Diabetic foot ulcers—where do we stand microbiologically?

Durgad, Shilpa; Koticha, Avani; Nataraj, Gita; Deshpande, Aparna; Mehta, Preeti

doi:10.1007/s13410-013-0180-9

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…The foot ulceration followed by subsequent invasion by the microorganism is one of the most frequent and serious complications of diabetes mellitus, resulting in frequent hospitalization. Also, infective agents retard the healing of ulcers worsening them [3]. While in some cases, if not treated properly would result in leg amputation causing severe economic burden for the patients [4].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of yeast in diabetic foot infections

Sugandhi

Prasanth

2016

Int J Diabetes Dev Ctries

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Diabetic foot infections are a serious threat which cause a long term of hospitalization of diabetes patients and lead to amputations. Hence, prompt diagnosis is an important criterion in the treatment of these infections. This study was carried out to determine the prevalence of yeast in diabetic foot infections. The pus samples were collected from patients presenting with diabetic foot ulcer and processed for microbiological investigation. The patients investigated comprised of 82 males and 78 females. Most of the patients were grade I ulcers followed by grade II ulcers. Out of 160 samples, 138 samples were culture positive, in which yeast isolate Candida glabrata was the predominant isolate followed by Candida albicans, Candida dubliniensis, Candida krusei and Candida tropicalis. C. albicans and C. dubliniensis were differentiated by using tobacco agar due to the presence of hyphal fringes. The methylene blue sabouraud dextrose agar and corn meal agar were also used to differentiate C. albicans from non albicans. The antifungal susceptibility pattern showed 29 % of C. albicans was sensitive to Amphotericin B and Clotrimazole, while 75 % of C. glabrata was sensitive to Amphotericin B, Ketoconazole and Itraconazole. C. dublinensis and C. albicans showed the highest percentage of resistant to Ketoconazole, Fluconazole, Nystatin and Itraconazole. Thus, the results indicating that effective alternate drug of choice are required and the proper selection of antifungal agents will play an important role for the treatment of fungal foot infections. This study will also add substantial knowledge of yeast as one of the pathogenic organisms in diabetic foot infections.

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Section: Introductionmentioning

confidence: 99%

Prevalence of yeast in diabetic foot infections

Sugandhi

Prasanth

2016

Int J Diabetes Dev Ctries

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“…This could be related to a high incidence of self-medication with empirical antibiotics among the general population, laboratory error, or fungal infections. 12 The organisms most commonly causing foot infections are Staphylococcus aureus and Streptococcus pyogenes suggesting that these organisms are probably part of the patient's flora of the skin, while the anaerobes, the enterococci, and the coliforms are probably part of the patient's gut flora. Due to this, the issue of differentiating colonization from infection remains, even when the specimen is properly collected.…”

Section: Resultsmentioning

confidence: 99%

Infective agents in diabetic foot ulcers and their sensitivity patterns

Mehmood¹,

Khan²,

Ahmed

et al. 2021

JRMC

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Background: Diabetic-foot syndrome is a difficult & debilitating complication of inadequately regulated Diabetes Mellitus. Attributed to neural & vascular pathology, the condition is further potentiated by glycemic healing impairment. A wide array of microorganisms have been implicated & sensitivity-guided antibiotics are essential to save both limb as well as to minimize rampant microbial resistance. Present study aims to determine the culture & sensitivity pattern of bacteria in stated cohort of patients at a Surgical Unit. Materials & Methods: This prospective cohort study was conducted over a period of 1 year-duration at a tertiary-care-Hospital. All patients presenting with diabetic-foot who had not been subjected to empiric antibiotic-therapy were enrolled. Demographic & lesion-based variables were studied and the Culture & Sensitivity pattern was evaluated and statistically analyzed. Results:100 patients were included in the study,of which 80 were male (mean-age 60.8±12.7 years) & rest female (mean-age 58.4±11.3-years).35% cultures yielded no growth. Remaining cases showed following pathogens in descending order of incidence. Maximal sensitivity was also reported as mentioned. 1) Staphylococcus-aureus & Klebseilla-Pneumoenae– Piperacillin/Tazobactam,2) Pseudomonas-Aerugionas-Cefotaxime,3)E-coli–Amikacin& Sulbactam,4) Proteus -Gentamicin, 5) Streptococci– Amikacin and 6) Bacteroides – Cefoperazone & Aztreonam. Of 71 cases, 70 had aerobic-organisms isolates & only 1 had anaerobic-isolate. Conclusions: Six pathogens were identified in present study of which Staphylococcus-Aureus was the most prevalent as well as the most resistant. Streptococci & Gram-negative Organisms were observed in remaining cases. While formulation of an adequate antibiotic regime is rendered difficult by resistance & mixed infections, targeted antibiotic administration is decisively crucial to achieve optimal & timely outcome in diabetic foot.

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“…The study of Durgad et al [4] emphasizes the microbial etiology of diabetic foot ulcers and their susceptibility patterns. They studied 70 diabetics and isolated 147 organisms from wound swabs and pus aspirates.…”

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confidence: 99%

“…Additional therapies include the use of antibiotic impregnated beads, application of negative pressure wound therapy and hyperbaric oxygen treatment [8][9][10]. In the study of Durgad et al [4], the empiric antibiotic therapy administered to the patients failed to act against MDROs and lead to progressive infection of the lesions which was evidenced by grade 3-5 lesions. Delayed or improper treatment of these infections leads to gangrene and amputation.…”

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confidence: 99%

“…Most of the amputations can be prevented and limbs rescued through an aggressive and multipronged treatment of antibiotics, debridement, revascularization, and staged wound closure. As mentioned by Durgad et al [4], timely evaluation of patients with diabetic foot ulcers will help to determine the prevalent flora, their susceptibility profile and also, help to formulate the empiric antimicrobial therapy. Therefore, there is an urgent need to prevent diabetic foot infection and amputation by ensuring good glycemic control, preventive foot care and prompt treatment of trivial foot lesions in people with diabetes.…”

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confidence: 99%

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An aggressive and multi-pronged approach to prevent amputations in India

Viswanathan

2014

Int J Diabetes Dev Ctries

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Foot complications are a major cause of hospitalization in diabetes. Diabetic foot ulceration results from decreased blood supply, poor weight-bearing, loss of sensation and poor foot care. Foot complications both increase the health care costs and pose a heavy socioeconomic burden.A study from India reported that the cost of diabetes care for a patient with foot ulcers was more than 4 times higher (INR 19 020; US$409) than that for a patient without foot ulcers (INR 4493; US$97) [1]. In India, most of the patients undergo major or minor amputations due to the failure of antimicrobial therapy against infections. The causes of amputations may vary based on geographical variations. An earlier hospitalbased multi-centric study to determine the prevalence of diabetic foot in India reported that the prevalence of foot infection among diabetic patients was 6-11 % and that of amputation was 3 % [2]. Another multicentric study involving 31 study sites across India reported that major amputations comprised about 29.1 % and minor amputations 70.9 % among diabetic patients with foot infection, and 82 % of them had neuropathy and 35 % had peripheral vascular disease. This study also observed that infection was a significant cause of amputation in approximately 90 % of the study population [3].The study of Durgad et al.[4] emphasizes the microbial etiology of diabetic foot ulcers and their susceptibility patterns. They studied 70 diabetics and isolated 147 organisms from wound swabs and pus aspirates.About 42 % of the diabetic patients were in poor glycemic control and more than 50 % of patients studied had more serious form of infection as indicated by Wagner's grade 3-5 lesions. Out of 70 diabetics, 73 % of patients were infected by the polymicrobial infection and the microbiological analysis revealed the high proportion of gram negative bacilli (57 %) compared to gram positive cocci (27 %). Among gram positive cocci, 23 % of Staphylococcus aureus isolates and 17 % of coagulase negative Staphylococcal isolates were found to be methicillin resistant. As to gram negative bacilli, 23 % of isolate belonged to the Enterobacteriaceae family and were extended spectrum beta lactamase producers. The high prevalence of multidrug-resistant organisms (MDROs) in the clinical settings, increase the extent of hospitalization and cost of management. These data report the prevailing existence of MDROs in the tertiary clinical settings and the diabetic patient's vulnerability to infections. Vulnerability to infection is due to defective inflammatory response against pathogens. Apart from susceptibility, the diabetic patients have defective wound healing due to defective phagocytic clearance, increased oxidative stress which causes prolonged inflammatory state and down regulation of different growth factors, resulting defective angiogenesis [5]. Bagdade et al. [6] observed reduced leukocyte phagocytosis in poorly controlled diabetes patients, and the improvement of microbicidal rates was directly correlated with correction of hyperglycemia....

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Diabetic foot ulcers—where do we stand microbiologically?

Cited by 6 publications

References 13 publications

Prevalence of yeast in diabetic foot infections

Prevalence of yeast in diabetic foot infections

Infective agents in diabetic foot ulcers and their sensitivity patterns

An aggressive and multi-pronged approach to prevent amputations in India

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