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.