Microbiological Study of Diabetic Foot Ulcer

Abstract

Background: Diabetic foot is one of the most feared complications of diabetes and is the leading cause of hospitalization in diabetic patients. Limb-threatening infection in diabetic patients are usually polymicrobial involving both multiple aerobic and anaerobic organisms.Methods: The present study was a cross sectional study, conducted in the Department of Surgery and Microbiology at BIRDEM General Hospital, Dhaka, over a period of 9 months during January 2017- September’ 2017. The study included a total of 77 adult patients of clinically diagnosed diabetic foot patients presenting to outpatient department and emergency ward. The standard case definition of diabetic foot is ‘any pathology occurring in the foot of a patient suffering from diabetes mellitus or as a result of long term complication of diabetes mellitus’.Results: 17(22.1%) patients had Klebsiella pneumonia, 14(18.2%) had Pseudomonas aeruginosa, 11(14.3%) had Staphylococcus aureus, 10(13.0%) had Escherichia coli, 6(7.8%) had Coagulase-negative staphylococci and 8(10.4%) had Providencia spp. In Escherichia coli 100% sensitivity to imipenem, 70% to amoxicillinclavulanic acid, amikacin, piperacillin-tazobactam. In Coagulase-negative Staphylococci 83.3% sensitivity to tetracycline, 66.7% to ceftriaxone. In Proteus mirabilis 100% sensitivity to tetracycline, amikacin, ceftriaxone, imipenem, piperacillin-tazobactam. In Enterococcus spp.75.0% sensitivity to tetracycline. In Citrobacter spp. 100% sensitivity to imipenem.Conclusion: Common organism found in diabetic foot ulcer patients were Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Coagulase-negative staphylococci and Providencia spp. In tetracycline, amikacin, ceftriaxone, imipenem, piperacillin-tazobactam was 100% sensitive in Proteus mirabilis and only imipenem found in Citrobacter spp.Birdem Med J 2018; 8(3): 251-256

Bacterial Diversity with Emerging Antimicrobial Resistance of Diabetic Foot Ulceration and Current Detection Techniques: A Review

“…In a study by Birdem General Hospital, Bangladesh, they used fermentation, indole, nitrate disk reduction, specialpotency disk test, catalase andurease test, sodium polyanethol sulphonate disk test, bile esculin hydrolysis test, lipase and lecithinase test, colony observation of fluorescence study and pigment production test [35]. However, anerobic bacteria is very difficult to detect.…”

“…However, anerobic bacteria is very difficult to detect. To detect anaerobes a specialized detection test called the simple two step combustion technique in candle jar was used [35]. The same techniques were used by a study in India as well [32].…”

“…The same techniques were used by a study in India as well [32]. This modified candle jar technique was cheaper and simpler option than the traditional gas pak system which is used to detect anaerobes [26,35]. PCR, DGGE, 16S rRNA gene sequencing analysis, metagenomics and metatranscriptomics have emerged as an option for researchers and scientists to get a deep understanding of the bacterial population [36].…”