Infections with Pseudomonas aeruginosa in Charcot arthropathy of the foot.

BACKGROUND: Patients with Charcot arthropathy present a high risk for ulcers with secondary bone infection. Infections with Pseudomonas aeruginosa represent a severe threat to the patients. We hypothesized that infections with P aeruginosa result in a longer stay in hospital and more operations than infections with other bacteria.

METHODS: All patients who underwent surgery for Charcot arthropathy of the feet between 1996 and 2006 (n = 205) in our clinic were included. The duration of hospitalization and number of surgeries for infections due to methicillin-resistant Staphylococcus aureus (MRSA) versus P aeruginosa were compared to infections with other bacteria. All patients were scanned for MRSA and were isolated when tested positive and treated according to a defined algorithm.

RESULTS: Seventy-nine intraoperative samples exhibited bacterial growth: 12 cases of MRSA, 14 cases of P aeruginosa, and 53 case of other bacteria. Patients with deep infections due to P aeruginosa stayed significantly longer in the hospital (52 vs 35 days, P < .041) and needed significantly more surgery (1.71 vs 1.28 surgeries, P < .027). There was no significant difference between patients with MRSA infections and those without MRSA or P aeruginosa.

CONCLUSION: Infections with P aeruginosa resulted in more surgeries and a longer stay in the hospital. Early debridement is the basic treatment. A specific algorithm for isolation and operative and antibiotic treatment for P aeruginosa infections is proposed similar to an algorithm for MRSA that has been shown to be successful.

LEVEL OF EVIDENCE: Level IV, retrospective case Series.