled, and randomized manner in 28 patients. There were 12 patients in the THO group (group 1) and 16 in the control group (group 2). Clinical management of the two patient groups was similar except for THO treatment in the group 1 patients. Clinical parameters, including age, sex, baseline fasting serum glucose levels, duration of diabetes mellitus, duration of foot ulcers, presence of peripheral neuropathy or arterial insufficiency, and evidence of osteomyelitis as determined by radiographs and/or radionuclide scans, were comparable in both groups of patients. No statistical differences (Student's t test) were seen in the number of microorganisms isolated from curettage cultures of the base of the ulcer at days 0, 7, and 14 of the study between groups 1 and 2. In contrast to previous studies, there was a paucity of anaerobic microorganisms isolated from these foot ulcers without associated gangrenous changes. Ulcer areas were estimated by multiplying the maximum width by the maximum length in millimeters at days 0, 7, and 14. Analysis of variance and Student's t test revealed progressive significant reductions in the ulcer areas in both groups when days 0, 7, and 14 were compared and in ulcer depths in both groups when days 0 and 14 were compared. However, such ulcer size changes did not differ statistically between the control and THO groups. A trend toward slower healing was observed in the THO group. Healing of diabetic foot ulcers was not accelerated by THO in this study.

LY146032, alone and in combination with gentamicin, for the treatment of enterococcal pyelonephritis in the rat model.

The in vivo and in vitro activity of LY146032 against Streptococcus faecalis GK was examined. The following MICs and MBCs in micrograms per milliliter were obtained: ampicillin, 0.8 and 1.5; vancomycin, 0.8 and 50; gentamicin, 12 and 25; and LY146032, 0.8 and 6. A time-kill-curve study involving approximately 10(6) organisms per ml showed a drop in the number of organisms of almost 2 log10 in the tube containing LY146032 (2 micrograms/ml) plus gentamicin (4 micrograms/ml) compared with bacterial numbers for the control at 4 h of incubation. However, regrowth was observed at 24 and 48 h, and no in vitro synergism was observed with the combination. A sample (1 ml) of overnight growth of this enterococcal strain at a concentration of 10(7) was then injected intravenously into 184 male Wistar rats weighing about 100 g each. After 12 days, 10 rats were sacrificed and the remaining ones were randomized into four treatment groups: (i) untreated control, (ii) LY146032 (3 mg) given subcutaneously, (iii) gentamicin (0.8 mg) given intramuscularly, and (iv) LY146032 plus gentamicin at the same dosages as when the drugs were used singly. The rats received antibiotics for 4 weeks twice daily, and approximately 10 rats in each group were sacrificed for quantitative kidney cultures at 1, 2, 4, and 6 weeks after the start of therapy. At the end of the 4- and 6-week periods, significantly better results were obtained with the combination of LY146032 plus gentamicin than with no treatment or treatment with single antibiotics.

Anaerobic bacteria isolated from foot infections in diabetic patients: in vitro susceptibility to nine antibiotics.

Twenty-nine isolates of anaerobic bacteria from foot infections in diabetic patients were tested, using the agar dilution method, for in vitro susceptibility to nine antimicrobial agents. Imipenem and metronidazole showed excellent activity; clindamycin and chloramphenicol were next in terms of efficacy. Cefoxitin and moxalactam demonstrated good activity, although three isolates of the Bacteroides fragilis group were resistant to moxalactam. Penicillin G, cefotaxime, and cefoperazone showed poor activity against the B fragilis group but were quite active against other anaerobes. Among the newer beta-lactam antibiotics studied, imipenem, cefoxitin and, to a lesser extent, moxalactam appear promising for clinical use as anti-anaerobic antibiotics in the treatment of foot infections in diabetic patients.

Failure of rifampin to eradicate methicillin-resistant Staphylococcus aureus colonization.

Four patients with methicillin-resistant Staphylococcus aureus (MRSA) carriage in one body site each (urine, anterior nares, throat, or wound) received 300 mg of oral rifampin twice daily for ten days. Treatment did not eradicate MRSA carriage in any patient, and three of the posttherapy isolates were highly resistant to the drug. Rifampin by itself does not appear to be an effective drug for the eradication of MRSA carriage.