<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0001-6002</journal-id>
<journal-title><![CDATA[Acta Médica Costarricense]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. costarric]]></abbrev-journal-title>
<issn>0001-6002</issn>
<publisher>
<publisher-name><![CDATA[Colegio de Médicos y Cirujanos de Costa Rica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0001-60022021000400210</article-id>
<article-id pub-id-type="doi">10.51481/amc.v63i4.1211</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Infecciones óseas en el Pie Diabético: reporte de la microbiología]]></article-title>
<article-title xml:lang="en"><![CDATA[Microbiology of diabetic foot infections]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cascante-Serrano]]></surname>
<given-names><![CDATA[Daniel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Segura-Retana]]></surname>
<given-names><![CDATA[Elvira]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramírez-Cardoce]]></surname>
<given-names><![CDATA[Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Caja Costarricense del Seguro Social Hospital San Juan de Dios Laboratorio Clínico]]></institution>
<addr-line><![CDATA[San José ]]></addr-line>
<country>Costa Rica</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Caja Costarricense del Seguro Social Hospital San Juan de Dios Laboratorio Clínico]]></institution>
<addr-line><![CDATA[San José ]]></addr-line>
<country>Costa Rica</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Caja Costarricense del Seguro Social Hospital San Juan de Dios Servicio de Infectología]]></institution>
<addr-line><![CDATA[San José ]]></addr-line>
<country>Costa Rica</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>63</volume>
<numero>4</numero>
<fpage>210</fpage>
<lpage>216</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S0001-60022021000400210&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S0001-60022021000400210&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S0001-60022021000400210&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo: Describir y caracterizar la microbiología de las osteomielitis de pie diabético en pacientes hospitalizados en el Hospital San Juan de Dios en el año 2018.  Métodos:  Se consultó la base de datos local de pacientes de la Unidad de Pie Diabético para obtener los datos demográficos de los pacientes hospitalizados con diagnóstico de osteomielitis además del sistema de información de la división de Microbiología del Laboratorio Clínico con el fin de obtener los datos de especies bacterianas y sus perfiles de susceptibilidad a los antimicrobianos aisladas de las respectivas muestras de hueso. Con estos datos se construyó una base de datos para el proyecto y el análisis estadístico descriptivo se realizó en hojas de cálculo de Excel.  Resultados: Enterococcus faecalis fue el agente más frecuentemente aislado (21%), seguido de Staphylococcus aureus (14%), de los cuales 70% presentó fenotipo de meticilino resistencia y Escherichia coli como tercer lugar (11%). Otros bacilos Gram negativos ocuparon un cuarto lugar, con Enterobacter cloacae (8%) y Klebsiella pneumoniae (8%) como las principales especies aisladas; cabe destacar que se evidenció la presencia de 24% de cepas portadoras de &#7838;-lactamasas de espectro extendido, con K. pneumoniae como la principal especie portadora de este fenotipo de resistencia.  Conclusiones: Se reportó por primera vez a E. faecalis como la bacteria más aislada en OPD, lo cual permite concluir que la microbiología de estos cuadros en Costa Rica difiere a lo reportado en la literatura internacional y es necesario actualizar a la comunidad médica costarricense. Además, es importante destacar que a pesar de que el porcentaje obtenido de bacilos Gram negativos portadores de BLEE es inferior a lo reportado en la literatura, el 100% de las cepas de K. pneumoniae fueron portadoras de este fenotipo de resistencia, por lo tanto, es posible considerar a nivel local que el hallazgo preliminar de esta especie debería modificar el espectro terapéutico a utilizar en espera de reportes de PSA.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Aim:  Describe and characterize the microbiology of diabetic foot osteomyelitis (DFO) in hospitalized patients of the San Juan de Dios Hospital in 2018.  Methods:  The local database of patients of the Diabetic Foot Unit was consulted to obtain the demographic data of hospitalized patients with a diagnosis of osteomyelitis in addition to the information system of the Microbiology division of the Clinical Laboratory to obtain data on species bacteria and their antimicrobial susceptibility profiles isolated from the respective bone samples. With these data, a database for the project was built and the descriptive statistical analysis was carried out in Excel spreadsheets.  Results:  Enterococcus faecalis was the most frequently isolated agent (21%), followed by Staphylococcus aureus (14%) of which 70% presented a methicillin resistance phenotype, and Escherichia coli as third place (11%). Other Gram negative bacilli occupied a fourth place, being Enterobacter cloacae (8%) and Klebsiella pneumoniae (8%) the main isolated species; it should be noted the presence of 24% of strains carrying extended spectrum &#7838;-lactamases, with K. pneumoniae as the main carrier species of this resistance. Conclusion: E. faecalis was reported for the first time as the most isolated bacterium in DFO, which allows to conclude that the microbiology of these conditions in Costa Rica differ from that reported in the international literature and it is necessary to update the Costa Rican medical community. It is also important to note that even though the percentage obtained from Gram negative rods carrying ESBL is lower than that reported in the literature, 100% of the K. pneumoniae strains were carriers of this resistance phenotype, therefore it is possible consider at the local level that the preliminary finding of this species should modify the therapeutic spectrum to be used pending final reports.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Osteomielitis]]></kwd>
<kwd lng="es"><![CDATA[Pie Diabético]]></kwd>
<kwd lng="es"><![CDATA[Microbiología]]></kwd>
<kwd lng="en"><![CDATA[Osteomyelitis]]></kwd>
<kwd lng="en"><![CDATA[Diabetic Foot]]></kwd>
<kwd lng="en"><![CDATA[Microbiology]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Singh]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Armstron]]></surname>
</name>
<name>
<surname><![CDATA[Lipsky]]></surname>
<given-names><![CDATA[BA.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Preventing foot ulcers in patients with diabetes]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2005</year>
<volume>293</volume>
<page-range>217-28</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kimberlee]]></surname>
<given-names><![CDATA[B.]]></given-names>
</name>
<name>
<surname><![CDATA[Hobizal]]></surname>
<given-names><![CDATA[DPM]]></given-names>
</name>
<name>
<surname><![CDATA[Dane]]></surname>
<given-names><![CDATA[K.]]></given-names>
</name>
<name>
<surname><![CDATA[Wukich]]></surname>
<given-names><![CDATA[MD.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diabetic foot infections: current concept review]]></article-title>
<source><![CDATA[Diabetic Foot &amp; Ankle]]></source>
<year>2012</year>
<volume>3</volume>
<numero>18409</numero>
<issue>18409</issue>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Abdulrazak]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bitar]]></surname>
<given-names><![CDATA[ZI]]></given-names>
</name>
<name>
<surname><![CDATA[Al-Shamali]]></surname>
<given-names><![CDATA[AA.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bacteriological study of diabetic foot infections]]></article-title>
<source><![CDATA[J Diabetes Complications.]]></source>
<year>2005</year>
<volume>19</volume>
<page-range>138-41</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Miller]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Henry]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Update in diagnosis and treatment of diabetic foot infections]]></article-title>
<source><![CDATA[Phys Med Rehabil Clin N Am.]]></source>
<year>2009</year>
<volume>20</volume>
<page-range>611-25</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Newman]]></surname>
<given-names><![CDATA[LG]]></given-names>
</name>
<name>
<surname><![CDATA[Waller]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Palestro]]></surname>
<given-names><![CDATA[CJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>1991</year>
<volume>266</volume>
<page-range>1246-51</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zimmerli]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Fluckiger]]></surname>
<given-names><![CDATA[U.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Classification and microbiology of osteomyelitis]]></article-title>
<source><![CDATA[Orthopade]]></source>
<year>2004</year>
<volume>33</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>267-72</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lipsky]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
<name>
<surname><![CDATA[Berendt]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Deery]]></surname>
<given-names><![CDATA[HG]]></given-names>
</name>
<name>
<surname><![CDATA[Embil]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Joseph]]></surname>
<given-names><![CDATA[WS]]></given-names>
</name>
<name>
<surname><![CDATA[Karchmer]]></surname>
<given-names><![CDATA[AW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Infectious Diseases Society of America. Diagnosis and treatment of diabetic foot infections]]></article-title>
<source><![CDATA[Clin Infect Dis]]></source>
<year>2004</year>
<volume>39</volume>
<page-range>885-910</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Game]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Jeffcoate]]></surname>
<given-names><![CDATA[W.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[MRSA and osteomyelitis of the foot in diabetes]]></article-title>
<source><![CDATA[Diabet Med.]]></source>
<year>2004</year>
<volume>21</volume>
<page-range>16-9</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hatipoglu]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Mutluoglu]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Turhan]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Uzun]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Lipsky]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Sevim]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Causative pathogens and antibiotic resistance in diabetic foot infections: a prospective multi-center study.]]></article-title>
<source><![CDATA[Journal of Diabetes and its Complications.]]></source>
<year>2016</year>
<volume>30</volume>
<page-range>910-6</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hartemann-Heurtier]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Senneville]]></surname>
<given-names><![CDATA[E.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diabetic foot osteomyelitis]]></article-title>
<source><![CDATA[Diabetes &amp; metabolism]]></source>
<year>2008</year>
<volume>34</volume>
<page-range>87-95</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Citron]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Goldstein]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
<name>
<surname><![CDATA[Merriam]]></surname>
<given-names><![CDATA[CV.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents]]></article-title>
<source><![CDATA[J Clin Microbiol]]></source>
<year>2007</year>
<volume>45</volume>
<page-range>2819-28</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Saltoglu]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Ergonul]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Tulek]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Yemisen]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kadanali]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Karagoz]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Influence of multidrug resistant organisms on the outcome of diabetic foot infection.]]></article-title>
<source><![CDATA[Int J Infect Dis]]></source>
<year>2018</year>
<volume>70</volume>
<page-range>10-4</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nakai]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Hagihara]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kato]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Hirai]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Nishiyama]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Koizumi]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Sakanashi]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Suematsu]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Yamagishi]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Mikamo]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence and risk factors of infections caused by extended-spectrum &#7838;-lactamase (ESBL)- producing Enterobacteriaceae]]></article-title>
<source><![CDATA[J Infect Chemother]]></source>
<year>2016</year>
<volume>22</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>319-26</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rattanaumpawan]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Choorat]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Takonkitsakul]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Tangkoskul]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Seenama]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Thamlikitkul]]></surname>
<given-names><![CDATA[V.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A prospective surveillance study for multidrug- resistant bacteria colonization in hospitalized patients at a Thai University Hospital.]]></article-title>
<source><![CDATA[Antimicrob Resist Infect Control]]></source>
<year>2018</year>
<volume>7</volume>
<numero>102</numero>
<issue>102</issue>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Doernberg]]></surname>
<given-names><![CDATA[SB]]></given-names>
</name>
<name>
<surname><![CDATA[Winston]]></surname>
<given-names><![CDATA[LG.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Risk factors for acquisition of extended-spectrum &#7838;-lactamase- producing Escherichia coli in an urban county hospital.]]></article-title>
<source><![CDATA[Am J Infect Control]]></source>
<year>2012</year>
<volume>40</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>123-7</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Briongos-Figuero]]></surname>
<given-names><![CDATA[LS]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez-Traveso]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Bachiller- Luque]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Domínguez-Gil González]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez-Nieto]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Palacios-Martín]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[González-Sagrado]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Dueñas- Laita]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez-Castrillón]]></surname>
<given-names><![CDATA[JL.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.]]></article-title>
<source><![CDATA[Int J Clin Pract]]></source>
<year>2012</year>
<volume>66</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>891-6</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
