Clinico-bacteriological study of diabetic foot ulcer and its management based on Wagner’s classification and HbA1c as an indicator for duration of antibiotic therapy in a tertiary hospital in Sullia

Abstract

Background: Diabetic foot ulcer is a serious and common complication of diabetes mellitus. 12%–25% have a risk of developing a foot ulcer during their lifetime. Diabetic neuropathy and micro- or macro-ischemia are the two main risk factors that cause diabetic foot ulcer.Methods: A cross sectional study was conducted in dept of general surgery, KVGMCH between 1st November 2019 and 30th August 2020 among 90 pts with diabetic foot ulcers, selected by systematic random sampling methods. Considering prevalence of DFU, among the diabetic pts as 8.8%, the sample size was estimated to be 90 using the formula 4pq/L2, with absolute error as 6%. Patients will be managed conservatively with antibiotics like aminoglycosides, cephalosporins, penicillin derivatives and dressings and if needed surgical interventions will be performed.Results: Maximum number of pts had HbA1c levels of >8% and they accounted for 35.55%. Almost 98% of the patients had neuropathy, 50% of them had signs of ischemia and 80% had infection. Maximum number of patients (58.88%) presented with diabetic ulcers belonging to Class 2 of Wagners classification. The most commonly isolated P. aeruginosa was sensitive to colistin, imipenem and amikacin. Most diabetics with HbA1C levels >8, had mean antibiotic duration of 19.04±4.65 days.Conclusions: Prevention is the best treatment. Wagner’s classification helps in correlating appropriate treatment to proper grade of lesion with better outcome. Effective glycemic control and education are of key importance for decreasing diabetic foot disease.