DOI: http://dx.doi.org/10.18203/2349-3933.ijam20212345

Clinical and microbiological profile of diabetic foot ulcers in a tertiary care setup: a cross sectional analysis

Siddharth Rai, Harleen Uppal, Arvind Kumar Sharma, Anil Kumar Gupta

Abstract


Background: Diabetes associated neuropathy and vasculopathy leads to development of diabetic foot ulcers (DFU). They are responsible for considerable morbidity and a significant cost of health‐care worldwide. The magnitude of the problem becomes worse in regions where foot care is inadequate like in our country. The aim of the study to determine the microbiological profile and antimicrobial susceptibility pattern of organisms isolated from patients with diabetic foot ulcers.  

Methods: The study was a cross sectional study done at King George’s Medical College, Lucknow from 2012-2014 in Lucknow, Uttar Pradesh. Based on the inclusion criteria sample were collected from 112 patients. The standard protocol for the identification of microorganisms was followed.  A descriptive analysis of the data was done.

Results: Out of the 112 ulcers total 180 isolates were found. Of the 112 cases, 78 were monomicrobial, 32 were polymicrobial, and 2 cases were sterile on culture. The most common bacteria found was Staphylococcus aureus. Most of the staphylococcus isolated were sensitive to vancomycin, teicoplanin, cephalosporins, linezolid levofloxacin and pipercillin-tazobactum. Nearly 65% of S. aureus were methicillin‐resistant S. aureus.

Conclusions: This study compiled clinical and microbiological profile of diabetic foot ulcers along with their antibiotic susceptibility patterns. Our study illuminates light on a high figure of neglected and poorly treated NHUs which could have been managed well and early treatment will prevent devastating consequences such as sepsis and amputation.  


Keywords


Diabetic foot ulcer, Diabetes mellitus, Non-healing ulcer, Diabetic foot

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References


Pandey SK, Sharma V. World diabetes day 2018: Battling the Emerging Epidemic of Diabetic Retinopathy. Indian J Ophthalmol. 2018;66(11): 1652-3.

Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;3(1):4.

Rubinstein A, Pierce CE, Bloomgarden Z. Rapid healing of diabetic foot ulcers with continuous subcutaneous insulin infusion. Am J Med. 1983;75:161‐5.

Siddiqui AR, Bernstein JM. Chronic wound infection: Facts and controversies. Clin Dermatol. 2010;28:519‐26.

Michael B, Pfeifer J. Lavin ME and O’Neal LW. The diabetic foot. 7th ed. St. Louis: CW Mosby; 1988: 203-205.

Viswanathan V. Epidemiology of diabetic foot and management of foot problems in India. Int J Low Extrem Wounds. 2010;9(3):122-6.

Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2(2):64-122.

Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med. 1998;158:289-92.

Hsu JD, Michael J, Fisk J. AAOS Atlas of Orthoses and Assistive Devices. 4th ed. Philadelphia: Mosby Elsevier Health; 2008.

Puri V, Venkateshwaran N, Khare N. Trophic ulcers-Practical management guidelines. Indian J Plast Surg. 2012;45(2):340-51.

Baal JG. Surgical treatment of the infected diabetic foot. Clin Infect Dis. 2004;39(2):123-8.

Hafner A, Sprecher E. Ulcers. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia: Elseiver; 2012: 1729‐1739.

Antony B, Justin S, Raveendran R, Shetty AK, Kuruvilla TS, Boloor R. Spectrum of anaerobes encountered in surgical infections in a tertiary care hospital in Mangalore, coastal Karnataka: A prospective study. Muller J Med Sci Res. 2016;7:40‐3.

Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care. 2006;29(8):1727-32.

Gopi A, Samreen F, Jain S. Diabetic foot ulcers at a tertiary care hospital: A clinic-microbiological profile. Indian J Microbiol Res. 2017;4(4):403-7.

Panda P, Tripathy S. Prevalence of microbial agents associated with chronic nonhealing ulcers: A cross-sectional study. Med J DY Patil Vidyapeeth. 2020;13:447-53.

Amit K, Bhatt MP, Kumar S, Punita K. Chronic Nonhealing Ulcers‒ Garhwal Region (Etiopathology, Microbiology with Susceptibility, Managements & Outcomes). Int J Tropical Disease Health. 2020;41(5):53-64.

Otta S, Debata NK, Swain B. Bacteriological profile of diabetic foot ulcers. Chrismed J Health Res. 2019;6:7-11.

Tiwari S, Pratyush DD, Dwivedi A, Gupta SK, Rai M, Singh SK. Microbiological and clinical characteristics of diabetic foot infections in northern India. J Infect Dev Ctries. 2012;6(4):329-32.

Criado E, Stefano AA, Keagy BA, Upchurch GR, Johnson G. The course of severe foot infection in patients with diabetes. Surg Gynecol Obstet. 1992;175(2):135-40.

Zubair M, Malik A, Ahmad J. Clinico‐bacteriology and risk factors for the diabetic foot infection with multidrug resistant microorganisms in North India. Biol Med. 2010;2:22-34.

Raja NS. Microbiology of diabetic foot infections in a teaching hospital in Malaysia: A retrospective study of 194 cases. J Microbiol Immunol Infect. 2007;40:39‐44.

Bernard L. For the Societe de Pathologie Infectieuse de Langue Francaise. Management of diabetic foot infections. Méd Mal Infect. 2007;37:14-25.

Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, et al. Bacteriology of diabetic foot lesions. Indian J Med Microbiol. 2004;22:175‐8.

Bessa LJ, Fazii P, Giulio M, Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: Some remarks about wound infection. Int Wound J. 2015;12:47‐52.

Chincholikar DA, Pal RB. Study of fungal and bacterial infections of the diabetic foot. Indian J Pathol Microbiol. 2002;45(1):15-22.

Pathare NA, Bal A, Talvalkar GV, Antani DU. Diabetic foot infections: A study of microorganisms associated with the different Wagner grades. Indian J Pathol Microbiol. 1998;41:437‐41.

Rahim K, Saleha S, Zhu X, Huo L, Basit A, Franco OL. Bacterial contribution in chronicity of wounds. Microb Ecol. 2017;73:710‐21.

Bowler PG, Davies BJ. The microbiology of infected and noninfected leg ulcers. Int J Dermatol 1999;38:573‐8.

Johnson S, Lebahn F, Peterson LR, Gerding DN. Use of an anaerobic collection and transport swab device to recover anaerobic bacteria from infected foot ulcers in diabetics. Clin Infect Dis. 1995;20(2):289‐90.

Sapico FL, Witte JL, Canawati HN, Montgomerie JZ, Bessman AN. The infected foot of the diabetic patient: Quantitative microbiology and analysis of clinical features. Rev Infect Dis. 1984;6(1):171‐6.

Telles F, Esterre P, Perez BM, Vitale RG, Salgado CG, Bonifaz A. Chromoblastomycosis: An overview of clinical manifestations, diagnosis and treatment. Med Mycol. 2009;47(1):3‐15.

Veraldi S, Tortorano AM, Lunardon L, Chiara Persico M, Francia C. Mycologic evaluations in chronic leg ulcers. Wounds. 2008;20(9):250-3.

Chellan G, Shivaprakash S, Karimassery RS, Varma AK, Varma N, Thekkeparambil SM, et al. Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes. J Clin Microbiol. 2010;48(6):2097-102.

Lema T, Woldeamanuel Y, Asrat D, Hunegnaw M, Baraki A, Kebede Y, et al. The pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy in ALERT, Kuyera and Gambo hospitals, Ethiopia. Lepr Rev. 2012;83(1):40-51.

Ramos JM, Perez TR, Garcia GC, Prieto PL, Bellon MC, Mateos F, Tisisano G, et al. Leprosy ulcers in a rural hospital of Ethiopia: pattern of aerobic bacterial isolates and drug sensitivities. Ann Clin Microbiol Antimicrob. 2014;13:47.