Background: Diabetic foot sepsis (DFS) is the leading cause of lower extremity amputations and timely initiation of effective antimicrobial therapy is paramount during its management. This study investigated causative microorganisms and their antimicrobial susceptibility profile in patients with DFS. Materials and Methods: A retrospective review was conducted on patients who were 18-years and older admitted with DFS. Data collected included demographic information, comorbidities, clinical findings, types of specimens collected and results of microscopy, culture, and sensitivity (MC&S), treatment, and outcomes. Results: One hundred and sixty-eight records were found, of which 64.3% were of male patients. The median (IQR) age of males was 58 years (IQR 54–65) compared to 61 years (IQR 54–67) for females. Results of MC&S were available in 63.1% of the records, and E. faecalis was cultured in 16%, P. mirabilis in 10%, and S. aureus in 8% of cases. Amoxicillin/Clavulanic acid was prescribed in 69% of the cases. Resistance to at least one antimicrobial was shown in 88% of S. aureus and 80% of P. mirabilis species. Conclusions: The commonly cultured organisms in patients with DFS were E. faecalis 16%, P. mirabilis 10%, and S. aureus. Amoxicillin/Clavulanic was prescribed empirically in 69% of the cases despite high rates of resistance, and in 37% treatment was not preceded by collection of specimens for MC&S. We therefore recommend collection of specimens for MC&S before initiation of antimicrobial therapy in all patients with DFS.

Diabetic foot sepsis (DFS) is the leading cause of lower extremity amputations and timely initiation of effective antimicrobial therapy is paramount during its management. This study investigated causative microorganisms and their antimicrobial susceptibility profile in patients with DFS. Methods: A retrospective review was conducted on patients who were 18-years and older admitted for DFS. . Data collected included demographic: information, comorbidities, clinical findings, type of specimen collected for microbiology and microbiology results, treatment and outcomes. Data was analysed using STATA/SE version 17.0 and a p-value of 0.05 considered statistically significant. Results: Hundred and sixty-eight records were found of which 64.3% of patients were male who also had a median (IQR) age of 58 years (IQR 54-65). In comparison, females had a median age of 61 years (IQR 54-67). The microbiology results were available in 63.1% of the records and 60.4% were taken from tissue specimens (60.4%) and 14.2% from pus swabs (14.2%). Enterococcus faecalis was cultured in 16%, Proteus mirabilis 10%, and Staphylococcus aureus in 8%. Amoxicillin/Clavulanic acid was prescribed for 69% of the cases. Resistance to at least one antimicrobial was observed in 88% of Staphylococcus aureus and 80% of Proteus mirabilis species. Conclusions: Diabetic foot sepsis commonly affects males around the age of 60 years. The commonly cultured organism in patients with DFS are Enterococcus faecalis 16%, Proteus mirabilis 10%, and Staphylococcus aureus. Amoxicillin/Clavulanic acid as the primary antimicrobial therapy and in close to 40% of patients, with DFS, antimicrobial treatment is not preceded by collection of a specimen for MC&S despite high rates of resistance seen in the common cultured organisms. This data may assist with updating local guidelines so as to better manage this condition in an evidenced based way.

Background: Kidney transplantation outcomes in resource-limited settings remain underreported. This 10-year retrospective review examined the clinical characteristics, long-term pharmacokinetics, and outcomes of kidney transplant recipients at a South African public hospital. Methods: Data from kidney transplant recipients between January 2012 and December 2022 were analysed. Graft and patient survival were assessed using Kaplan–Meier analysis. Cox proportional hazards models were used to evaluate the associations between clinical and pharmacokinetic variables and outcomes. Results: The one- and five-year graft survival rates were 87.9% and 65.6%, respectively. Acute rejection, as confirmed by biopsy, was associated with graft failure (HR, 2.46; p = 0.010). Increasing recipient age at transplantation increased the graft failure risk by about 5.0% per year (HR: 1.05, p = 0.006). Tacrolimus trough and normalised trough levels were lower in the graft loss group 73% and 93% of the time, respectively, despite similar tacrolimus doses. Whereas achieving optimal tacrolimus concentration did not significantly affect graft survival, maintaining a haemoglobin level >10 g/dL improved the chances of 3-, 4-, and 5-year graft survival (p-value, 0.001, 0.001, and <0.001, respectively). Patient survival rates were more favourable than graft survival rates. The 1-year and 5-year patient survival rates were 90.0% and 77.4%, respectively. Conclusions: This study offers insights into transplant outcomes in low-resource public health settings. The findings emphasise the impact of rejection and age on the risk of graft failure and the significance of maintaining adequate haemoglobin levels after transplantation. The results also indicate the need for more nuanced and personalised approaches to tacrolimus monitoring in the long-term following transplantation.