BACTERIOLOGY OF DIABETIC FOOT IN TERTIARY CARE HOSPITAL; FREQUENCY, ANTIBIOTIC SUSCEPTIBILITY AND RISK FACTORS
AbstractBackground: Diabetic foot being one of the frequent and disabling complications of diabetes. In view of widespread regional variation in causative organisms and antimicrobial susceptibility, the current study aimed to determine frequency of causative organisms, their antimicrobial susceptibility and associated risk factors. Methods: This descriptive cross-sectional study was conducted in 6 months’ duration at dept. of Medicine; PIMS Hospital Islamabad. Type 2 Diabetes mellitus patients with diabetic foot ulcer were enrolled after informed consent. Patients already receiving antibiotics, having no growth on culture and >3 weeks’ duration of ulcer were excluded. Sample from wound was sent for culture and sensitivity. Antibiotic susceptibility testing identified the susceptible and resistant strains of organisms. Results: Among 114 patients (66.67% males and 33.33% females); mean age was 55.11±11.96 years. Staphylococcus aureus was identified in 46%, E. coli in 28%, Pseudomonas in 6%, Klebsiella in 3.5% and other organisms in 17%. 92% of S. aureus was sensitive to Vancomycin and 67% to Clindamycin. Amongst E. coli, 81% showed sensitivity to Imipenem, 69% to Aminoglycosides and 31% to Quinolones. Glycaemic control was unsatisfactory in 65.8%. Peripheral vascular disease was found in 46% patients and sensory neuropathy in 94%. Conclusion: Staphylococcus aureus was the most frequent isolate amongst gram positive organisms while E. coli amongst gram-negatives. Vancomycin is suggested to be the drug of choice for gram positive and Imipenem for gram negative organisms. Appropriate antimicrobial therapy according to susceptibility patterns would reduce the morbidity and emergence of multidrug resistant organisms in diabetic foot infections.Keywords: Antibiotic susceptibility; Bacteriology; Diabetic foot; Glycaemic control
Sivakumari V, Shanthi G. Antibiotic susceptibility of common bacterial pathogens isolated from diabetic pus. Antibiot Susceptibility Common Bact Pathog Isol Diabet Pus 2009;8(10):10–3.
Hayyat AS, Khan AH, Masood N, Shaikh N. Study for microbiological pattern and in vitro antibiotics susceptibility in patients having diabetic foot infections at tertiary care hospital in Abbotabad. World Appl Sci J 2011;12(2):123–31.
Richard JL, Sotto A, Jourdan N, Combescure C, Vannereau D, Rodier M, et al. Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers. Diabetes Metab 2008;34(4):363–9.
Alavi SM, Khosravi AD, Sarami A, Dashtebozorg A, Montazeri EA. Bacteriologic study of diabetic foot ulcer. Pak J Med Sci. 2007;23(5):681–84.
Lipsky BA, Stoutenburgh U. Daptomycin for treating infected diabetic foot ulcers: evidence from randomized, controlled trial comparing daptomycin with vancomycin or semi-synthetic Penicillins for complicated skin and skin-structure infections. J Antimicrob Chemother 2005;55(2):240–45.
Bates MC, Aburahma AF. An update on endovascular therapy of the lower extremities. J Endovasc Ther 2004;11(Suppl 2):107–27.
Hasnain S, Sheikh NH. Knowledge and practices regarding foot care in diabetic patients visiting diabetic clinic in Jinnah Hospital, Lahore. J Pak Med Assoc 2009;59(10):687–90.
Lipsly BA, Tabek YP, Johannes RS, Vo L, Hude L, Weigelt JA. Skin and soft tissue infections in hospitalized patients with diabetes; culture isolates and risk factors associated with mortality, length of stay and cost. Diabetologia 2010;53(5):914–23.
Stein GE, Schooley S, Peloquin CA, Missavage A, Havlichek DH. Linezolid tissue penetration and serum activity against strains of Methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility in diabetic patients with foot infections. J Antimicrob Chemother 2007;60(4):819–23.
Lipsky BA. New developments in diagnosing and treating diabetic foot infections. Diabetes Metab Res Rev 2008;24(Suppl 1):S66–71.
Yoga R, Khairul A, Sunita K, Suresh C. Bacteriology of diabetic foot lesions. Med J Malaysia 2006;61(Suppl A):14–6.
Martinez-Gomez DA, Ramirez-Almagro C, Campillo-Soto A, Morales-Cuenca G, Pagán-Ortiz J, Aguayo-Albasini J. Diabetic foot infections. Prevalence and antibiotic sensitivity of the causative microorganisms. Enferm Infecc Microbiol Clin 2009;27(6):317–21.
Eleftheriadou I, Tentolouris N, Argiana V, Jude E, Boulton AJ. Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs 2010;70(14):1785–97.
Van Baal JG, Harding KG, Lipsky BA. Foot infections in diabetic patients: an overview of the problem. Clin Infect Dis 2004:39(Suppl 2):S71–2.
Teppler H, McCarroll K, Gesser RM, Woods GL. Surgical infections with enterococcus: outcome in patients treated with Ertapenem versus Piperacillin-tazobactam. Surg Infect (Larchmt) 2002;3(4):337–49.
Cunha BA. Antibiotic selection for diabetic foot infections: a review. J Foot Ankle Surg 2000;39(4):253–57.
Nyamu PN, Otieno CF, Amayo EO, McLigeyo SO. Risk factors and prevalence of diabetic foot ulcers at Kenyatta National Hospital, Nairobi. East Afr Med J 2003;80(1):36–43.
Mohanasoundaram KM. The microbiological profile of diabetic foot infections. J Clin Diagn Res 2011;6(11):409–11.
Davis WA, Norman PE, Bruce DG, Davis TM. Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 2006;49(11):2634–41.
Dhanasekaran G, Sastry G, Viswanathan M. Microbial pattern of soft tissue infections in diabetic patients in South India. Asian J Diabet 2003:5:8–10.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993;329(14):977–86.
Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes Complications 2005:19(3):138–41.
Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med 2006;355(18):1903–11.
Senneville E, Melliez H, Beltrand E, Legout L, Valette M, Cazaubiel M, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis 2006;42(1):57–60.
Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004;39(7):885–910.
Gu JH, Li M, Li C, Vuong M, Otto Y, Wen Y, et al. Bacterial insertion sequence IS256 as a potential molecular marker to discriminate invasive strains from commensal strains of Staphylococcus epidermidis. J Hosp Infect 2005;61(4):342–8.
Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR. Bacterial etiology of diabetic foot infections in South India. Eur J Int Med 2005:16(8):567–70.
Varaiya AY, Dogra JD, Kulkarni MH, Bhalekar PN. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in diabetic foot infections. Indian J Pathol Microbiol 2008;51(3):370–2.
Yao Y, Sturdevant DE, Villaruz A, Xu L, Gao Q, Otto M. Factors characterizing Staphylococcus epidermidis invasiveness determined by comparative genomics. Infect Immun 2005;3(3):1856–60.
Singh SK, Gupta K, Tiwari S, Shahi SK, Kumar S, Kumar A, et al. Detecting aerobic bacterial diversity in patients with diabetic foot wounds using ERIC-PCR: a preliminary communication. Int J Low Extrem Wounds 2009:8(4):203–8.
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