Perfil microbiológico das infecções de úlceras de perna: estudo de revisão

Garcia, Taysa de Fátima; Borges, Eline Lima; Junho, Thaisa Oliveira de Castro; Spira, Josimare Aparecida Otoni

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Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVISÃO • Rev. Bras. Enferm. 74 (3) • 2021 • https://doi.org/10.1590/0034-7167-2019-0763 copiar

Perfil microbiológico das infecções de úlceras de perna: estudo de revisão

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivos:

analisar o perfil microbiológico de úlceras de perna de pacientes atendidos em ambulatório e hospital quanto ao tipo de microrganismo, seleção microbiológica aos antibióticos e técnicas de coleta de material para cultura.

Métodos:

revisão da literatura realizada nas bases LILACS, IBECS, MEDLINE e CINAHL, resultando em 27 estudos analisados descritivamente.

Resultados:

ocorreram em ambulatório, 35,7% dos estudos; e em hospitais, 64,2%. Predominaram swab (100%) em ambulatório e biópsia (55,5%) no hospital. Escherichia coli, Pseudomonas aeruginosa e o Staphylococcus aureus foram mais comuns nos dois níveis de assistência. Houve o isolamento de Staphylococcus aureus resistente à meticilina em ambos.

Conclusões:

o perfil microbiológico das infecções foi semelhante, com presença de bactérias resistentes nos dois ambientes. Esse fato causa preocupação e suscita necessidade de pesquisas para elucidá-lo. Os estudos não compararam a efetividade entre biópsia e swab.

Descritores:
Úlcera de Perna; Técnicas de Cultura; Crescimento Bacteriano; Infecção; Enfermagem

Referência	Ano/País	Delineamento do estudo/ Amostra	Intervenções	Desfecho
Cooper RA, Ameen H, Price P, McCulloch DA, Harding KG. A clinical investigation into the microbiological status of 'locally infected' leg ulcers⁽⁹9 Cooper RA, Ameen H, Price P, McCulloch DA, Harding KG. A clinical investigation into the microbiological status of ‘locally infected‘ leg ulcers. Int Wound J. 2009;6(6):453-62. https://doi.org/10.1111/j.1742-481X.2009.00640.x https://doi.org/10.1111/j.1742-481X.2009... ⁾	2009 Reino Unido	Descritivo n = 20	Avaliação qualitativa e quantitativa do status microbiológico das úlceras venosas da perna.	Detecção de 5,8 microrganismos por úlceras.
Sotto A, Richard JL, Combescure C, Jourdan N, Shuldiner S, Bouziges N. et al. Beneficial effects of implementing guidelines on microbiology and costs of infected diabetic foot ulcers⁽¹⁰10 Sotto A, Richard JL, Combescure C, Jourdan N, Shuldiner S, Bouziges N, et al. Beneficial effects of implementing guidelines on microbiology and costs of infected diabetic foot ulcers. Diabetol. 2010;53:2249-2255. https://doi.org/10.1007/s00125-010-1828-3 https://doi.org/10.1007/s00125-010-1828-... ⁾	2010 França	Transversal n = 405	Implementação de diretrizes sobre microbiologia e os custos das úlceras diabéticas infectadas. Comparação dos dados bacteriológicos e custos relacionados com o uso de antimicrobianos.	Prevalência de MRSA e economia nos custos e carga de trabalho.
Wang SH, Sun ZL, Guo YJ, Yang BQ, Yuan Y, Wei Q. et al. Meticillin-resistant Staphylococcus aureus isolated from foot ulcers in diabetic patients in a Chinese care hospital: risk factors for infection and prevalence⁽¹¹11 Wang SH, Sun ZL, Guo YJ, Yang BQ, Yuan Y, Wei Q, et al. Meticillin-resistant Staphylococcus aureus isolated from foot ulcers in diabetic patients in a Chinese care hospital: risk factors for infection and prevalence. J Med Microbiol. 2010;59:1219-24. https://doi.org/10.1099/jmm.0.020537-0 https://doi.org/10.1099/jmm.0.020537-0... ⁾	2010 China	Caso-controle n = 118	Cultura e antibiograma	Staphylococcus aureusfoi o microrganismo mais frequente. Identificação de MRSA.
Shanmugam P, Jeya M, Linda Susan S. The Bacteriology of Diabetic Foot Ulcers, with a Special Reference to Multidrug Resistant Strains⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ⁾	2013 Índia	Descritivo n = 50	Avaliação do perfil microbiológico de úlceras diabéticas - coleta de amostras para cultura microbiana.	Gram-negativos foram mais prevalentes. Presença de microrganismos multirresistentes
Souza JM, Vieira EC, Cortez TM, Mondelli LA, Miot HA, Abbade LPF. Clinical and Microbiologic Evaluation of Chronic Leg Ulcers: A Crosssectional Study⁽¹³13 Souza JM, Vieira EC, Cortez TM, Mondelli LA, Miot HA, Abbade LPF. Clinical and microbiologic evaluation of chronic leg ulcers: a crosssectional study. advances in skin e wound care. 2014;27(5):222-7. https://doi.org/10.1097/01.ASW.0000445952.83084.a0 https://doi.org/10.1097/01.ASW.000044595... ⁾	2014 Brasil	Transversal n = 77	Cultura microbiana para avaliação do perfil bacteriológico de úlceras de perna.	Gram-negativos foram mais frequentes, e úlceras infectadas apresentaram maior carga microbiana.
Garcia EC, González RG, Albor AR, Salazar-Schettino. Infections of Diabetic Foot Ulcers With Methicillin-Resistant Staphylococcus aureus⁽¹⁴14 Garcia EC, González RG, Albor AR, Salazar-Schettino. Infections of diabetic foot ulcers with methicillin-resistant staphylococcus aureus. Int J Lower Extremy Wounds. 2015;14(1):44-9. https://doi.org/10.1177/1534734614564053 https://doi.org/10.1177/1534734614564053... ⁾	2015 México	Descritivo n = 100	Cultura microbiana para avaliação do perfil bacteriológico de úlceras do pé diabético.	Prevalência de Staphylococcus aureus, Escherichia coli e MRSA
Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers⁽¹⁵15 Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K, et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers. J Med Microbiol. 2016;65:1392-404. https://doi.org/10.1099/jmm.0.000370 https://doi.org/10.1099/jmm.0.000370... ⁾	2016 Índia	Coorte prospectiva n = 200	Cultura microbiana e tipagem cromossômica de genes que codificam a produção de biofilme.	Infecções monomicrobianas e polimicrobianas; predominância de Staphylococcus aureus e presença de biofilme.
Ertugrul BM, Lipsky BA, Ture M, Sakarya S. Risk Factors for Infection with Pseudomonas aeruginosa in Diabetic Foot Infections⁽¹⁶16 Ertugrul BM, Lipsky BA, Ture M, Sakarya S. Risk factors for infection with pseudomonas aeruginosa in diabetic foot infections. J Am Podiatric Med Assoc. 2017;107(6):483-9. https://doi.org/10.7547/15-167 https://doi.org/10.7547/15-167... ⁾	2017 Turquia	Descritivo n = 174	Análise microbiológica	Prevalência de Pseudomonas aeruginosa e Staphylococcus aureus.
Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial Prevalence and Antibiotic Resistance in Clinical Isolates of Diabetic Foot Ulcers in the Northeast of Tamaulipas, Mexico⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl⁾	2017 México	Observacional n = 215	Cultura e antibiograma	Sthaphylococus aureus e Enterobacter sp. foram mais comuns, e penicilina e dicloxacilina foram mais eficazes contra bactérias Gram-positivas.
Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. Inflammatory Markers as Risk Factors for Infection with multidrug - resistance microbes in diabetic foot subjects⁽¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ⁾	2017 Índia	Descritivo n = 65	Cultura de aspirados da ferida e biópsia de tecidos moles para avaliação microbiológica	Gram-negativos foram mais frequentes que Gram-positivos, e 57% dos pacientes apresentaram cultura positiva para microrganismos multirresistentes.
Pemayun TGD, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang⁽¹⁹19 Pemayun TGD, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Diabetic Foot E Ankle. 2017;8(1):1-8. https://doi.org/10.1080/2000625X.2017.1312974 https://doi.org/10.1080/2000625X.2017.13... ⁾	2017 Indonésia	Descritivo n = 189	Análise de prontuários	Gram-negativos foram mais comuns; em 36,3%, ocorreram amputações dos membros inferiores e múltiplas amputações em sete pacientes. A taxa de mortalidade atingiu 10,7%.
Santos SLV, Martins MA, Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers?⁽²⁰20 Santos SLV, Martins MA, Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers? J Vasc Nurs. 2017;35(4):178-86. https://doi.org/10.1016/j.jvn.2017.08.001 https://doi.org/10.1016/j.jvn.2017.08.00... ⁾	2017 Brasil	Transversal n = 69	Observação clínica e cultura microbiológica das lesões.	Predominaram dois indicadores de infecção: descoloração do tipo opaco e/ou vermelho-escuro e aumento do volume de exsudato; e cultura positiva para Staphylococcus aureus e Pseudomonas spp. Ocorreu em 31,6% das amostras.
Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z. et al. Distribution of Microbes and Drug Susceptibility in Patients with Diabetic Foot Infections in Southwest China⁽²¹21 Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z, et al. Distribution of microbes and drug susceptibility in patients with diabetic foot infections in Southwest China. J Diabetes Res. 2018;1-9. https://doi.org/10.1155/2018/9817308 https://doi.org/10.1155/2018/9817308... ⁾	2018 China	Transversal n = 428	Cultura e antibiograma de secreção profunda das úlceras.	Infecções por patógenos múltiplos; 36,9%, cepas gram-positivas; 51%, bacilos Gram-negativos; e 12,1%, linhagens de fungos.
Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer⁽²²22 Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer. Diabetes Metabol Syndr: Clin Res Rev. 2018:1-5. https://doi.org/10.1016/j.dsx.2018.03.001 https://doi.org/10.1016/j.dsx.2018.03.00... ⁾	2018 Índia	Coorte prospectiva n = 50	Ensaios bioquímicos convencionais e genômicos, reação em cadeia da polimerase.	Patógenos mais prevalecentes: Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa e Escherichia coli.
Pugazhendhi S, Dorairaj AP. Appraisal of Biofilm Formation in Diabetic Foot Infections by Comparing Phenotypic Methods With the Ultrastructural Analysis⁽²³23 Pugazhendhi S, Dorairaj AP. Appraisal of biofilm formation in diabetic foot infections by comparing phenotypic methods with the ultrastructural analysis. J Foot Ankle Surg. 2018,57:309-315. https://doi.org/10.1053/j.jfas.2017.10.010 https://doi.org/10.1053/j.jfas.2017.10.0... ⁾	2018 Índia	Descritivo n = 160	Cultura e antibiograma	Resistência microbiana foi identificada em microrganismos produtores de biofilme. Microrganismos mais frequentes foram Staphylococcus aureus e Pseudomonas aeruginosa.
Sonal SM, Rodrigues GS, Vyasc N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital⁽²⁴24 Sonal SM, Rodrigues GS, Vyasc N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot. 2018;37:95-100. https://doi.org/10.1016/j.foot.2018.07.002 https://doi.org/10.1016/j.foot.2018.07.0... ⁾	2018 Índia	Transversal n = 260	Cultura e antibiograma	As infecções monomicrobianas foram menos comuns do que as polimicrobianas. As bactérias Gram-negativas foram as mais comuns entre os isolados. Staphylococcus aureus e Pseudomonas aeruginosa foram os mais frequentes.
Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos⁽²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ⁾	2009 Espanha	Coorte prospectiva n = 62	Cultura e antibiograma	Predomínio de microorganismos Gram-positivos; Staphylococcus aureus foi o mais comum.
Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients⁽²⁶26 Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients. Rev Soc Bras Med Trop. 2012,45(6):717-22. https://doi.org/10.1590/S0037-86822012000600012 https://doi.org/10.1590/S0037-8682201200... ⁾	2012 Brasil	Transversal n = 69		A prevalência de Staphylococcus aureus foi de 83% e 15% de Staphylococcus coagulase-negativo, além de Staphylococcus aureus resistente a meticilina (MRSA) e 47% de Stafhylococus coagulase-negativo resistente à meticilina.
Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na Atenção Primária⁽²⁷27 Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária. Rev Eletr Enf. 2014;(16):2. https://doi.org/10.5216/ree.v16i2.24670 https://doi.org/10.5216/ree.v16i2.24670... ⁾	2014 Brasil	Transversal n = 64	Entrevista, exame clínico, registro fotográfico e swab das lesões.	Prevaleceram Pseudomonas aeruginosa e Escherichia coli.
Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections⁽²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾	2015 Brasil	Coorte prospectiva n = 41	Cultura e antibiograma	As infecções foram predominantemente polimicrobianas. As bactérias Gram-positivas mais comuns foram Staphylococcus Aureus; e Gram-negativas, Proteus spp.
Balbuena JO, Madero RG, Gómez TS, Caballero MC, Romero IS, Martínez AR. Microbiología de las infecciones de úlceras por presión y de origen vascular⁽²⁹29 Balbuena JO, Madero RG, Gómez TS, Caballero MC, Romero IS, Martínez AR. Microbiología de las infecciones de úlceras por presión y de origen vascular. Rev Esp Geriatr Gerontol. 2015;50(1):5-8 https://doi.org/10.1016/j.regg.2014.08.001 https://doi.org/10.1016/j.regg.2014.08.0... ⁾	2015 Espanha	Transversal n = 159	Cultura microbiológica	Maior número de infecções causadas por enterobactérias e menor número de infecções por S. aureus em pacientes com lesão por pressão em comparação com aqueles com úlcera venosa. Das cepas de S. aureus isoladas, 41% eram resistentes à meticilina (MRSA).
Cardoso NA, Cisneiros LL, Machado CJ, Cenedezi JM, Procópio RJ, Navarro TP. Gênero bacteriano é fator de risco para amputação maior em pacientes com pé diabético⁽³⁰30 Cardoso NA, Cisneiros LL, Machado CJ, Cenedezi JM, Procópio RJ, Navarro TP. Gênero bacteriano é fator de risco para amputação maior em pacientes com pé diabético. Rev Col Bras Cir. 2017;44(2):147-53. https://doi.org/10.1590/0100-69912017002007 https://doi.org/10.1590/0100-69912017002... ⁾	2017 Brasil	Caso-controle n = 189	Cultura de tecido profundo das lesões - Biópsia	As culturas foram positivas em 86,8%, sendo monomicrobianas em 72%. Nos pacientes com amputação maior, os gêneros de bactérias mais frequentes foram Acinetobacter spp.
Agwu E, Lhongbe J, Inyang N. Prevalence of Quinolone-susceptible Pseudomonas aeruginosa and Staphylococcus aureus in Delayed-healing DFU's in Ekpoma, Nigeria⁽³¹31 Agwu E, Lhongbe J, Inyang N. Prevalence of Quinolone-susceptible Pseudomonas aeruginosa and Staphylococcus aureus in Delayed-healing DFU's in Ekpoma, Nigeria. Int Wound J. 2010;22(4):100-5. Available from: https://www.woundsresearch.com/content/prevalence-quinolone-susceptible-pseudomonas-aeruginosa-and-staphylococcus-aureus-delayed-he https://www.woundsresearch.com/content/p... ⁾	2010 Nigéria	Descritivo n = 220	Cultura e antibiograma	Predomínio de Pseudomonas aeruginosa, Staphylococcus aureus, e coinfecção por ambos microrganismos.
Xie X, Bao Y, Ni L, Liu D, NiuS, Lin H et al. Bacterial Profile and Antibiotic Resistance in Patients with Diabetic Foot Ulcer in Guangzhou, Southern China: Focus on the Differences among Different Wagner's Grades, IDSA/IWGDF Grades, and Ulcer Types⁽³²32 Xie X, Bao Y, Ni L, Liu D, NiuS, Lin H, et al. Bacterial profile and antibiotic resistance in patients with diabetic foot ulcer in Guangzhou, Southern China: focus on the differences among different Wagner‘s Grades, IDSA/IWGDF Grades, and Ulcer Types. Int J Endocrinol. 2017;(8694903):1-12. https://doi.org/10.1155/2017/8694903 https://doi.org/10.1155/2017/8694903... ⁾	2017 China	Descritivo n = 117	Cultura e antibiograma	A proporção de bactérias Gram-negativas foi maior que das bactérias Gram-positivas, destacando-se Enterobacteriaceae e Staphylococcus.
Arjunan SP, Tint AN, Aliahmad B, Kumar DK, Shukla R, Miller J et al. High-Resolution Spectral Analysis Accurately Identifies the Bacterial Signature in Infected Chronic Foot Ulcers in People With Diabetes. SAGE⁽³³33 Arjunan SP, Tint AN, Aliahmad B, Kumar DK, Shukla R, Miller J, et al. High-Resolution spectral analysis accurately identifies the bacterial signature in infected chronic foot ulcers in people with diabetes. SAGE. 2018;17(2):78-86. https://doi.org/10.1177/1534734618785844 https://doi.org/10.1177/1534734618785844... ⁾	2018 Austrália	Descritivo n = 18	Swab e espectroscopia de alta resolução do centro da ferida e da área peri-ferida para estimativa multiespectral de bactérias na base das úlceras do pé diabético.	Swab: presença de Staphylococcus aureus e Escherichia coli. Os resultados da análise multiespectral demonstraram 100% de sensibilidade, com valores preditivos 100% negativos de identificação da presença da bactéria, que foi a causa da infecção na ferida.
Ayed MYA, Ababneh M, Robert AA, Alzaid A, Ahmed RA, Salman A, et al. Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia⁽³⁴34 Ayed MYA, Ababneh M, Robert AA, Alzaid A, Ahmed RA, Salman A, et al. Common pathogens and antibiotic sensitivity profiles of infected diabetic foot ulcers in Saudi Arabia. Int J Lower Extrem Wounds. 2018;00(0):1-8. https://doi.org/10.1177/1534734618793557 https://doi.org/10.1177/1534734618793557... ⁾	2018 Arábia Saudita	Descritivo n = 126	Cultura e antibiograma	Pseudomonas aeruginosa e Staphylococcus aureus foram os microrganismos mais frequentes.
Yildiz PA, Özdil T, Dizbay M, Tunçcan OG, Hizel K. Peripheral arterial disease increases the risk of multidrug-resistant bacteria and amputation in diabetic foot infections⁽³⁵35 Yildiz PA, Özdil T, Dizbay M, Tunçcan OG, Hizel K. Peripheral arterial disease increases the risk of multidrug-resistant bacteria and amputation in diabetic foot infections. Turk J Med Sci. 2018;48:845-50. https://doi.org/10.3906/sag-1803-217 https://doi.org/10.3906/sag-1803-217... ⁾	2018 Turquia	Descritivo n = 112	Análise de prontuários	Predominância de bactérias Gram-positivas. Staphylococcus aureus e Streptococcus spp. foram mais frequentes. Microrganismos multirresistentes foram comuns em pacientes com doença arterial periférica.
Lázaro-Martínez JL, Álvaro-Afonso FJ, Sevillano-Fernández D, Molines-Barroso RJ, García-Álvarez Y, García-Morales E. Clinical and Antimicrobial Efficacy of a Silver Foam Dressing With Silicone Adhesive in Diabetic Foot Ulcers With Mild Infection⁽³⁶36 Lázaro-Martínez JL, Álvaro-Afonso FJ, Sevillano-Fernández D, Molines-Barroso RJ, García-Álvarez Y, García-Morales E. Clinical and antimicrobial efficacy of a silver foam dressing with silicone adhesive in diabetic foot ulcers with mild infection. Int J Lower Extrem Wounds. 2019;18(3):269-78. https://doi.org/10.1177/1534734619866610 https://doi.org/10.1177/1534734619866610... ⁾	2019 Espanha	Prospectivo, aberto, não conrolado n = 21	Cultura e antibiograma	O tratamento com o curativo de prata reduziu significativamente a carga biológica de organismos patogênicos da úlcera do pé, como Staphylococcus aureus, incluindo MRSA, Enterobacteriaceae, Pseudomonas aeruginosa e outros bacilos Gram-negativos não fermentadores.

Microrganismos resistentes	Antibiótico(s)	n (%)
Gram-positivos
Staphylococcus aureus	Meticilina	8 (57,1)⁽¹⁰10 Sotto A, Richard JL, Combescure C, Jourdan N, Shuldiner S, Bouziges N, et al. Beneficial effects of implementing guidelines on microbiology and costs of infected diabetic foot ulcers. Diabetol. 2010;53:2249-2255. https://doi.org/10.1007/s00125-010-1828-3 https://doi.org/10.1007/s00125-010-1828-... ^-¹¹11 Wang SH, Sun ZL, Guo YJ, Yang BQ, Yuan Y, Wei Q, et al. Meticillin-resistant Staphylococcus aureus isolated from foot ulcers in diabetic patients in a Chinese care hospital: risk factors for infection and prevalence. J Med Microbiol. 2010;59:1219-24. https://doi.org/10.1099/jmm.0.020537-0 https://doi.org/10.1099/jmm.0.020537-0... ^,¹⁴14 Garcia EC, González RG, Albor AR, Salazar-Schettino. Infections of diabetic foot ulcers with methicillin-resistant staphylococcus aureus. Int J Lower Extremy Wounds. 2015;14(1):44-9. https://doi.org/10.1177/1534734614564053 https://doi.org/10.1177/1534734614564053... ^,²¹21 Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z, et al. Distribution of microbes and drug susceptibility in patients with diabetic foot infections in Southwest China. J Diabetes Res. 2018;1-9. https://doi.org/10.1155/2018/9817308 https://doi.org/10.1155/2018/9817308... ^,²⁴24 Sonal SM, Rodrigues GS, Vyasc N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot. 2018;37:95-100. https://doi.org/10.1016/j.foot.2018.07.002 https://doi.org/10.1016/j.foot.2018.07.0... ^,³²32 Xie X, Bao Y, Ni L, Liu D, NiuS, Lin H, et al. Bacterial profile and antibiotic resistance in patients with diabetic foot ulcer in Guangzhou, Southern China: focus on the differences among different Wagner‘s Grades, IDSA/IWGDF Grades, and Ulcer Types. Int J Endocrinol. 2017;(8694903):1-12. https://doi.org/10.1155/2017/8694903 https://doi.org/10.1155/2017/8694903... ^,³⁴34 Ayed MYA, Ababneh M, Robert AA, Alzaid A, Ahmed RA, Salman A, et al. Common pathogens and antibiotic sensitivity profiles of infected diabetic foot ulcers in Saudi Arabia. Int J Lower Extrem Wounds. 2018;00(0):1-8. https://doi.org/10.1177/1534734618793557 https://doi.org/10.1177/1534734618793557... ^-³⁵35 Yildiz PA, Özdil T, Dizbay M, Tunçcan OG, Hizel K. Peripheral arterial disease increases the risk of multidrug-resistant bacteria and amputation in diabetic foot infections. Turk J Med Sci. 2018;48:845-50. https://doi.org/10.3906/sag-1803-217 https://doi.org/10.3906/sag-1803-217...
	Penicilina	5 (35,7)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ^,³²32 Xie X, Bao Y, Ni L, Liu D, NiuS, Lin H, et al. Bacterial profile and antibiotic resistance in patients with diabetic foot ulcer in Guangzhou, Southern China: focus on the differences among different Wagner‘s Grades, IDSA/IWGDF Grades, and Ulcer Types. Int J Endocrinol. 2017;(8694903):1-12. https://doi.org/10.1155/2017/8694903 https://doi.org/10.1155/2017/8694903...
	Tetraciclina	2 (14,3)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl⁾
	Ciprofloxacino	3 (21,4)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁵15 Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K, et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers. J Med Microbiol. 2016;65:1392-404. https://doi.org/10.1099/jmm.0.000370 https://doi.org/10.1099/jmm.0.000370... ^,²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ⁾
	Gentamicina	4 (28,6)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁵15 Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K, et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers. J Med Microbiol. 2016;65:1392-404. https://doi.org/10.1099/jmm.0.000370 https://doi.org/10.1099/jmm.0.000370... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ⁾
	Eritromicina	5 (35,7)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁵15 Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K, et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers. J Med Microbiol. 2016;65:1392-404. https://doi.org/10.1099/jmm.0.000370 https://doi.org/10.1099/jmm.0.000370... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... 26 Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients. Rev Soc Bras Med Trop. 2012,45(6):717-22. https://doi.org/10.1590/S0037-86822012000600012 https://doi.org/10.1590/S0037-8682201200... 27 Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária. Rev Eletr Enf. 2014;(16):2. https://doi.org/10.5216/ree.v16i2.24670 https://doi.org/10.5216/ree.v16i2.24670... -²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Amoxicillina + ácido clavulânico	3 (21,4)⁽²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ^,²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... 26 Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients. Rev Soc Bras Med Trop. 2012,45(6):717-22. https://doi.org/10.1590/S0037-86822012000600012 https://doi.org/10.1590/S0037-8682201200... 27 Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária. Rev Eletr Enf. 2014;(16):2. https://doi.org/10.5216/ree.v16i2.24670 https://doi.org/10.5216/ree.v16i2.24670... -²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Cefoxitina	3 (21,4)⁽¹⁴14 Garcia EC, González RG, Albor AR, Salazar-Schettino. Infections of diabetic foot ulcers with methicillin-resistant staphylococcus aureus. Int J Lower Extremy Wounds. 2015;14(1):44-9. https://doi.org/10.1177/1534734614564053 https://doi.org/10.1177/1534734614564053... ^-¹⁵15 Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K, et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers. J Med Microbiol. 2016;65:1392-404. https://doi.org/10.1099/jmm.0.000370 https://doi.org/10.1099/jmm.0.000370... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Cefalotina	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Sulfametoxazol + trimetoprima	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Vancomicina	3 (21,4) ⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Oxacilina	3 (21,4)⁽¹⁴14 Garcia EC, González RG, Albor AR, Salazar-Schettino. Infections of diabetic foot ulcers with methicillin-resistant staphylococcus aureus. Int J Lower Extremy Wounds. 2015;14(1):44-9. https://doi.org/10.1177/1534734614564053 https://doi.org/10.1177/1534734614564053... ^,¹⁵15 Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K, et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers. J Med Microbiol. 2016;65:1392-404. https://doi.org/10.1099/jmm.0.000370 https://doi.org/10.1099/jmm.0.000370... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Ampicilina	2 (14,3)⁽¹⁵15 Shettigar K, Jain S, Bhat DV, Achrya R, Ramachandra L, Satyamoorthy K, et al. Virulence determinants in clinical Staphylococcus aureus from monomicrobial and polymicrobial infections of diabetic foot ulcers. J Med Microbiol. 2016;65:1392-404. https://doi.org/10.1099/jmm.0.000370 https://doi.org/10.1099/jmm.0.000370... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl⁾
Staphylococcus epidermidis	Cefalotina	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Eritromicina	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Penicillina	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Sulfametoxazol + trimetoprima	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Vancomicina	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,²¹21 Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z, et al. Distribution of microbes and drug susceptibility in patients with diabetic foot infections in Southwest China. J Diabetes Res. 2018;1-9. https://doi.org/10.1155/2018/9817308 https://doi.org/10.1155/2018/9817308... ⁾
Gram-negativos
Escherichia coli	Amicacina	3 (21,4)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^-¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ⁾
	Ampicillina	4 (28,6)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^-¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Aztreonam	2 (14,3)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Cefotaxime	3 (21,4)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^,¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ⁾
	Cefepime	3 (21,4)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^-¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ⁾
	Cefoperazone	2 (14,3)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ⁾
	Ciprofloxacina	2 (14,3)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ⁾
	Gentamicina	4 (28,6)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl^-¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Tobramicina	2 (14,3)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ⁾
	Ceftriaxona	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl 18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... 19 Pemayun TGD, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Diabetic Foot E Ankle. 2017;8(1):1-8. https://doi.org/10.1080/2000625X.2017.1312974 https://doi.org/10.1080/2000625X.2017.13... 20 Santos SLV, Martins MA, Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers? J Vasc Nurs. 2017;35(4):178-86. https://doi.org/10.1016/j.jvn.2017.08.001 https://doi.org/10.1016/j.jvn.2017.08.00... 21 Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z, et al. Distribution of microbes and drug susceptibility in patients with diabetic foot infections in Southwest China. J Diabetes Res. 2018;1-9. https://doi.org/10.1155/2018/9817308 https://doi.org/10.1155/2018/9817308... 22 Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer. Diabetes Metabol Syndr: Clin Res Rev. 2018:1-5. https://doi.org/10.1016/j.dsx.2018.03.001 https://doi.org/10.1016/j.dsx.2018.03.00... 23 Pugazhendhi S, Dorairaj AP. Appraisal of biofilm formation in diabetic foot infections by comparing phenotypic methods with the ultrastructural analysis. J Foot Ankle Surg. 2018,57:309-315. https://doi.org/10.1053/j.jfas.2017.10.010 https://doi.org/10.1053/j.jfas.2017.10.0... 24 Sonal SM, Rodrigues GS, Vyasc N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot. 2018;37:95-100. https://doi.org/10.1016/j.foot.2018.07.002 https://doi.org/10.1016/j.foot.2018.07.0... 25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... 26 Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients. Rev Soc Bras Med Trop. 2012,45(6):717-22. https://doi.org/10.1590/S0037-86822012000600012 https://doi.org/10.1590/S0037-8682201200... 27 Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária. Rev Eletr Enf. 2014;(16):2. https://doi.org/10.5216/ree.v16i2.24670 https://doi.org/10.5216/ree.v16i2.24670... ^-²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Sulbactam	2 (14,3)⁽¹²12 Shanmugam P, Jeya M, Linda Susan S. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagnost Res. 2013;7(3):441-5. https://doi.org/10.7860/JCDR/2013/5091.2794 https://doi.org/10.7860/JCDR/2013/5091.2... ^,¹⁸18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... ⁾
	Amoxicilina + ácido clavulânico	2 (14,3)⁽²⁵25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... ^,²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
Pseudomonas aeruginosa	Amicacina	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl 18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... 19 Pemayun TGD, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Diabetic Foot E Ankle. 2017;8(1):1-8. https://doi.org/10.1080/2000625X.2017.1312974 https://doi.org/10.1080/2000625X.2017.13... 20 Santos SLV, Martins MA, Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers? J Vasc Nurs. 2017;35(4):178-86. https://doi.org/10.1016/j.jvn.2017.08.001 https://doi.org/10.1016/j.jvn.2017.08.00... 21 Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z, et al. Distribution of microbes and drug susceptibility in patients with diabetic foot infections in Southwest China. J Diabetes Res. 2018;1-9. https://doi.org/10.1155/2018/9817308 https://doi.org/10.1155/2018/9817308... 22 Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer. Diabetes Metabol Syndr: Clin Res Rev. 2018:1-5. https://doi.org/10.1016/j.dsx.2018.03.001 https://doi.org/10.1016/j.dsx.2018.03.00... 23 Pugazhendhi S, Dorairaj AP. Appraisal of biofilm formation in diabetic foot infections by comparing phenotypic methods with the ultrastructural analysis. J Foot Ankle Surg. 2018,57:309-315. https://doi.org/10.1053/j.jfas.2017.10.010 https://doi.org/10.1053/j.jfas.2017.10.0... 24 Sonal SM, Rodrigues GS, Vyasc N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot. 2018;37:95-100. https://doi.org/10.1016/j.foot.2018.07.002 https://doi.org/10.1016/j.foot.2018.07.0... 25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... 26 Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients. Rev Soc Bras Med Trop. 2012,45(6):717-22. https://doi.org/10.1590/S0037-86822012000600012 https://doi.org/10.1590/S0037-8682201200... 27 Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária. Rev Eletr Enf. 2014;(16):2. https://doi.org/10.5216/ree.v16i2.24670 https://doi.org/10.5216/ree.v16i2.24670... ^-²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Levofloxacino	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl 18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... 19 Pemayun TGD, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Diabetic Foot E Ankle. 2017;8(1):1-8. https://doi.org/10.1080/2000625X.2017.1312974 https://doi.org/10.1080/2000625X.2017.13... 20 Santos SLV, Martins MA, Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers? J Vasc Nurs. 2017;35(4):178-86. https://doi.org/10.1016/j.jvn.2017.08.001 https://doi.org/10.1016/j.jvn.2017.08.00... 21 Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z, et al. Distribution of microbes and drug susceptibility in patients with diabetic foot infections in Southwest China. J Diabetes Res. 2018;1-9. https://doi.org/10.1155/2018/9817308 https://doi.org/10.1155/2018/9817308... 22 Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer. Diabetes Metabol Syndr: Clin Res Rev. 2018:1-5. https://doi.org/10.1016/j.dsx.2018.03.001 https://doi.org/10.1016/j.dsx.2018.03.00... 23 Pugazhendhi S, Dorairaj AP. Appraisal of biofilm formation in diabetic foot infections by comparing phenotypic methods with the ultrastructural analysis. J Foot Ankle Surg. 2018,57:309-315. https://doi.org/10.1053/j.jfas.2017.10.010 https://doi.org/10.1053/j.jfas.2017.10.0... 24 Sonal SM, Rodrigues GS, Vyasc N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot. 2018;37:95-100. https://doi.org/10.1016/j.foot.2018.07.002 https://doi.org/10.1016/j.foot.2018.07.0... 25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... 26 Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients. Rev Soc Bras Med Trop. 2012,45(6):717-22. https://doi.org/10.1590/S0037-86822012000600012 https://doi.org/10.1590/S0037-8682201200... 27 Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária. Rev Eletr Enf. 2014;(16):2. https://doi.org/10.5216/ree.v16i2.24670 https://doi.org/10.5216/ree.v16i2.24670... ^-²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾
	Cefepime	2 (14,3)⁽¹⁷17 Sánchez-Sanchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-Garcia V. Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the Northeast of Tamaulipas, Mexico. Int J Lower Extremy Wounds. 2017;1-6. https://doi.org/10.1177/1534734617705254journals.sagepub.com/home/ijl 18 Noor S, Borse AG, Ozair M, Raghav A, Parwez I, Ahmad J. inflammatory markers as risk factors for infection with multidrug - resistance microbes in diabetic foot subjects. Foot. 2017;1-19. https://doi.org/10.1016/j.foot.2017.05.001 https://doi.org/10.1016/j.foot.2017.05.0... 19 Pemayun TGD, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Diabetic Foot E Ankle. 2017;8(1):1-8. https://doi.org/10.1080/2000625X.2017.1312974 https://doi.org/10.1080/2000625X.2017.13... 20 Santos SLV, Martins MA, Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers? J Vasc Nurs. 2017;35(4):178-86. https://doi.org/10.1016/j.jvn.2017.08.001 https://doi.org/10.1016/j.jvn.2017.08.00... 21 Wu M, Pan H, Leng W, Lei X, Chen Liu, Liang Z, et al. Distribution of microbes and drug susceptibility in patients with diabetic foot infections in Southwest China. J Diabetes Res. 2018;1-9. https://doi.org/10.1155/2018/9817308 https://doi.org/10.1155/2018/9817308... 22 Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer. Diabetes Metabol Syndr: Clin Res Rev. 2018:1-5. https://doi.org/10.1016/j.dsx.2018.03.001 https://doi.org/10.1016/j.dsx.2018.03.00... 23 Pugazhendhi S, Dorairaj AP. Appraisal of biofilm formation in diabetic foot infections by comparing phenotypic methods with the ultrastructural analysis. J Foot Ankle Surg. 2018,57:309-315. https://doi.org/10.1053/j.jfas.2017.10.010 https://doi.org/10.1053/j.jfas.2017.10.0... 24 Sonal SM, Rodrigues GS, Vyasc N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot. 2018;37:95-100. https://doi.org/10.1016/j.foot.2018.07.002 https://doi.org/10.1016/j.foot.2018.07.0... 25 Martínez-Gomes DA, Ramírez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini JL. Infecciones del pie diabético: prevalencia de los distintos microorganismos y sensibilidad a los antimicrobianos. Enfermed Infec Microbiol Clín. 2009;27(6):317-21. https://doi.org/10.1016/j.eimc.2008.07.004 https://doi.org/10.1016/j.eimc.2008.07.0... 26 Martins MA, Santos SLV, Leão LSNO, Araujo NP, Bachion MM. Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients. Rev Soc Bras Med Trop. 2012,45(6):717-22. https://doi.org/10.1590/S0037-86822012000600012 https://doi.org/10.1590/S0037-8682201200... 27 Santos SLV, Martins MA, Vasconcelos LSNOL, Lima ABM, Malaquias SG, Bachion MM. Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária. Rev Eletr Enf. 2014;(16):2. https://doi.org/10.5216/ree.v16i2.24670 https://doi.org/10.5216/ree.v16i2.24670... ^-²⁸28 Perim MC, Borges JC, Celeste SRC, Orsolin EF, Mendes RR, Mendes GO, et al. Aerobic bacterial proﬁle and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54. https://doi.org/10.1590/0037-8682-0146-2015 https://doi.org/10.1590/0037-8682-0146-2... ⁾

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[1] Autor Correspondente: Taysa de Fátima Garcia. E-mail: taysafati@hotmail.com