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

Abstract

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.

Clinicomicrobiological Profile and Antibiotic Resistance Analysis of Diabetic Foot Ulcer From a Tertiary Care Hospital

“…All of them were males between 34 to 74 years with the mean age of 56.32 years. Our findings were in concordance with studies carried out by Patil SV et al, [19] Ramani et al [20] and Viswanathan et al [21] who also reported that DFU was most common among males and late 50's age group. Male predominance may be due to the factors that males spend more time in outdoor works and exposure to traumas may be higher in these groups.…”

“…Our study findings were similar to the findings of Viswanathan et al [21] and Patil SV et al [19] who also reported that mean diabetic duration was 9 years. Our study results depict that occurrence of DFU starts even with diabetic duration of 1 year.…”

“…Most common predisposing factor for DFU was neuropathy (48%) followed by trauma (30%), which was similar to the results of Ramani et al [20] and EM Shankar et al, [22] but discordant with the findings of Reiber et al [23] and Patil SV et al [19] who reported that history of trauma was the main predisposing factor. Discordance may be due to the fact that our patients not able to recollect the trauma history and neuropathy in diabetes also showing raising trend.…”

Bacteriological Spectrum and their Anti-Microbial Susceptibility Pattern in Diabetic Ulcer Patients Attending the Tertiary Care Hospital to Facilitate the Reduction in Morbidity and Amputation

“…In this study it showed a great sensitivity to Piperacillin-tazobactam and Imipenem similar to other studies (38,39,40 showed Proteus spp were most sensitive to Cefotaxime followed by Ceftriaxone (35,43,44). The present study showed that 100% isolates of Proteus species were sensitive to beta lactum -lactamase inhibitor combinations such as both cefoperazone-sulbactam.…”

Antibiotic Susceptibility Profiles of Bacteria from Diabetic Foot Infections in Selected Teaching Hospitals in Southwestern Nigeria

“…The understanding of bacteria associated with diabetic foot infections (DFI) and their antibiotic susceptibility profiles is essential for appropriate treatment and infection eradication. The empirical initiation of antibiotic therapy in patients with serious infections is necessary to prevent systemic invasion by infecting bacteria while awaiting microbiology laboratory results [31]. Clinicians should consider the results of bacterial culture and susceptibility testing in the light of the clinical outcome of the infection for the empirical therapy regimen.…”