Amputation in Diabetic Patients

Singh, Gurjit; Chawla, Sumit

doi:10.1016/s0377-1237(06)80151-6

Cited by 23 publications

(21 citation statements)

References 14 publications

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“…In our study, the most common organism isolated was Staphylococcus aureus . This correlates with other local (14, 18) and international studies (16, 19). …”

Section: Discussionsupporting

confidence: 91%

A developing world experience with distal foot amputations for diabetic limb salvage

Salahuddin

Azhar²,

Imtiaz³

et al. 2013

Diabetic Foot & Ankle

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ObjectivesTo evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients.Materials and methodsThis prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and wounds were managed with daily dressings, nursing care and debridement of necrotic tissue with adequate antibiotic coverage.ResultsIn total, 149 patients (mean age: 56±7.52 years) with 171 amputations were included in the study. The mean duration of diabetes mellitus (DM) was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM. Wound debridement was performed under general anesthesia in 48 (33.2%) patients, whereas local anesthesia was used for the rest of the patients after having good glycemic control and improvement in general health. The most common pathogen isolated from the infected wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of amputation, partial toe amputation was performed in 21 (12.2%) cases, second-toe amputation in 60 (35%) cases, hallux amputation in 41 (24%) cases, multiple toe amputations in 29 (17%) cases, bilateral feet involvement was observed in 16 (9.3%) cases, and transmetatarsal amputation was performed in 4 (2.3%) cases. The wounds healed well except in 19 cases where amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of wound-related complications and 36 died of systemic complications.ConclusionWith the ever-increasing epidemic of DM, the number of patients with diabetic foot ulcers has also significantly risen. Early surgical management with good glycemic control and foot care with close monitoring can decrease amputations and thus foot salvage can be successfully achieved.

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“…In our study, the most common organism isolated was Staphylococcus aureus . This correlates with other local (14, 18) and international studies (16, 19). …”

Section: Discussionsupporting

confidence: 91%

A developing world experience with distal foot amputations for diabetic limb salvage

Salahuddin

Azhar²,

Imtiaz³

et al. 2013

Diabetic Foot & Ankle

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“…[8][9][10] The foot problems are observed in 25 cases (40.66 %) having DM for the duration of 5-10 years which in accordance with findings reported by Singh and Chawla. [10,11] The 90% (54 out 60 ) of cases of type II diabetes had developed foot infections which is comparable with finding which is comparable with the reviewed literature. The present study revealed 43.33 % infections are caused by gram positive organisms, Staphylococcus aureus and Streptococcus whereas Aamir et al from Pakistan reported 46 % of DFI caused by staphylococcus aureus.…”

Section: Discussionsupporting

confidence: 83%

“…[4][5][6][7] The main aim was to study the DFI which is responsible for increased morbidity, amputations and even mortality in diabetic patients. [8][9][10] Diabetic foot infections were more common (33.33%) in age group of 45-54 years whereas P.C Leung reported 75% infections occurred above the age of 50 years. The male patients showed 66.67% of foot infections which is double than female population this is self-explanatory as out of 60 subjects males were 40 in number.…”

Section: Discussionmentioning

confidence: 99%

Diabetic foot infections and management: A Rural Indian Perspective

Mote¹,

Mote²

2015

Int Jour of Biomed Res

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Aim and objective: This study was carried out to study demographic features of patients suffering from diabetic foot infections and also to know microorganism causing infections and its management. Study design: It is a hospital based cohort study. Place and duration of study: Department of General Surgery, K.I.M.S, Andhra Pradesh, from Jan 2007 to December 2009. Material and methods: The study was conducted at tertiary care teaching hospital in Andhra Pradesh from 2007 to 2009. The patients of both gender and all age groups who presented with diabetic foot infections comprised the study. The history of diabetic foot was obtained and thorough clinical examination was carried out after written informed consent from patient. The Subject underwent routine and specialized investigations like swab for culture and sensitivity, radiographs of foot. The patients were managed with insulin or oral anti diabetic agents, debridement, drainage, skin grafting. The severe infection cases required amputations to save life of patients. All patients followed until discharge or death. Results: Out of 60 cases 40 were male and 20 female patients. Diabetic foot ulcers were more common in age group of 45-54 (33.33%).Diabetic foot infections were observed more in patients having diabetes for duration of more than years (75.00%). More than 60 % of cases were in Wagner's grade III to V. Most common organisms responsible for diabetic foot infection were gram positive organisms, 43.33% of cases whereas 16.67% had poly microbial infection.The present study revealed that ceftriaxone was found to be effective in 33.33% of cases of infections followed by amikacin in 25% of cases . Amputations were done in 43.33% cases due to severe life threating spreading, uncontrolled infections. Conclusion: As the diabetic mellitus cases are increasing globally, it is becoming the public health problem. There is huge burden on economy, health system and on society. It is affecting the quality of life of citizens which requires orchestrated efforts from all stake holders to prevent and minimise the foot infections and reduce the number of amputations.

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“…20 Increased incidence of diabetic foot lesions with increasing duration of diabetes was also noted by previous studies. 21,22 The present study found predisposing factors like history of trauma in 78 patients, neuropathy in 63 and vasculopathy in 13 and smoking was concomitantly present in 53 patients. This was comparable to Reiber et al series in which 77% of patients had a history of trauma.…”

Section: Discussionsupporting

confidence: 55%

Bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques

Patil

Mane

2017

Int J Res Med Sci

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INTRODUCTIONDiabetes mellitus (DM) is one of the major public health problems whose prevalence is rapidly rising all over the globe at an alarming rate. Nowhere is the diabetic epidemic more pronounced than in India, as the WHO reports show that 69.2 million people had diabetes in the year 2015.1 Patients with DM are prone to multifarious complications such as diabetic foot ulcer (DFU). DFU is a common complication of DM that has shown an growing trend over previous periods. [2][3][4] At some time in their life, 15% of people with diabetes mellitus develop foot ulcers that are highly susceptible to infection.5 On estimation, the prevalence of this complication ranges ABSTRACT Background: Diabetic foot ulcers (DFU) are the complications of diabetes mellitus. The diabetic foot ulcer infections are polymicrobial in nature. If they are not recognized and controlled it leads to many devastating consequences like limb amputation, sepsis, and even mortality. Hence, the present study was undertaken to determine the bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques and the antimicrobial sensitivity pattern of the isolates. Methods: A total number of 103 patients with a foot ulcer of Wagner's grade II or more and evidence of purulent exudates or edema were included in the study. Swab samples were obtained from the base of ulcers and were sent for bacteriological study. The specimen was processed in the microbiology laboratory for Gram stain, aerobic culture, and anaerobic culture. The organisms isolated were identified by standard procedures and antimicrobial susceptibility was done by Kirby-Bauer disc diffusion method. Results: A total no of 253 organisms were isolated from 103 patients. Out of these, 217 aerobes were isolated, and the most common organism isolated from gram positive bacteria was Staphylococcus aureus, 53 (24.42 %). Pseudomonas aeruginosa, 42 (19.35 %) was the predominant organism isolated from gram negative bacteria. Among the total 36 anaerobes, Bacteroides fragilis group, 17 (47.22 %) was the most common organism isolated. All the gram positive aerobic organisms were found to be sensitive for vancomycin. Among the gram negative organisms, E. coli, Proteus mirabilis, Proteus vulgaris, showed more sensitivity to cefotaxime (90.62%, 91.66%, 75%) respectively. Metronidazole was the drug of choice in case of anaerobes followed by imipenem. Conclusions: It is necessary to identify the etiological factors and susceptible microorganisms responsible for causation of DFU. So that prompt management of diabetic foot ulcers is possible for successful outcome. Appreciation of the causative organisms in diabetic foot and their antibiotic sensitivity is essential for institution of appropriate antibiotic therapy.

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Amputation in Diabetic Patients

Cited by 23 publications

References 14 publications

A developing world experience with distal foot amputations for diabetic limb salvage

A developing world experience with distal foot amputations for diabetic limb salvage

Diabetic foot infections and management: A Rural Indian Perspective

Bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques

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