Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

Abstract

Background: Diabetes is considered as one of the most important and rapidly evolving non-communicable disease which requires top priority around the world. 10-25% of diabetics develop foot infections [DFI’s] during the course of their disease period ranging from simple calluses to major Osteomyelitis. 3 Microbial infections of the diabetic foot ulcers are difficult to manage because of multiple factors associated in response including overall glycaemic control, associated complications like vascular disease and neuropathy. The present study was done to assess the microbial flora according to Wagner’s classification for diabetic foot disease. To isolate, identify the aerobic bacterial pathogens and their drug sensitivity pattern with reference to ESBL productionMethods: A prospective study was conducted at a tertiary care hospital by department of general surgery among Diabetics presenting with diabetic foot infections. All the enrolled cases were classified based on Wagner’s classification and socio demographic data was noted. Specimens from the ulcer were collected and processed for isolation, identification of pathogens based on standard CLSI guidelines. The antibiotic sensitivity of the isolates was done and ESBL production was demonstrated by standard guidelines.Results: 346 cases were enrolled in study and grade-3 Wagner’s ulcers were predominant. Males were predominant, 46-55 years age group was common with mean age of 55.3±1.4 years. Peripheral arterial disease was more common than peripheral neuropathy and both were found significantly associated with development of ulcers. Methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa were most common isolates. MRSA exhibited maximum sensitivity to vancomycin, clindamycin and linezolid. Gram negative isolates exhibited maximum sensitivity to meropenems, piperacillin-tazobactam. The prevalence of ESBL producers in the study was 16.24%.Conclusions: DFI are a serious concern in uncontrolled diabetics and require proper management. Outcome of the infection depends upon the grading of the ulcer as per Wagner’s classification and also the nature of the infection either polymicrobial or with a single organism. Our study highlights and suggests that prospective multicentre studies are required to assess the appropriate antibiotic regimen in diabetic foot ulcers and proper management of antibiotics must be implemented to decrease the incidence and development of multi drug resistant organisms.

Assessment role of phagocytic neutrophil cells among different Wagner’s grades of diabetic foot ulcers infections

“…coli 17.9% isolated from DFU [36]. Also, C. freundii and Serratia species isolates accounted 4.8% in this study, and is comparable with other results 5% [22], 3.85% [5], 4.3% [43] for C. freundii and 2.3% for Serratia species [44]. Different geographical area could have contributed to different types of bacterial isolated [35].…”

“…This similar to other studies 90.1% [55], 95% [36], 98.2% [24], while other study showed low sensitivity of vancomycin 44.5% [44]. However, other studies showed 100% of Gram positive bacteria susceptible to vancomycin [5,27,32,35,50,58].…”

“…In this study, Gram positive bacteria showed an increased prevalence 57.1% in diabetic ulcers with similar results of different studies 77% [21], 35% [22] and 51.1% [5]. invasive form, sometimes in diabetics which fails to respond to topical antibiotic therapy [40].…”

“…The distribution of different bacterial species isolated from DFU cases according to Wagner's grades classification given in figure (1). Antibiotics resistance patterns associated with Wagner's ulcers grades The mean of phagocytosis was completely different between the three groups studied (control, DM and DFU patients) using LSD with high significant difference statistics as shown in table (5). In this study we correlated the degree of wounds with phagocytic efficiency to understand the development of the ulcer grade and role of neutrophil phagocytic cells.…”

“…Foot ulcers remain one of the most distressing complications of a diabetic patient and it's one of the most significant and devastating complications of diabetes [4]. Wagner's ulcer grades classification is one of the most widely used and universally accepted grading systems for diabetic foot ulcers (DFU), consisting of six simplistic wound grades used to assess ulcer depth as following: grade-0; high risk foot and no ulceration, grade-1; superficial ulceration, grade-2; deep ulcer -cellulitis, grade-3; osteomyelitis with ulceration or abscess, grade-4; gangrenous patches and grade-5; gangrene of entire foot [5].…”