Microbial Profile and Antibiotic Sensitivity in Obstructive Jaundice: Insights from a Single-Center Study

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Authors:
Adianto Nugroho, Aditomo Widarso, Anti Dharmayanti, Hana Ayu Shafira, Indah Jamtani, Rofi Y Saunat

Body of Abstract:
Background. Biliary obstruction poses a significant risk of biliary tract infections, warranting prompt and effective antibiotic administration. Empiric antibiotic selection necessitates a comprehensive understanding of the microbial profile. Our study comprehensively describes the microbiology profile of bile culture in biliary obstructive patients.
Methods. A cross-sectional descriptive study was held with data gathered from medical records in our single institution from November 2020 – December 2021 and January – September 2024. Patients’ characteristics, jaundice etiology, bile culture results, and antibiotic resistance were studied.
Results. Among 45 patients that had been analyzed, we found that the most microorganisms found in positive bile culture were gram-negative bacteria, with Escherichia coli and Klebsiella pneumonia being the most found. Two cases had Candida sp. The bacteria were most resistant to penicillin-group antibiotics and most sensitive to carbapenem, amikacin, and tigecycline.
Conclusions. The most prevalent microbes discovered in biliary tract obstruction were gram negative bacteria, with penicillin-group antibiotics being the most resistant antibiotics. Administering the right antibiotics that fit the microorganism profile is critical to prevent antibiotic resistance.

Efficacy of Short vs. Long Course Antibiotics in Treatment of Hinchey 3 and 4 Diverticulitis

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Authors:
Abanoub Awad, Cara Kollwitz, Isaac Theerman, Jason Beckermann, Jennifer Rich, Justin York, Kirstin Kooda, Maria Linnaus, Sara Herrick, Theodore Yang

Body of Abstract:
Background: Antibiotic therapy plays a critical role in the post-operative management of complicated diverticulitis. Traditionally, treatment has involved antibiotics until signs of infection subside, typically spanning 7-14 days. Recent studies, including the STOP-IT trial and national guidelines, support short-course antibiotics once definitive source control has been obtained. Shorter courses are favored to reduce costs and adverse effects associated with prolonged use. In addition, short-course antibiotic regimen supports antibiotic stewardship objectives. We observed variation in clinical practice for patients with extensive intra-abdominal infections such as Hinchey 3 and 4 diverticulitis and sought to evaluate outcomes in this population.
Methods: Retrospective chart review was performed of all adults (>18 years old) patients who underwent a sigmoid colectomy with stoma secondary to Hinchey class 3 and 4 diverticulitis at a large hospital system across several states from January 1st, 2018, to December 31st, 2023. Patients were divided into two groups: those with short-course antibiotics (SAC group) (≤5 days) and those with long-course antibiotics (LAC group) (>5 days).
The primary outcome was composite superficial surgical-site, incisional, organ space infection or death within 30 days after the procedure.
Results: A total of 133 met inclusion across 4 major hospital sites; 51.1% were male. Most common comorbid condition among all patients was HTN (53%) while most common ASA scores were ASA 3, ASA 2 and ASA 4 (57.1%, 21.1% and 20.3%, respectively). LAC group patients had higher ASA scores (p=0.001), higher incidence of acute kidney injury on admission (p=0.0135) and had higher rates of immune compromise (p=0.0002) than SAC group patients. Composite rates of 30-day mortality, superficial, incisional and organ space infections occurred 8 of 53 patients (15.1%) in SAC group and 27 of 80 patients (33.8%) in LAC group, (p=0.02601), When broken down by SSI type, there were similar rates of superficial, deep incisional and organ space infection between the groups. Mortality rate was higher in LAC group (10% vs 0%, p = 0.0213).

Conclusion: Longer antibiotic therapy for Hinchey 3-4 diverticulitis does not improve composite mortality, SSI, and organ space infection in patients undergoing sigmoidectomy and stoma. In our practice patients with higher ASA scores, immunocompromised state, and acute kidney injury were more likely to receive a longer course of antibiotics. Mortality rates were higher in longer antibiotic therapy group potentially indicating severity of illness and aggressive treatment to prevent a negative outcome.

Impact of Induction Agents on CMV Infection and Seroconversion in Pediatric Renal Transplant Recipients, an Analysis of UNOS Data from 2000-2024

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Authors:
Alejandro Navarro, Geovani Faddoul, Jason Perlmutter, Jorge Ortiz, Meng-Hao Li, Naoru Koizumi

Body of Abstract:
Background: Cytomegalovirus (CMV) infection affecting kidney transplant recipients can lead to graft failure, increased morbidity, and mortality 1. Although efforts have focused on identifying risk factors for CMV infections, large data analyses are centered on the adult population2. This assessment examines induction regimens and risk factors associated with primary and secondary CMV infections, including seroconversion, in pediatric kidney transplants.

Methods: The UNOS database was analyzed from year 2000 to 2024. Cox regression evaluated the occurrence of CMV IgM+ from IgG- or IgG+ (N=10,591). Logistic regression examined seroconversion analysis (IgM-/IgG- to IgM+/IgG+) (N = 7,207)

Results: Prednisone maintenance correlated with higher infection and seroconversion (HR 1.32 95%CI[1.03-1.69]; p=0.028 and OR 1.53 95%CI[1.25 – 1.89]; p=<0.001 respectively). Seroconversion was less likely with dual induction anti-thymocyte globulin (ATG) + IL2 receptor antagonist (IL2Ra) (OR 0.41 95%[0.22-0.77]; p=0.006). Seroconversion was less likely for recipients transplanted between 2012-2024 compared to the previous era (OR 0.69 95%[0.57 - 0.82]; p=<0.001). CMV negative to positive transplant had the highest odds of infection and seroconversion (HR 2.7 95%[2.10 - 3.71]; p=<0.001 and OR 2.7 95%[2.27 - 3.44]; p=<0.001 respectively). Conclusion: Alemtuzumab and IL2Ra did not correlate with better CMV infection of seroconversion compared to ATG in pediatric kidney transplants. Improvement in seroconversion rates over the last decade may be attributed to improved prophylactic and induction protocols. 1. Balani SS, Sadiq S, Jensen CJ, Kizilbash SJ. Prevention and management of CMV infection in pediatric solid organ transplant recipients. Front Pediatr. 2023 Feb 20;11:1098434. doi: 10.3389/fped.2023.1098434. PMID: 36891229; PMCID: PMC9986459 2. Al Atbee MYN, Tuama HS. Cytomegalovirus infection after renal transplantation. J Med Life. 2022 Jan;15(1):71-77. doi: 10.25122/jml-2021-0209. PMID: 35186139; PMCID: PMC8852648.

Reduced wound contamination of a chlorhexidine gluconate (CHG) containing surgical incise drape using an ex vivo porcine skin incisional model.

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Authors:
Isaac Salvatierra, Marnie Peterson, Ranjani Parthasarathy, Shazia Siddiqui

Body of Abstract:
Background: Adhesive drapes, including antimicrobial-impregnated drapes, have been utilized to help decrease the risk of wound contamination during surgery. However, an increase in the risk of wound contamination has been noted when drape adhesion was compromised at the wound edge. This study examined a new investigational CHG Drape for its antimicrobial effectiveness and ability to help reduce wound contamination via the adhesive properties of the drape compared to a non-antimicrobial adhesive drape (Non-AM Drape).
Methods: An ex vivo porcine skin, incisional wound model was developed to assess these properties for up to 6 hours. Skin was inoculated with Methicillin-Resistant Staphylococcus aureus (MRSA), Escherichia coli or Pseudomonas aeruginosa (seeded areas) followed by application of drapes, incision, irrigation, manipulation followed by microbial recovery/assessment of migration.
Results: CHG Drape placement demonstrated a significant reduction in MRSA counts at all time points in the seeded and incision/wound areas when compared to Non-AM Drape placement (p<0.05). MRSA migration was quantified by the mean wound/seeded ratio (log CFU/mL) at 4 hours (CHG Drape 0.13, Non-AM Drape 0.70, n=7, p<0.0001). CHG Drape placement also demonstrated a significant reduction of E. coli and P. aeruginosa in incision/wound areas (p<0.0001); and reduction in the seeded area of E. coli (p<0.0001) and P. aeruginosa (p<0.05) compared to the Non-AM Drape placement. Migration after 4 hours was also mapped by drape blotting on agar plates. CHG Drape demonstrated little to no colonies present in the migration zone for all microorganisms tested. Conclusions: The new investigational CHG incise drape demonstrated broad-spectrum antimicrobial effectiveness and helped reduce microbial migration and wound contamination compared to a non-antimicrobial incise drape. These findings suggest that the CHG Drape’s antimicrobial effectiveness combined with its superior skin adhesive properties, which reduces the risk of drape lift, can potentially be used to reduce risk of wound contamination in surgical procedures.

Incidence of Surgical Site Infections in Indigenous Populations of the United States and Canada: A Scoping Review

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Authors:
Alexandria Brackett MA, MLIS, Arpana Jain, MD, Fabrizio Darby, Jacob D. Edwards, MD, L. Andrew O. Benedict, MD, Margarita Elloso, MD, Sabrina Sanchez, MD, Shaan Bhandarkar, BS, Surgical Infection Society Diversity, Equity and Inclusion Committee N/A, Vanita Ahuja, MD, MPH, MBA

Body of Abstract:
Background: Several studies have highlighted higher rates of adverse outcomes, including superficial surgical site infections (SSI) in Indigenous populations. However, there is a paucity of review literature regarding SSI in these populations compared to other ethnic and racial groups. The aim of this project was to complete a thorough scoping review of the incidence of SSI in Indigenous populations in the USA and Canada compared to non-Indigenous patients.

Methods: Based upon systematic assessment of relevant articles found in Scopus, PubMed, and PubMed Central, a comprehensive scoping review was conducted. The search terms surgical wound infection, surgical site infection, Native American, Indigenous, and First Nation were utilized. Studies in English that were either cohort, cross-section, case-control, or randomized control studies on humans of all ages and genders were included. Studies that were reviews, case series, case reports, editorials, letters to editors, animal studies, or studies that did not examine surgical site infection as a direct outcome of surgery were excluded.

Results: We retrieved 1718 articles, 9 of which were included for review. The most reported adverse surgical infection was superficial SSI. Five studies reported a statistically significant increased risk of superficial SSI in Indigenous populations compared to white patients. Two of these studies reported outcomes from elective procedures (tympanoplasty and cervical discectomy and fusion). The tympanoplasty study showed an odds ratio of 5.503 (2.572 – 11.776; p-value<0.0001) of SSI in Indigenous patients compared to white patients; the cervical discectomy and fusion study showed an odds ratio of 2.59 (1.05 - 6.36; p-value=0.037). Increased rates of deep incisional SSI for Indigenous populations compared to white patients were statistically significant in one of three studies looking at this outcome. The study reported an odds ratio of 1.26 (1.12 - 1.41; p-value=0.0002). With regards to organ space SSI, two studies out of the three reporting this variable found statistically significant increases for Indigenous patients compared to white patients. Additionally, one study reported increases in rates of pneumonia (odds ratio=2.24; 1.58 - 3.19; p-value <0.0001) and another an increase in sepsis with prevalence of 4.3% in Indigenous populations compared to 2.3% in white patients (p-value <0.001.) Conclusions: There are statistically significant differences in the incidence of SSI and other surgical infections for Indigenous patients when compared to their white counterparts, the most glaring being increased odds of superficial SSI, though deep incisional SSI and organ space SSI rates are also elevated in these populations. Further studies are warranted to investigate causes of these increased infection rates and formulate strategies for reducing these adverse outcomes. Figure 1. PRISMA Flow Diagram of Screening Process

Rare in the Air: Disseminated Coccidiomycosis in an Immunocompetent Patient

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Authors:
Allison Maxwell, Andrew Simms, Beverly Sha, Evan Anderson, Geoffrey Yang, Manish Bhojwani, Melisssa Gunchenko, Nicole Siparsky, Ziyi Sun

Body of Abstract:
Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States, often manifesting as a mild respiratory illness in immunocompetent individuals. Disseminated coccidioidomycosis occurs rarely (1%), typically in immunocompromised patients, involving extrapulmonary sites such as skin/soft tissue, bones, and the central nervous system (CNS). We present an unusual case of disseminated coccidioidomycosis with extensive multi-system involvement in an otherwise healthy young male, complicated by significant psychiatric and treatment adherence challenges.
Methods: We performed a retrospective case review after obtaining expedited Institutional Review Board approval by exemption, including notes, labs, imaging, culture data, and procedural reports.
Results: A 23-year-old male with asthma presented with an 8-month history of generalized pain, weight loss, intermittent chills, and limited ambulation due to right hip pain. Residential history included Arizona and the Great Lakes region with notable prior incarceration in Arizona. Examination revealed tachycardia (HR 120 beats per minute), lethargy, and tender swellings of the right thigh and left buttock. Labs demonstrated anemia (Hgb 7.9 g/dL), leukocytosis (13 × 10³/μL), elevated C reactive protein (165 mg/L), and hypoalbuminemia (2.5 g/dL). Imaging revealed a miliary pattern of pulmonary micronodules, cystic structures in multiple anatomical regions, and destructive bony lesions. Fine needle aspiration of a thigh lesion confirmed Coccidioides immitis. Cerebrospinal fluid sampling revealed WBC 0/uL, glucose 55 mg/dL, protein 28.9 mg/dL, and negative bacterial and fungal cultures. He was initially treated with fluconazole 400 mg daily. Subsequent admissions highlighted complications from poor medication adherence and worsening fungal burden despite increasing the fluconazole dose to 400 mg twice daily. Repeat imaging demonstrated extensive fluid collections and abscesses involving the pelvis, lumbar spine, and femoral regions. Psychiatry also noted psychotic features and cognitive decline, further complicating care. The antifungal regimen escalated to liposomal amphotericin B and voriconazole due to new neurologic involvement and significant disease progression. His course also included surgical drainage of a 22 cm buttock muscle abscess by skip-incision technique with insertion of four long-term surgical loop drains to prevent recurrence, as well as percutaneous drainage of deep space abscesses of the right thigh not amenable to simple drainage.
Conclusion: This case highlights the atypical presentation and challenges in managing disseminated coccidioidomycosis in an immunocompetent patient. Delayed diagnosis, medication nonadherence, and psychiatric comorbidities necessitated a multidisciplinary approach. Effective management required antifungal therapy escalation and surgical interventions. This case emphasizes the importance of early diagnosis and comprehensive care.

Antibiotic Stewardship in Acute Appendicitis

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Authors:
Abby Gross, Ajita Prabhu, Benjamin T. Miller, Jeffrey Claridge, Sayf Said, Sofya Asfaw

Body of Abstract:
Background: Optimizing antibiotic stewardship in acute appendicitis is essential to improving care quality and combating antimicrobial resistance. We aimed to reduce the overutilization of broad-spectrum antibiotics for acute appendicitis within our hospital system through the implementation of an Emergency General Surgery (EGS) care pathway.

Methods: A task force comprised of residents and general surgery staff developed an evidence-based EGS care pathway for managing acute appendicitis in an iterative process. This pathway was implemented across six teaching hospitals within our health system through educational sessions, with periodic updates every three months based on outcomes review. This pathway was not implemented at an additional ten hospitals within our health system. Cases of acute appendicitis were identified via ICD-10 codes, covering 6 months before and after implementation (9/13/2023–9/13/2024).

The primary outcome was the use of guideline-compliant narrow-spectrum antibiotic regimens (Ceftriaxone, Ciprofloxacin, Levofloxacin, or Ertapenem with Flagyl) compared to broad-spectrum regimens (Piperacillin-tazobactam, Meropenem, Aztreonam/Flagyl, Cefepime/Flagyl). Secondary outcomes included postoperative antibiotic usage and duration, length of stay, and 30-day all-cause readmission.

Results: There were 972 cases evaluated during the study period, of which 460 were pre-implementation (44.2%) and 581 were post-implementation (55.8%). There was no significant difference in age, sex, Charlson Comorbidity Index, or complicated appendicitis rate before versus after implementing the care pathway (Table 1).

After care pathway implementation, the rate of narrow-spectrum antibiotics increased by 42.10% (p=0.035), while broad-spectrum antibiotic use decreased by 8.34% (p=0.012). The increase occurred at all six hospitals (Hospital A: 39.4% to 43.8%, Hospital B: 11.7% vs 31.6%, Hospital C: 18.7% to 19.5%, Hospital D: 15.1% to 18.2%, Hospital E: 16.7% to 20.0%, Hospital F: 12.2% to 13.7%). The appendectomy rate increased by 17.42% with the implementation of the care pathway (p<0.001). There was no statistically significant difference in the use of post-operative antibiotics (p=0.648) or duration of post-operative antibiotics (p=0.823). There was also no significant difference in length of stay (p=0.224), 30-day readmission rate (p=0.236), or percutaneous drain rate (p=1.000). A total of 1,876 cases of acute appendicitis occurred at the hospitals where the care pathway was not implemented during the same period. Among those hospitals, the rate of broad-spectrum antibiotic use increased from 55.29% to 61.50% (434 of 785 vs. 671 of 1,091; p=0.002), and post-operative antibiotics increased from 71.26% to 75.38% (434 of 611 vs. 686 of 911; p=0.075). Conclusion: Standardized care pathways across health systems promote antibiotic stewardship in acute appendicitis, reducing reliance on broad-spectrum antibiotics while maintaining clinical outcomes.

DUPLICATE SUBMISSION – DO NOT SCORE**Assessing the Gap: SIS Guidelines vs. Real-World Antibiotic Use in Facial Fractures

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Authors:
Ahmad El Nouiri, Hadi Hamdan, Jeffrey Johnson

Body of Abstract:
Introduction:
Facial fractures account for over 400,000 ED visits annually in the United States. They are managed operatively (open reduction and internal fixation, ORIF), non-operatively (closed reduction), or via observation with diet and activity modification. Regardless of management, antibiotics are commonly prescribed. The Surgical Infection Society (SIS) published 2020 guidelines advocating against antibiotic use in all pre- and post-operative as well as non-operative cases (upper face, mid-face, or mandibular).

Methodology:
This retrospective chart review evaluates antibiotic prescribing practices at a quaternary regional academic level one trauma center for patients with isolated facial fractures. It assesses potential antibiotic days saved by adhering to SIS guidelines. Data for all admitted patients above 18 presenting to Henry Ford Hospital’s trauma service with a facial fracture from January 2019 to August 2024 were acquired from the trauma registry. Patients were manually screened to ensure eligibility. Patients with clear antibiotic indications (e.g., open fractures, complex lacerations) were excluded. Antibiotic timing classification followed SIS guidelines: pre-op (>1 hour before surgery), peri-op (within 1 hour before surgery to 24 hours after), and post-op (>24 hours after surgery). Statistical analysis included descriptive methods for quantitative variables and Chi-Square for qualitative variables.

Results:
A total of 119 patients fit the criteria. 89.1% received antibiotics, with 57.6% receiving at least two. 80.2% of the antibiotics given were against the recommendations of the SIS. Total antibiotic days were 584. Mandibular (49.6%) and midface (41.2%) fractures were most common. The antibiotic administration rate for mandibular fractures was 98.3%. Operative management accounted for 93.2% of cases, mostly open. Antibiotic use did not significantly differ between operative and non-operative management (p=0.18). The rate of antibiotic use between open and closed operative management did not differ significantly either (p=0.99). Cephalosporins and Penicillins were most prescribed. Peri-op antibiotics were used in 89.9% of cases, but non-guideline operative use (pre and post-op) rates were 47.5% and 63.6%, respectively. No significant association existed between guideline publishing and non-guideline use (p=0.60). Surgical site infection and Clostridium Difficile complication rates were 0%.

Conclusion:
There is a clear discordance between antibiotic prescribing practices at our institution and the SIS guideline recommendations for facial fractures. Implementing guidelines could yield substantial cost savings and is vital in combating antibiotic resistance.

Emergency Cesarean Section Preoperative Antibiotic Prophylaxis – Opportunities for improvement

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Authors:
Alex Kaizer, Dante Yeh, Gabriela Cortese, Heather Young, Robyn Bronshtein, Stefka Fabbri

Body of Abstract:
Background: Surgical Care Improvement Project (SCIP) recommends intravenous prophylactic antibiotics (abx) to be given within 60 minutes before incision to reduce the risk of surgical site infection (SSI). In non-elective cesarean sections, time constraints present challenges to timely abx administration. The aim of this quality improvement study was to assess SCIP compliance in emergent cesareans to identify opportunities for improvement.

Methods: This retrospective study included patients undergoing emergent cesarean at our institution between May 2016 and Dec 2023. Cases of emergent cesarean in the context of major trauma were excluded. Maternal demographic, obstetric, medical, and labor outcomes were abstracted from the medical record. The primary outcome was the incidence of timely (within 60 minutes of incision) administration of abx. Secondary outcomes included maternal ICU admission, hospital length of stay (LOS), loss to follow-up, SSI, and 30-day outcomes such as readmission, reoperation, and Emergency Department (ED) visit. Logistic regression analyses were performed using select variables to identify predictors of SCIP compliance.

Results: A total of 891 patients were included in the study and the majority were non-Caucasian with public insurance (Table). The most common indication for cesarean delivery was non-reassuring fetal status and the most common form of anesthesia was epidural. Antibiotics were administered in 96% of cases, but only 72% were given within 60 minutes before skin incision (SCIP compliance). Chlorhexidine-alcohol was most commonly used for abdominal skin preparation. There were significant differences between the SCIP Not Compliant vs. Compliant group (Table), but multiple logistic regression identified only ASA Class 3 (OR 0.69 95% CI 0.49-0.97, p=.034), ASA Classes 4/5 (OR 0.22 95% CI 0.04-0.96, p=.047), and prolapsed cord as indication for C-section (OR 0.22 95% CI 0.10-0.49, p<.001) as predictors of SCIP Not Compliant. Race and Insurance Status were not significant predictors of SCIP compliance. Maternal morbidity was low, with only 2% ICU admission and median hospital LOS 4 days. A large proportion (32%) were lost to follow-up. The SSI rate was low (1%) and patients infrequently needed interventions. Conclusion: At our safety net hospital, we identified multiple opportunities for improvement, including timeliness of preoperative abx administration, abdominal skin preparation agent, and post-discharge follow-up. SCIP non-compliance was significantly associated with indications for emergent cesarean and higher ASA class. Post-operative SSI rates were low, though a selection bias may be present due to high loss-to-follow-up. Further research is necessary to develop strategies to improve compliance.

Spectrum of pathogens associated with foot infections: review of 178 episodes from a rural hospital

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Authors:
Hugo Bonatti, Krupesh Patel, Manuel Linarte, Rachel Tuer

Body of Abstract:
Background: The spectrum of pathogens associated with foot infections seems to be expanding due to changes in demographics, more invasive medical therapy, spread of multidrug resistant pathogens and improved microbiologic test systems.
Patients and Methods: Our institutional database was searched for all cases of foot infection treated by a single podiatrist during a 4-year period in which a pathogen was identified. Identification of organisms was done using biochemical assays until 2020 and in 2021 matrix assisted laser desorption/ionization – time of flight (MALDI-TOF) mass spectrometry was introduced. All patients underwent incision and drainage of abscesses, wound debridement or minor amputation as indicated during which the specimens for microbiology were retrieved.
Results: A total of 310 isolates in 178 patients (1.7 isolates/patient) were analyzed. Only 1st isolates were considered. There were 124 men and 54 women with a median age of 58.3 (range 10.1 to 91.6) years) including 13 pediatric cases (7%). Median BMI was 30.9 (range 18.6 – 85.7) kg/m2 with an obesity rate of 56%. Rate of DM was 51%, 20% of patients were active smokers. 33% of specimens consisted of tissue biopsies, 25% came from drained abscesses, 22% from drained fluid collections, and 20% from wounds. In 177 cases microscopy was done showing WBC in 67%, Gram positive cocci in 68%, Gram negative rods in 29% and Gram positive rods in 15%. 45% of pathogens were diagnosed using MALDI-TOF, 36% of infections were polymicrobial and in 58% in addition to pathogens, “normal flora” was reported. Staphylococci were isolated in 112 cases (63%) with MSSA accounting for 32% and MRSA for 24%; streptococci were reported in 50 cases (22%) with Streptococcus agalactiae (23 isolates) being the most common; enterococci were found only in 3 patients. In 31% of patients Gram negative rods were reported and Pseudomonas aeruginosa was the most common with 11 isolates followed by Citrobacter spp (8), Proteus spp (7) and E. coli (6). Anaerobes were also found in 31% of patients with Bacteroides spp and Prevotella spp accounting for 12 and 6 isolates, respectively, however, Gram positive anaerobic cocci including Finegoldia magna (10), Parvimonas micra (1), Anaerococcus prevotii (6), Peptostreptococcus anaerobius (4) and Peptoniphilus asaccharolyticus (9) outnumbered Gram negative rods.
Conclusion: Whereas staphylococci remain the most common pathogens causing foot infections requiring treatment by podiatry, many other pathogens must be considered. Empiric treatment should cover MRSA, Gram negative rods including Pseudomonas aeruginosa as well as anaerobes and appropriate specimens for microbiology should be sent during surgery in order to tailor treatment.