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      Abstract    

        

CLINICO-BACTERIOLOGICAL PROFILE IN DIABETICS ADMITTED FOR FOOT ULCERS: OBSERVATIONS FROM A TERTIARY CARE HOSPITAL

 

E Saldanha, A Alva, RP Jakribettu, S Sajan, P Simon, N Sequeira, F Fazal, MS Baliga

 

ABSTRACT: Aim: To study the clinical profile with co-morbidities of patients admitted with Diabetic foot ulcer (DFU) infection. Also, to study the microbiological flora causing the infection, along with antibiotic susceptibility pattern of the pathogens isolated from these ulcers. Material and method: A prospective study was carried out on 95 diabetic patients with foot ulcers for a period of 1½ years. The demographic details of the patients with Diabetic foot ulcer (DFU) along with Wagner’s grade and treatment profile were also collected. The tissue sample were collected and processed as per standard microbiological procedure and antibiotic susceptibility testing was done as per Clinical & Laboratory Standards Institute (CLSI). The data was analyzed by percentage and correlated. Results: A total of 95 patients were included in the study with 83 males. The majority of patients with DFU were below the age of 40 years. Around 36.48% patients developed DFU following 6-10 years of diagnosed as Diabetes mellitus. Hypertension (26.88%) and neuropathy (20%) were the most common co-morbidity and complications among these patients. A total of 92 pathogens isolated from these patients, with Gram negative pathogens being predominant. The most common pathogens isolated were Pseudomonas aeruginosa (30%), followed by Escherichia coli(28.8%) and Staphylococcus aureus (72.5%) among Gram negative and Gram positive pathogens, respectively. Minimal resistance was noted for high end antimicrobials like Beta lactam- Beta lactamase inhibitors & carbapenems. But, for empirical therapy, fluoroquinoles and aminoglycosides may be considered as alternative for cephalosporins. Conclusion: Diabetic foot ulcer infection is mainly seen in individuals with > 5 years of diabetes and complications especially peripheral neuropathy and nephropathy. Gram negative bacteria, coliforms are predominant pathogens isolated. Flouroquinolones and aminoglycoside group of antimicrobials can be considered for empirical therapy provided antibiogram is monitored on regular basis.

KEY WORDS: Diabetic foot infection, Diabetes mellitus, Wagner’s grade, antibiogram

REFERENCES:

  1. MuruganS,Mani K R,Uma Devi.Prevalence of MRSA among diabetic patients with foot ulcers and their antimicrobial susceptibility pattern.Journal of Clinical and diagnostic Research 2008 August (cited 2009 Jun 2)2:+979-984

  2. Singh N, Armstrong DG, Lipsky BA.Preventing foot ulcers in patients with diabetes.JAMA (2005)293:217-28

  3. Sadikot SM.The Diabetic Foot: Treatment (http://www.diabetesindia. com/ diabetes/updates.htm#footproblem (refered on April 10th 2019)

  4. Frkberg GR, Diabetic Foot Ulcers: Pathogenesis and management.Journal of American academy of family physicians 2002 November66:9 1655-1662

  5. Bowering CK: Diabetic foot ulcers: pathophysiology, assessment, and therapy.Can FamPhys 47:1007–1016, 2001.

  6. Zochodone DW: Diabetic polyneuropathy: an update.CurrOpinNeurol 21:527–533, 2008.

  7. Mugambi-Nturibi E, Otieno CF, Kwasa TO, Oyoo GO, Acharya K.Stratification of persons with diabetes into risk categories for foot ulceration.East Afr Med J.2009;86(5):233-239.

  8. Leese GP, Cochrane L, Mackie AD.Measuring the accuracy of different ways to identify the ‘at-risk’ foot in routine clinical practice.Diabet Med.2011;28(6):747-754.17.

  9. Ndip EA, Tchakonte B, Mbanya JC. A study of the prevalence and risk factors of foot problems in a population of diabetic patients in Cameroon.Int J Low Extreme Wounds.2006;5(2):83-88.

  10. Pscherer S, Dippel FW, Lauterbach S, Kostev K.Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany.Prim Care Diabetes.2012;6(3):241-246.

  11. Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG.Practical criteria forscreening patients at high risk for diabetic foot ulceration.Arch Intern Med.1998;158(2):157-162.

  12. ShahradBejestani H, Motabar AR.Assessment of diabetic foot ulcer’s predisposing factors and its outcomes in patients with diabetic foot syndrome hospitalized in HazratRasol-eAkram hospital in Tehran during 1996-2001.J Iran Med Sci Uni.2004;39:77-84.

  13. Apelqvist J, Agardh CD (1992) The association between clinical risk factors and outcome of diabetic foot ulcers.Diabetes Res ClinPract 18: 43-53.

  14. Golinko MS, Margolis DJ, Tal A, Hoffstad O, Boulton AJ, et al.(2009) Preliminary development of a diabetic foot ulcer database from a wound electronic medical record: a tool to decrease limb amputations.Wound Repair Regen 17: 657-665.

  15. Ince P, Kendrick D, Game F, Jeffcoate W (2007) The association between baseline characteristics and the outcome of foot lesions in a UK population with diabetes.Diabet Med 24: 977-981.

  16. Zubair M, Malik A, Ahmad J (2012) Incidence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital.Foot (Edinb) 22: 24-30.

  17. Nelson A, Wright-Hughes A, Backhouse MR, Lipsky BA, Nixon J, Bhogal MS, Reynolds C, Brown S; CODIFI collaborators.CODIFI (Concordance in Diabetic Foot Ulcer Infection): a cross-sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England..2018 Jan 31;8(1):e019437.doi: 10.1136/bmjopen-2017-019437.

  18. Gadepalli R, Dhawan B, Sreenivas V,KapilA, Ammini, Chaudhry R.A Clinico- microbiological Study of Diabetic Foot Ulcers in an Indian Tertiary Care Hospital. Diabetes Care 2006.29; 8: 1727-32.

  19. Malepati S, Vakamudi P, Kandati J, Sreeram S.Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study.IntSurg J 2018;5:98-104.

  20. Sasikumar K, Vijayakumar C, Jagdish S, et al.(March 01, 2018) Clinico-microbiological Profile of SepticDiabetic Foot with Special Reference to Anaerobic Infection.Cureus 10(3): e2252.DOI 10.7759/cureus.2252.

  21. Doupis J, Grigoropoulou P, Voulgari C, Stylianou A, Georga A, Thomakos P, et al. . High rates of comorbid conditions in patients with type 2 diabetes and foot ulcers. Wounds 2008; 20:132–138.

  22. Gershater MA, Löndahl M, Nyberg P, Larsson J, Thörne J, Eneroth M, et al. . Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia2009;52:398–407

  23. Inlow S, Orsted H, SibbaldRG. Best practices for the prevention, diagnosis and treatment of diabetic foot ulcers. Ostomy Wound Manage2000;46:55–68quiz 70–71

  24. Huijberts MS, Schaper NC, SchalkwijkCG. Advanced glycation end products and diabetic foot disease. Diabetes Metab Res Rev2008; 24Suppl 1S19–S24

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