Title: Microbiological Pattern and Antibiotic Sensitivity in Diabetic Foot Ulcer in a Tertiary Care Center- A Cross Sectional Study
Authors: Dr Sreenivasan M, Dr Vinu C.V, Dr Suresh Kumar V
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.13
Abstract
The problem of Diabetes is rapidly growing worldwide, making it the most challenging health problem of present century. The burden is supposed to rise from 382 million adults in 2013 to 592 million adults by 2035.The organism associated with diabetic foot ulcer varies in different geographical location. The aim of the present study is to describe the pattern of microbiological spectrum in the diabetic foot ulcers. In addition, we aimed to compare the difference in various variables between the mono microbial and microbial infections in the diabetic foot ulcers and associate these with different grades of the SINBAD grading.
After a priori sample size calculation was done, 100 consecutive patients were recruited for the study. All diabetic foot ulcer patients aged more than 30 years were included in the study. Data analysis was done using R statistical software. Continuous data was summarized with mean (±) and standard deviation or median and interquartile range. Categorical data were summarized with proportion and %cent ages. Difference in the mean (±) s were analyzed with t test and Mann Whitney test. Chi square test was used to test categorical variables.
Using a pretested well-structured data collection form, patient’s data were taken. All variables needed for the SINBAD grading were recorded. Sixty four percent of the study population were males. The average age of the patients was 58.1 years (SD=9.59). The median duration of diabetes was 10 years (IQR 5.75-15). The most common site affected was mid foot/hind foot. Most of the lesions (48%) occurred spontaneously, followed by trauma in 44% of the patient (Table1.) In addition, there were statistically significant difference in ulcer area when ulcer characteristics are compared across the type of microbial organisms obtained as per culture and sensitivity
In the 91 patients with infection, gram positive organism was present in 35(38.5%) of the patients, mixed organisms in 32(35.2%) and gram negative in 24(26,4%) of the patients. Proteus, citrobacter and klebsiella were the most common organisms in the mixed category. Ploy microbial organism constituted 39 % of the patients and 61 % mono microbial.
Most sensitive antibiotic in our study is Gentamycin (24%) followed by Cloxacillin(17%) and Amikacin (16%). Moreover, mono microbial group was sensitive to these antibiotics. Our analysis shows that an FBS > 200 mg/dl is an important factor for development of foot ulcer.Males are more affected than females. Both aerobic & anaerobic pathogens are involved in diabetic wound Infection, but among them staph aureus is more common. Common site of ulcer in foot was mid/hind foot, developing spontaneously in a background of neuropathy & vasculopathy.
The first requirement in the management of DFU is strict control of diabetes, & early detection and treatment of lesions; after identifying the organism & its antibiotic sensitivity. Regular foot care is also important. The importance of grading ulcer& treating with appropriate antibiotic according to culture & sensitivity is essential for controlling infection and progression of ulcer and thereby preventing limb amputation.
References
- Federation ID. IDF diabetes atlas. Brussels: International Diabetes Federation 2013.
- Intemational Working Group on the Diabetic Foot. International consensus on the diabetic foot and practical guidelines on the management and the prevention of the diabetic foot Amsterdam Intematlonal Working Group on the Diabetic Foot DVD 2011.
- Acker K, Leger P, Haltemann A, Chawla A. Van Burden of diabetic foot disorders, guidelines for management, and disparities in implementation in Europe: a systematic literature review. Diabetes Metab Res Rev Jan 27 doi 101002dm1T2523 Epub ahead of print 2014.
- Prompers L, Schaper N, Apelqvist J, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 2008; 51(5): 747-55.
- Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes care 1999; 22(7): 1036-42.
- Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes care 1999; 22(1): 157-62.
- Annstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system: contribution of depth, infection, and vascular disease to the risk of amputation. Diabetes Care 855 859 1998; 21 SRC - GoogleScholar.
- 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(1): 39-44.
- 19th European Congress of Clinical Microbiology and Infectious Diseases.
- Louie TJ, Bartlett JG, Tally FP, Gorbach SL. Aerobic and anaerobic bacteria in diabetic foot ulcers. Annals of internal medicine 1976; 85(4): 461-3.
- Edmonds M. The treatment of diabetic foot infections: focus on ertapenem. Vasc Health Risk Manag 2009; 5: 949-63.
- Kavitha KV, Tiwari S, Purandare VB, Khedkar S, Bhosale SS, Unnikrishnan AG. Choice of wound care in diabetic foot ulcer: A practical approach. World J Diabetes 2014; 5(4): 546-56.
- Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Risk factors predicting lower extremity amputations in patients with NIDDM. Diabetes care 1996; 19(6): 607-12.
- Chaturvedi N, Stevens LK, Fuller JH, Lee ET, Lu M. Risk factors, ethnic differences and mortality associated with lower-extremity gangrene and amputation in diabetes. The WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001; 44 Suppl 2: S65-71.