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

Table 3

Potential and alarming empirical regimens for different Wagner’s grades, IDSA/IWGDF grades, and types of diabetic foot infections.

Classification	Usual pathogen(s)^a	Potential empirical regimens^b	Alarming empirical regimens^c
Type
NFU	Enterobacteriaceae	Aztreonam; cefotetan; 2nd~4th gen ceph; carbapenem; FQ; cipro; T/S; β-L-ase 2; aminoglycosides	First gen ceph; ampicillin
IFU	Enterobacteriaceae	Aztreonam; 3rd/4th gen ceph; carbapenem; FQ; cipro; T/S; β-L-ase 2; aminoglycosides	Ampicillin
	Staphylococcus aureus	β-L-ase 1	Pen; second/third gen ceph; tetracycline
N-IFU	Enterobacteriaceae	Aztreonam; cefotetan; 3rd/4th gen ceph; carbapenem; β-L-ase 2; aminoglycosides	First/second gen ceph; ampicillin
	Staphylococcus aureus	β-L-ase 1; aminoglycosides; quinolones; rifampin; FQ; cipro	Pen
Wagner’s grade
1~2	Staphylococcus aureus	β-L-ase 1; aminoglycosides; rifampin; FQ; cipro	Pen
	Enterobacteriaceae	Aztreonam; cefotetan; 3rd/4th gen ceph; carbapenem; FQ; cipro; T/S; β-L-ase 2; aminoglycosides	First gen ceph; ampicillin
3	Enterobacteriaceae	Aztreonam; cefotetan; 3rd/4th gen ceph; carbapenem; FQ; β-L-ase 2; aminoglycosides	First/second gen ceph; ampicillin
	Staphylococcus aureus	β-L-ase 1	Pen; tetracycline
4	Enterobacteriaceae	Same to Wanger grade 3	First/second gen ceph; ampicillin
	Staphylococcus aureus	Same to Wanger grade 3	Pen; first~third gen ceph; tetracycline
IWGDF grade
1~2	Enterobacteriaceae	Aztreonam; cefotetan; 2nd~4th gen ceph; carbapenem; FQ; cipro; clindamycin; T/S; β-L-ase 2; aminoglycosides	First gen ceph; ampicillin
	Staphylococcus aureus	β-L-ase 1; aminoglycosides; rifampin; FQ; cipro;	Pen
3	Enterobacteriaceae	aztreonam; cefotetan; 2nd ~ 4th gen ceph; carbapenem; FQ; cipro; β-L-ase 2; aminoglycosides	First/second gen ceph; ampicillin
	Staphylococcus aureus	β-L-ase 1; rifampin	Pen; third gen ceph; tetracycline
4	Enterobacteriaceae	Carbapenem; β-L-ase 2	First/second gen ceph; ampicillin
	Staphylococcus aureus	β-L-ase 1	Pen; first~third gen ceph; tetracycline

β-L-ase: β-lactam, β-lactamase inhibitor; β-L-ase 1: amoxicillin/clavulanate, ampicillin/sulbactam; β-L-ase 2: ticarcillin/clavulanate, piperacillin/tazobactam; group 1: carbapenem, ertapenem; group 2: carbapenem, imipenem, meropenem; ceph: cephalosporin; gen: generation; FQ: fluoroquinolone with good activity against aerobic Gram-positive cocci (e.g., levofloxacin or moxifloxacin); cipro: antipseudomonal fluoroquinolone, for example, ciprofloxacin; T/S; trimethoprim/sulfamethoxazole; pen: penicilin. ^aAll the Staphylococcus aureus isolates were sensetive to teicoplanin, linezolid, tigecycline, and vancomycin; ^bthe agents whose resistant rates were <30%; ^cthe agents whose resistant rates were >70%.