A Clinico Microbiological Profile of Diabetic Foot Patients
Keywords:Diabetic foot, diabetes, microorganisms.
Introduction: Diabetic foot syndrome (DFS), a complex disorder, affects diabetics. It is the unique anatomy
of the foot that leads to potentially serious infection. Three cardinal aetiological factors that predispose
to diabetic foot ulcers are ischaemia, neuropathy and infection. DFUs are challenging to cure as often
the diagnosis is delayed; there is presence of ischaemia, infection with multidrug-resistant organism and
extension of infection to the bones. This study was conducted with the aim to determine the clinical and
microbiological profile of diabetic foot patients and to assess their outcome.
Methodology: Sixty five male and female patients of 18 and above age that presented with diabetic foot
ulcers were enrolled over a period of 18 months.
Results: Of the 65 patients enrolled, 70.77% (n=46) were males while 29.23% (n=19) were females. Male
to female ratio was 2.4:1. Diabetic foot ulcers are common in elderly population. Most commonly seen in
the age group of 51 to 60 years. When we evaluated the Wagner grade of the ulcers, it was observed that
majority of the patients had Wagner grade III ulcer (44.62%) followed by grade II ulcer in 24.62% of the
patients. None of the patients enrolled in the present study had wagner grade I ulcer. When the risk factors
presence was evaluated in the patients, 63.08% patient had suffered trauma, this was followed by peripheral
neuropathy which was present in 60.00% patients. Among the patient enrolled, 36.92% were smokers.
63.08% patients had diabetes for more than 10years while 20% had diabetes of 5-10 years duration and
only 16.92% patients had diabetes of less than 5 years. We observed that USG showed presence peripheral
vascular disease in 41.54% patients, which is considerably high. In the present study X-ray showed presence
of Charcot’s joint, osteomyelitis, fracture and osteoporosis in 10.77%, 24.62%, 3.08% and 4.62% patients
respectively. We observed that in our study, anemia was present in large proportion of patients, 67.69%, in
the present study. In the present study, ulcer was managed conservatively in 38.46% of the patients. I & D
was performed in 35.38% of the patients. While amputation was performed in 12.31% of the patients. In
the present study, the following organisms were isolated: Staphylococcus aureus, Pseudomonas Aeruginosa,
Klebsiella pneumonia, Streptococcus pyogenes and Proteus Mirabilis were present in 36.92%, 9.23%,
13.85%, 18.46% and 10.77% patients, respectively. Thus the most common isolate was Staphylococcus aureus followed by Klebsiella pneumonia. We
observed that 50% staphylococcus aureus
isolates were resistant to methicillin, that is
methicillin resistant staphylococcus aureus.
However, the isolated staphylococcus did
not demonstrate resistance to vancomycin or
linezolid. Gram negative organisms showed
no resistance to Piperacillin+tazobactum,Imipenem and Meropenem in the present study. Amputation was performed in all the patients with Wagner
grade IV and V ulcers, while it occurred in 48.15% patients with vasculopathy and 33.33% patients with
neuropathy. It was also observed that in those patients with proteus infection, amputation had to be performed
in 100% patients.
Conclusion: Diabetic foot ulcers pose a significant burden on the patients and on the health care system. The
cost of disability, loss of work and lower extremity amputation extends beyond the economic impact, with
regards to patient quality of life.
Proper management of diabetic infections requires appropriate antibiotic selection based on culture and
antimicrobial susceptibility results; however, initial management comprises empirical antimicrobial therapy,
which is often based on susceptibility data extrapolated from studies performed on general clinical isolates.
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