New insights in diabetic foot infection

INTRODUCTIONIn India, diabetic foot infection constitutes up to 10 percent of diabetes-related hospital admissions and the prevalence of diabetes is 2.4% in rural and 12-17% in urban.1 Almost 40,000 legs are amputated every year as a result of infected, neuropathic foot in India. 2 The risk of losing a limb is 25 times higher in diabetes mellitus than ABSTRACT Background: Diabetic foot infection constitutes up to 10 percent of diabetes-related hospital admissions and the prevalence of diabetes is 2.4% in rural and 12-17% in urban settings. The quest for better wound healing agents for diabetic ulcers is perhaps one of the oldest challenges for medical practice. One such agent that has been tried in wound healing is phenytoin. A common side effect of phenytoin (diphenylhydantoin) treatment for epilepsy is gingival hyperplasia. This stimulatory effect of phenytoin on connective tissue suggested a possibility for its use in wound healing. Methods: 60 patients with diabetic foot ulcer admitted in General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India were randomly assigned into two groups, the study group consisting of 30 patients who were treated with phenytoin dressing and 30 patients into control group who were treated with conventional saline dressing. Both groups underwent initial debridement and were started on parenteral antibiotics according to wound swab culture and sensitivity. Study group were treated with phenytoin dressing and the wound was assessed based on the rate of ulcer size reduction, the rate of granulation tissue, duration of hospital stays and antibacterial property of phenytoin. Patients were assessed weekly up to 21 days. Results: The rate of granulation tissue in phenytoin group was 90.36% which was statistically significant (p = 0.0011) as compared to control group which was 82.03%. Wound swab cultures repeated on day 21 revealed that there was 50% negative culture in phenytoin group when compared to control group of 24% which also was statistically significant. The mean hospital stay for the patient in phenytoin group was 29.2 days and in control group, it was 26.1 days. It was observed that surface area reduction in phenytoin group was 41.25cm 2 to 18.38cm 2 and in control group was 40.28cm 2 to 20.23cm 2 by the end of 21 days, but this was not statistically significant. Conclusions: Phenytoin dressing is effective in increasing the rate of granulation tissue by virtue of its action on stimulating fibroblast proliferation and decreasing collagenase activity. It not only hastens granulation tissue but also decreases bacterial load as compared to conventional dressing by virtue of its intrinsic antibacterial activity and indirectly through their effects on anti-inflammatory cells and neovascularization. Phenytoin prepares the foot ulcer for early grafting thereby improving the overall outcome.

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“…20 Phenytoin has been widely used in the treatment of epilepsy since 1937. It has been used for the treatment of various diseases.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study

Gunasekaran¹,

Subbaraj²,

Aroul³

2017

Int Surg J

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“…Since these wounds tend to be colonized by a range of microorganisms, definition of infection should be guided by clinical criteria and not by simply demonstrating growth of microorganisms in culture. 4,9,11 A critical value for colonizing bacteria of around 100,000 colonies has been proposed; however, it has also been demonstrated that more virulent pathogens, even when in smaller numbers, have greater potential to damage tissues than less virulent strains, even when colonizing the same tissues. 12,13 The objective is that by taking a sample from the wound, the bacteria that is probably responsible for the infection will be identified, rather than to achieve a simple proof of presence or absence of infection.…”

Section: 10mentioning

confidence: 99%

“…9 Serological markers, such as tests of inflammatory activity and white blood counts, tend to offer low sensitivity and specificity. 4 However, even though clinical features indicating local infection may present in a subtle form, they still remain the best method for diagnosing infection in the diabetic foot and can also be used to quantify the degree of infection, as proposed by the International Working Group on the Diabetic Foot (IWGDF).…”

Section: 8mentioning

confidence: 99%

“…3 Efforts should be concentrated on achieving early diagnosis of infection of diabetic ulcers, because infection is associated with up to 56 times greater risk of hospital admissions and up to 155 times the risk of amputation. 4,5 In addition to the suffering inflicted on patients, hospital treatment of the diabetic foot tends to be of high cost to the healthcare system. Even after hospital discharge, these patients generally require permanent care and, sometimes, repeated admissions to treat the same problem.…”

Section: Introductionmentioning

confidence: 99%

“…6 While there are protocols to guide administration of antimicrobial treatments for the diabetic foot empirically, knowledge of the microbiota in a given region and, better still, a specific hospital, can make a decisive contribution to choosing the most appropriate antimicrobial, which in turn has a direct impact on treatment success. 3,4 In this study we attempted to identify the most prevalent germs and to profile their antimicrobial resistance at a public hospital in the interior of the state of Santa Catarina, Brazil.…”

Section: Introductionmentioning

confidence: 99%

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Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections

Oliveira

Filho²

2014

J. vasc. bras.

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Introduction: Diabetic foot infections are a difficult problem to solve, often requiring hospitalization and exposing patients to the risk of amputations. Identification of the most prevalent pathogens is useful for administration of antibiotic therapy, and can reduce mutilations. Objective: To identify the microbiological profile and resistance to antimicrobial drugs in a series of patients with infected diabetic feet. Material and methods: an epidemiological, retrospective and descriptive study based on analysis of medical records from diabetic patients with plantar lesions who underwent surgical treatment over a 24-month period at a public hospital. Data were collected on age, sex, length of hospital stay, cultures from lesions, antibiotic therapy administered, bacterial resistance and surgeries conducted, with statistical analysis of means and standard deviations. Results: There were 66 admissions of diabetic patients, the majority elderly people (77%). Hospital stays ranged from 2 to 29 days, with a mean of 12.42. There were 91 surgical procedures, resulting in some kind of amputation in 65% of cases. The most common bacterial group was enterobacteria (47%), followed by staphylococci (27%). Three patients (4.5%) had multi-resistant organisms. Resistance to clindamycin was the most common at 39 admissions (59%), followed by resistance to cephalexin, seen in 24 admissions (36%). Conclusions: Diabetic foot infections were most often caused by germs found in the community, in particular the enterococci. Bacterial resistance was very widespread and was most commonly associated with drugs for oral administration, in particular clindamycin and cephalexin.

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Ceftaroline fosamil for treatment of diabetic foot infections: the CAPTURE study experience

Lipsky

Cannon

Ramani

et al. 2015

Diabetes Metabolism Res

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New insights in diabetic foot infection

Cited by 119 publications

References 61 publications

The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study

The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study

Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections

Ceftaroline fosamil for treatment of diabetic foot infections: the CAPTURE study experience

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