Evaluation of antimicrobial therapy and patient adherence in diabetic foot infections

Abstract

Background/objectives: Diabetic foot infections (DFI) are common complications among diabetics. These wounds can cause discomfort and often become infected. In India, currently there is a paucity of data on patient adherence towards antibiotic use in DFIs. Therefore, this study was aimed to evaluate antimicrobial susceptibility pattern, antimicrobial therapy and its adherence in DFI patients. Method: A prospective observation study (N = 150, newly diagnosed DFI patients) was conducted in Kasturba hospital, Manipal over a period of 6 months. Culture and Sensitivity pattern of the microbes of the patients were obtained from hospital data management system to develop cumulative antimicrobial susceptibility pattern. Medication adherence was measured by using Culig adherence scale at the first follow-up visit. Results: The most common microbes were Methicillin-sensitive Staphylococcus aureus (23.9%), Klebsiella pneumonia (13.3%) and Escherichia coli (13.3%). Inj. Amoxicillin-Clavulanic acid 1.2 gm (28.6%) was highest prescribed empirical therapy in DFI's followed by Inj. Cefuroxime-Sulbactam 2.25 gm (14.6%), Ceftriaxone (0.7%) and Trimethoprim-Sulfamethoxazole (2%) was the most sensitive antibiotic. Cumulative antimicrobial susceptibility pattern shows Chloramphenicol, Colistin, Levofloxacin, Rifampicin has developed resistance towards most of the common organisms in DFI. Statistically significant association was observed between empirical therapy with T.Cefuroxime 625 mg and improved clinical outcomes (p < 0.001). Adherence shows that only 14% of patients have high adherence rates during first follow-up visit. Conclusion: Ceftriaxone and Trimethoprim-Sulfamethoxazole are most sensitive antibiotics towards most common organisms in DFIs. T. cefuroxime 625 mg showed statistically significant improvement in clinical outcomes while adherence is very low in most of the DFI patients.

“When nothing happens, nobody is afraid!” beliefs and perceptions around self‐care and health‐seeking behaviours: Voices of patients living with diabetic lower extremity amputation in primary care

“…The analysis was conducted independently by all team members (ZX, ML, ECAL, GLJ, DL, and BB) following the guidelines set out by Smith, Flowers, and Larkin. 19 Upon the initial reading of the first three transcripts, there was an annotating phase of analysis. Descriptive, linguistic, and conceptual comments were noted, followed by identifying emergent themes within the text.…”

“…[13][14][15] However, despite provision of appropriate information and guidance, patients' self-care is often suboptimal, and adherence to foot self-care recommendations and compliance to medication remains low. [16][17][18][19] In addition, although early detection and referral of patients is crucial, [20][21][22] there are still a number of patients who delay reporting foot symptoms to health professionals, and up to 40% to 60% of amputations are related to patient delay. 23 Singapore has the highest rate of DLEA in the world, 24 and the trend is increasing.…”

Diabetic Foot Ulcer in India: Aetiological Trends and Bacterial Diversity

“…[ 30 , 31 , 68 , 69 ] The possible occurrence of low DFU patients could be due to under-reporting, the lack of awareness, younger age or as shorter duration of diabetes. [ 58 , 70 ] Microbiological studies of DFU were reported from urban cities, irrespective of the prevalence of individuals with diabetes patients in those regions. [ 1 ] In India, diabetes is more prevalent in urban areas of the states of Tripura, Chandigarh, Tamil Nadu, Jharkhand and Andhra Pradesh.…”

“…Overall, male patients were predominantly reported with a bacterial infection in DFU (71.59% males and 28.39% females; SE = 1.41; n = 43). The highest proportion of male patients was reported to be 92.6%,[ 58 ] and the lowest proportion of male patients was reported at 54%. [ 59 ] The average age of the patients with DFU in India is 56.39 ( n = 23 studies).…”

The antimicrobial susceptibility patterns of diabetic foot ulcers in the South African public healthcare sector

“…A study undertaken in India found that the prescribing patterns of empirical antibiotic regimens did not comply with the antibiotic policy of the study hospital. [57] In contrast, an Australian study determined that 83% of patients received empirical antibiotic treatment that complied with national guidelines. [58] A study carried out in Poland yielding outcomes similar to our findings found that although there was good adherence to local prescribing guidelines, the guidelines themselves did not cover the most common pathogens responsible for DFU infection.…”