Background:The study is to determine the relation between severity of the diabetic foot ulcers and the organisms isolated from the wounds; its implications and prognosis with particular reference to the differences in the final outcome depending upon the type of organism infecting the wound. The study try to correlate the severity of the diabetic foot infection according to Meggit-Wagner classification, the incidence of amputation and the impact on the hospital stay with the difference of bacterial flora isolated from the wounds. This is an observational study done in 53 patients who were admitted in the surgical ward of a large private medical college in Jadavpur, India. It has been found from this study that the incidence and severity of diabetic foot ulcer is more in patients with some particular type of bacteria found in their wounds. A strong correlation is found in patients whose wounds were infected with some particular bacteria had resulted in more severe type of foot ulcers with higher incidence of amputation and concomitant longer hospital stay. Methods: An observational study was done in 53 patients who were admitted in the surgical ward of a teaching hospital in Kolkata, India. The youngest patient was aged 28 years and the oldest patient was 83 years of age. All of them presented with clinically infected foot ulcers. The patients were explained about the study methods in their own language and due consent was taken. A standardized proforma in English, Hindi and the vernacular languages was made for recording the necessary data. The standard X-ray plates were taken into consideration for determination of the involvement of underlying bones. The microbiological studies were done in all patients from the wound swabs of the foot ulcers. The outcome of the diabetic foot ulcer was assessed from the severity of the disease, the presence of the different bacterial flora in their wounds, the incidence of amputation and the duration of hospital stay. Results: The positive wound culture was found in 67.92 of patients, Methicillin resistant Staph. aureus (MRSA) was the commonest isolated organism (44.44%) followed by mixed bacterial flora (Staph. aureus, Streptococcus epidermidis, Peptococcus, and Bacteroides fragilis) in 16.98% of patients. ESBL Klebsiella was found in 13.89% of patients, Pseudomonas aeruginosa and Enterococcus feacalis were isolated in 8.33% of patients. 80% of ESBL infected wounds presented with Grade IV ulcers. The incidence of amputation was highest in patients whose wounds were colonized by MRSA and 60% of patients with ESBL Klebsiella infected wounds had hospital stay of more than three weeks. Conclusions: The study observed that the prognosis and outcome of a diabetic foot ulcer vary considerably with the specific type of bacteria colonizing the wound.
Background:The study is to determine the relation between the high HbA1c and ESR as prognostic factors with the severity of the diabetic foot ulcer disease, particularly, in predicting the final outcome in the form of higher incidence of lower extremity amputation (LEA) and/or prolonged hospital stay. The study explored the importance of increased level of serum HbA1c and erythrocyte sedimentation rate (ESR) in determining the final outcome of the disease. It revealed that the severity of diabetic foot ulcer disease is more in patients who had concomitant high levels of baseline HbA1c and ESR on admission. Methods: This observational study was done in 89 patients who were admitted in the surgical wards of the two teaching hospitals in India. The cohort consisted of patients from the age of 26 to 83 years of age who presented with clinically infected foot ulcers. Routine blood tests were done which include HbA1C on the day of admission and fasting ESR (1st hour) on the next day morning. The standard X-ray plates were routinely taken on the first day for determination of the involvement of underlying bones and soft tissues. The outcome of the diabetic foot ulcer was assessed from the severity of the disease according to Meggit-Wagner classification, the incidence of lower extremity amputation and the duration of hospital stay. Results: The high levels of baseline HbA1C (more than 7.0%) in blood on the first day of admission was found in all of the 89 patients who were included in this study but the criteria for consideration of high risk was more than 9% which was found in 41 patients. The criteria for consideration of high ESR in this study was set to be 50 mm/h. High ESR of more than 50 mm was found in 63 patients. We had subdivided 31 patients into a High Risk Group whose baseline levels of HbA1C > 9% and ESR > 50 mm/h. The incidence of amputation was 79.31% and 44.44% with HbA1c of more than 9.0% and ESR of more than 50 mm respectively and was considerably increased (83.87%) when both HbA1c and ESR were more than the critical value as set in the study. Similarly, the incidence of prolonged hospital stay of more than 14 days was 58.54% in patients with HbA1C level of greater than 9 %, 51.85% in patients with baseline ESR > 50 mm/h and 93.55% in presence of high levels of both HbA1C (>9%) and ESR (>50 mm/h).. Conclusions: The study observed that the patients who presented with baseline high levels of HbA1C, ESR or both on admission had unfavourable prognosis with increased incidence of lower extremity amputation and prolonged hospital stay than the other patients in the cohort. .
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