Background: Our aim was to study a prescribing pattern of antibiotics used in diabetic foot ulcer (DFU).Methods: 50 patients were selected by inclusion and exclusion criteria basis. It was a prospective observational study conducted in Department of Surgery, Rajah Muthiah Medical College Hospital (RMMCH), Annamalai University.Results: This study reveals that male patients 60% are more prone to develop diabetic foot ulcer than the female patients 40%. Patients of 50 to 60 age group 32% has higher prevalence of DFU. The most commonly prescribed antibiotics are metronidazole 48% and cefotaxime 48% followed by piperacillin and tazobactam combination 30%, ciprofloxacin 20%, linezolid 18%, amoxicillin and clavulanic acid combination 12%, cefixime 6%, clindamycin 4%, amikacin 4%, faropenam 4%, ceftriaxone 2%, amoxicillin 2%, gentamicin 2%, cefoperazone sodium and sulbactam combination 2%.Conclusions: Lack of antibiotic sensitivity test leads to growth of organism, wrong antibiotic selection and irrational use of antibiotics. And also observed patient developed resistance to linezolid antibiotic when used as a first choice of drug to treat diabetic foot infection including methicillin-resistant Staphylococcus aureus (MRSA) infected patients.
Background: To study about the prevalence and anti-microbial susceptibility pattern of methicillin resistant Staphylococcus aureus (MRSA).Methods: Totally 110 non-repetitive Staphylococcus aureus isolates were enrolled in this study. Isolates from different clinical specimens like pus and blood obtained from patients in tertiary care hospital and Staphylococcus aureus was identified by conventional phenotypic methods. Complete antibiotic susceptibility testing of all MRSA isolates was determined by Kirby-Bauer disc diffusion method.Results: Out of 110 isolates of S. aureus 60 were found to be methicillin-resistant Staphylococcus aureus (MRSA). The prevalence of MRSA was 54%. Out of 60 isolates, male patients 37 (63%) and female patients are 22 (37%). Maximum numbers of isolates 25 (41.6%) were from the age group of 51 to 60 years. Among these 60 isolates, all of them were found to be resistant to penicillin and oxacillin. In contrast, 98% of the isolates were found to be sensitive to linezolid. The sensitivity to chloramphenicol 70%, co-trimoxazole 60%, amikacin 58%, clindamycin 43%, ciprofloxacin 38%, erythromycin 25%.Conclusions: The observed prevalence rate was 54%. Linezolid showed the best therapeutic outcome against MRSA. Active screening plays an important role in control of MRSA.
Background: The objective was to study about the drugs used in management of diabetic foot ulcer (DFU) and to grade the wounds using Wagner’s scale.Methods: An observational study was conducted at Department of Pharmacy, Rajah Muthiah Medical College Hospital over a period of six months from November 2018 to April 2019. The data was collected from 85 patients using data collection form. The patients were selected based on inclusion and exclusion criteria.Results: Overall 85 patients were enrolled in this study. The prevalence of DFU found to be 36% more in males 58 (68%) than in females 27 (32%). Considering the age group, higher prevalence was reported in patients among the age group of 60-70. This study shows, patients were found commonly to have habits of alcohol 18 (21%), smoking 11 (13%) and both 22 (26%). Overall, 23 classes of drugs were used in this study. Among these, mostly were antibiotics 12 (52%) then hypoglycemic drugs 5 (21%) and others are analgesics (9%), anti-ulcerant and vitamins. This study shows that the common antibiotics prescribed are metronidazole 39 (24%), cefotaxime 36 (22.7%), ciprofloxacin 25 (15.8%) and piperacillin 21 (13.2%). The common hypoglycemic drug used were of insulin 63 (74%), metformin 43 (77%), glimepiride 12 (14%) and metformin and glimepiride 12 (14%). By using Wagner’s scale, out of 85 patients, most of the ulcer were predominantly between grade IV and V.Conclusions: Targeting range of glycaemic levels and proper antibiotics is the best way of treating DFU. This study has provided the base line data regarding management of DFU which helps to improve therapeutic outcome.
BACKGROUND Gangrene refers to the dead or dying body tissue (s) that occurs because the local blood supply to the tissue is either lost or is inadequate to keep the tissue alive. Foot gangrene is becoming a major concern which changes the quality of life, and also the social and economic point of view. We wanted to study the clinical profile of foot gangrene, determine the most common aetiology, distribution of age and sex, presentation, associated risk factors, commonest organisms involved, ways to find and manage the complications, and study the outcomes of foot gangrene in a rural medical college. METHODS Clinical profiles of all 50 patients with foot gangrene were studied as a prospective observational study in a rural medical college from October 2018 to October 2020. All cases were evaluated by history, clinical examination, investigations, management and follow up. RESULTS Our study involved 50 patients; youngest patient was 33 years and oldest was 70 years. Majority of patients with foot gangrene were in the age group of 41 - 50 years, (22 cases) and highest number were males, (37 cases). Diabetes mellitus is the commonest aetiology accounting for 30 cases and commonest risk factor that confounds the disease process is smoking (17 cases). The commonest presentation was blackish discoloration of toe (s) along with cellulitis and ulceration (30 cases). The commonest organism isolated from culture is methicillin resistant Staphylococcal aureus (MRSA) (13 cases). Majority of the patients underwent Ray’s amputation (16 cases) in our study and majority had no post-operative wound complication (28 cases) within the minimum follow up period of 6 months. CONCLUSIONS We have therefore attempted in our study, to analyse the gangrene of the foot since diabetic cases and trauma cases are more in the rural setup and treatment of these gangrene cases is a challenging task as well. KEY WORDS Foot Gangrene, Amputation, Diabetes Mellitus
Introduction: Subareolar breast abscess has the tendency to recur and result in mammary fistula. The ideal management of subareolar abscess needs a clear understanding of the underlying pathological changes in the ducts and the clinicopathological progress of events that ultimately result in mammary fistula. We present our experience with 35 cases of subareolar abscess with respect to recurrence pattern and management outcomes. Materials and Methods: This is a retrospective descriptive study conducted in Raja Muthiah MedicalCollege, chidambaram during june 2014 to october 2017. All new patients with clinically or radiologically proven subareolar breast abscess were chosen. Those with breast cancer, immunocompromised status, peripheral breast abscess, Tuberculous mastitis were excluded. History, clinical and radiological examination findings, microbiological profile, treatment given and outcomes like number of recurrence, time to recurrence were recorded and analyzed. Results: Out of 35 new cases of subareolar abscess, all were females in age range 18-60 years, only 2 patients gave history of passive smoking. More than 90% of patients had underlying duct ectasia in either one or both breasts. Organisms were isolated in 14 out of 33 patients, mostly Staphylococci. Incision and Drainage with antibiotics was the commonly performed procedure. The average number of recurrence was 1.8 (range 0 to 3) and the average time to recurrence was 3 months (15 days to 18 months). Conclusion: Incision and drainage alone is insufficient for optimal management of subareolar abscess. The underlying duct has to be excised partially or totally to prevent development of mammary fistula and nipple inversion.
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