A Clinical Study to Evaluate Autofluorescence Imaging of Diabetic Foot Ulcers Using a Novel Artificial Intelligence Enabled Noninvasive Device

2021 ◽  
pp. 153473462110470
Author(s):  
Vijay Viswanathan ◽  
Senthil Govindan ◽  
Bamila Selvaraj ◽  
Secunda Rupert ◽  
Raghul Kumar
Keyword(s):  
Artificial Intelligence ◽  
Diabetic Foot ◽  
Predictive Value ◽  
Early Infection ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Autofluorescence Imaging ◽  
Gram Positive ◽  
Tissue Samples ◽  
Gram Negative

Diabetic foot ulcers, with worldwide prevalence ranging from 12%-25%, are an important cause of nontraumatic lower limb amputation. Evidence-based assessment of early infection can help the clinician provide the right first line treatment thus helping improve the wound closure rate. Illuminate®, a novel point of care device working on multispectral autofluorescence imaging, helps in the rapid identification and classification of bacteria. This study was aimed to evaluate the diagnostic accuracy of the device in detecting bacterial gram type against standard culture methods. A total of 178 patients from a tertiary care center for diabetes was recruited and 203 tissue samples were obtained from the wound base by the plastic surgeon. The device was handled by the trained investigator to take wound images. The tissue samples were taken from the color-coded infected region as indicated by the device's Artificial Intelligence algorithm and sent for microbial assessment. The results were compared against the Gram type inferred by the device and the device was found to have an accuracy of 89.54%, a positive predictive value of 86.27% for detecting Gram-positive bacteria, 80.77% for Gram-negative bacteria, and 91.67% for no infection. The negative predictive value corresponded to 87.25% for Gram-positive, 92% for Gram-negative, and 96.12% for no infection. The Results exhibited the accuracy of this novel autofluorescence device in identifying and classifying the gram type of bacteria and its potential in significantly aiding clinicians towards early infection assessment and treatment.

scholarly journals Microbiological profile of diabetic foot ulcers in Kuwait

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244306
Author(s):  
Asma Alhubail ◽  
May Sewify ◽  
Grace Messenger ◽  
Richard Masoetsa ◽  
Imtiaz Hussain ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcers ◽  
Antibiotics Resistance ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Gram Positive ◽  
Gram Negative ◽  
Glucose Levels ◽  
Microbiological Profile ◽  
Appropriate Treatment

Introduction Diabetic foot ulcers (DFU) and infection (DFI) are a major diabetes-related problem around the world due to the high prevalence of diabetes in the population. The aim of our study was to determine the microbiological profile of infected ulcers in patients attending Dasman Diabetes Institute (DDI) clinics in Kuwait and to analyze the distribution of microbial isolates according to wound grade, sex, age and diabetes control. Methods We collected and analyzed clinical data and samples from 513 diabetic patients with foot ulcers referred to our podiatry clinic at DDI from Jan 2011 till Dec 2017. Results We show a higher prevalence of DFU in men than in women, and a greater percentage of DFU occurred in men at an earlier age (p<0.05). Only about half of the DFU were clinically infected (49.3%) but 92% of DFU showed bacterial growth in the microbiological lab analysis. In addition, we isolated more monomicrobial (57.3%) than polymicrobial (34.8%) DFI and representing an average of 1.30 pathogens per patient. The presence of Gram-positive and Gram-negative strains was comparable between men and women regardless their age or glucose levels. Interestingly, more Gram-positive strains are present in ulcers without ischemia while more Gram-negative strains are present in ulcers with ischemia (p<0.05). While Staphylococcus aureus was common in infected ulcers without ischemia, Pseudomonas aeruginosa was predominant in ulcers with infection and ischemia, regardless of ulcer depth. Finally, a higher percentage of women has controlled HbA1c levels (19.41% versus 11.95% in men) and more women in this group displayed non-infected wounds (60.6% and 43.90% for women and men, respectively). Conclusion Our results provide an updated picture of the DFI patterns and antibiotics resistance in patients attending Dasman Diabetes Institute (DDI) clinics in Kuwait which might help in adopting the appropriate treatment of infected foot and improving clinical outcomes.

Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia

2018 ◽  
Vol 17 (3) ◽  
pp. 161-168 ◽  
Author(s):  
Mousab Yousef Al Ayed ◽  
Mutasem Ababneh ◽  
Asirvatham Alwin Robert ◽  
Aus Alzaid ◽  
Rania Ahmed Ahmed ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Saudi Arabia ◽  
Diabetic Foot ◽  
Antibiotic Sensitivity ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Gram Positive ◽  
Gram Negative ◽  
Klebsiella Spp

We sought to define the type and antibiotic sensitivity response of pathogens isolated from diabetic foot ulcers based on ulcer location and Wagner classification. This retrospective analysis was done among 126 patients between 40 and 70 years of age at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, using the swab culture method for microbiological assessment. Data on demographic variables, ulcer sites (location), and depth of ulcer (Wagner classification) were also collected. A total of 134 pathogens were isolated from 126 patients. The most common gram-negative pathogen identified was Pseudomonas aeruginosa (15.6%), followed by Klebsiella spp (6.7%). The most common gram-positive pathogen was Staphylococcus aureus (35%), followed by Streptococcus (8.9%). The most widely accepted antibiotic to which the gram-negative bacteria were sensitive was gentamycin (20.1%), followed by ciprofloxacin (19%). The most routinely used antibiotic in the treatment of the gram-positive bacteria was erythromycin (16%), with trimethoprim-sulfamethoxazole (14.1%) being the next most effective. In conclusion, Pseudomonas aeruginosa, Klebsiella spp, Staphylococcus aureus, and Streptococcus were the most common causes of diabetic foot infections. However, the frequency of encountered pathogens and respective sensitivity to antibiotic therapy may be influenced by the location site and severity of the ulceration.

scholarly journals Bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques

2017 ◽  
Vol 5 (2) ◽  
pp. 496 ◽  
Author(s):  
Swati V. Patil ◽  
Roshan R. Mane
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Profile ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Techniques ◽  
Common Organism

Background: Diabetic foot ulcers (DFU) are the complications of diabetes mellitus. The diabetic foot ulcer infections are polymicrobial in nature. If they are not recognized and controlled it leads to many devastating consequences like limb amputation, sepsis, and even mortality. Hence, the present study was undertaken to determine the bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques and the antimicrobial sensitivity pattern of the isolates.Methods: A total number of 103 patients with a foot ulcer of Wagner’s grade II or more and evidence of purulent exudates or edema were included in the study. Swab samples were obtained from the base of ulcers and were sent for bacteriological study. The specimen was processed in the microbiology laboratory for Gram stain, aerobic culture, and anaerobic culture. The organisms isolated were identified by standard procedures and antimicrobial susceptibility was done by Kirby-Bauer disc diffusion method.Results: A total no of 253 organisms were isolated from 103 patients. Out of these, 217 aerobes were isolated, and the most common organism isolated from gram positive bacteria was Staphylococcus aureus, 53 (24.42 %). Pseudomonas aeruginosa, 42 (19.35 %) was the predominant organism isolated from gram negative bacteria. Among the total 36 anaerobes, Bacteroides fragilis group, 17 (47.22 %) was the most common organism isolated. All the gram positive aerobic organisms were found to be sensitive for vancomycin. Among the gram negative organisms, E. coli, Proteus mirabilis, Proteus vulgaris, showed more sensitivity to cefotaxime (90.62%, 91.66%, 75%) respectively. Metronidazole was the drug of choice in case of anaerobes followed by imipenem.Conclusions: It is necessary to identify the etiological factors and susceptible microorganisms responsible for causation of DFU. So that prompt management of diabetic foot ulcers is possible for successful outcome. Appreciation of the causative organisms in diabetic foot and their antibiotic sensitivity is essential for institution of appropriate antibiotic therapy.

Antibiotic Resistance in Aerobic Bacterial Isolates From Infected Diabetic Foot Ulcers in North Eastern Tanzania: An Urgent Call to Establish A Hospital Antimicrobial Stewardship Committee

2021 ◽  
Author(s):  
Ahmed Ali Shabhay ◽  
Pius Horumpende ◽  
Martin Mujuni ◽  
Edna-Joy Munisi ◽  
Stephen Mshana ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcers ◽  
Coagulase Negative Staphylococcus ◽  
Surgical Removal ◽  
Diabetic Foot Ulcers ◽  
Bacterial Isolates ◽  
Diabetic Ulcer ◽  
Gram Negative ◽  
Surgical Department ◽  
E Coli

Abstract Background. Diabetic foot ulcers (DFU) is among major health problems which impact the socio economic burden globally. We aimed at assessing the susceptibility pattern of antimicrobials in DFU infections among patients admitted in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC). Methods. This descriptive cross-sectional study was conducted from September 2018 through March 2019. Pus swabs were collected on the first day of admission by deep wound swabbing after irrigation with normal saline solution. Kirby-Bauer method was done according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Results. Sixty diabetic ulcer patients had 62 bacterial isolates. Majority of the isolates were gram negative 49/62(79.03%). The most common isolate was Escherichia coli 15/62(24.19%) followed by Pseudomonas aeruginosa 14/62(22.58%), Proteus mirabilis 8/62(12.9%) and Staphylococcus aureus 5/62(8.06%). Klebsiella pneumoniae, Coagulase Negative Staphylococcus, Proteus Vulgaris, and Streptococcus pyogenes each contributed 4/62(6.25%) isolates. Of the 49/62(79.3%) gram negative isolates, 8/49(16.33%) were mono resistant, 30/49(61.22%) were multiresistant, and 11/49(22.45%) were susceptible. Of the multi-resistant isolates, E. coli 12/15(80.00%), and P.aeruginosa 7/14(50.00%) were predominant. A total of 39/62(62.90%) isolates in patients contributed to poorer outcomes including loss of body part. Patients with ulcers infected by P. aeruginosa 11/39 (28.21%) had the highest number of surgical removal of body parts followed by E. coli 8/39(20.51%). Gram negative bacteria were highly susceptible to amikacin 91.18%, meropenem 93.33% and imipenem 95.24%. Isolates susceptibility to ceftriaxone was 32%. Conclusions. Amikacin, meropenem and imipenem can be safely used as broad-spectrum antimicrobials in DFU. The Standard of care remains culture and sensitivity of isolated microorganisms in combating diabetic foot ulcers infections.

Bacterial Prevalence and Antibiotic Resistance in Clinical Isolates of Diabetic Foot Ulcers in the Northeast of Tamaulipas, Mexico

2017 ◽  
Vol 16 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Mario Sánchez-Sánchez ◽  
Wendy Lizeth Cruz-Pulido ◽  
Eduardo Bladinieres-Cámara ◽  
Rodrigo Alcalá-Durán ◽  
Gildardo Rivera-Sánchez ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Gram Positive ◽  
Phenotypic Resistance ◽  
Gram Positive Bacteria ◽  
Patients With Diabetes ◽  
Muscle Biopsies ◽  
Extremity Amputation ◽  
Gram Positive Cocci

Diabetic foot ulcers (DFUs) are a serious and common problem in patients with diabetes mellitus and constitute one of the major causes of lower extremity amputation. The microbiological profile of DFUs depends on the acute or chronic character of the wound. Aerobic gram-positive cocci are the predominant organisms isolated from DFUs. Diabetic foot biopsies from patients admitted to the Angiology and Vascular Surgery Hospital of the Northeast, in Reynosa, Tamaulipas from December 2011 to April 2016 were analyzed. The samples were processed using standard microbiology techniques. Antimicrobial susceptibility testing was carried out according to the protocol established by the Clinical & Laboratory Standards Institute (CLSI). We obtained 246 bacterial isolates, based on the results of phenotypic resistance. The least effective antibiotics for gram-positive bacteria were penicillin and dicloxacillin; for gram-negative bacteria, cefalotin and penicillin were the least effective. Levofloxacin, cefalotin, and amikacin were the most effective antibiotics for gram-positive and negative bacteria, respectively. Enterobacter genus was significantly associated with muscle biopsies ( P = .011) and samples without growth were significantly associated with specimens of pyogenic origin ( P = .000). In 215 DFU samples, we found that Staphylococcus aureus was the most commonly isolated pathogen followed by Enterobacter sp. This is consistent with previous reports. Enterobacter species may play an important role in the colonization/infection of certain tissues; however, further studies are needed in this regard.

scholarly journals Study on bacteriological profile and antibiotic susceptibility pattern in patients with diabetic foot ulcers in a tertiary care teaching hospital

2018 ◽  
Vol 06 (01) ◽  
pp. 040-047
Author(s):  
Javedh Shareef ◽  
Sandra Sunny ◽  
K Bhagavan
Keyword(s):  
Diabetic Foot ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Susceptibility Pattern ◽  
Antibiotic Susceptibility Pattern ◽  
Gram Negative ◽  
Bacteriological Profile ◽  
Gram Negative Organisms

Introduction:Diabetic foot ulcer and infections are one of the major complications in diabetic patients leading to frequent hospitalization and increased mortality. Knowledge about the microbes that cause infections will be helpful for providing appropriate antimicrobial therapy. Aim:To evaluate the bacteriological profile of patients with diabetic foot ulcers and their antibiotic susceptibility pattern. Methodology:A cross-sectional study was carried out for a period of eight months in the Department of surgery in patients with diabetic foot ulcer at a tertiary care teaching hospital. Patient data relevant to the study were collected using a standard data collection form designed as per the need of the study. Details of the organisms isolated and susceptibility pattern were collected from microbiology department. Results:A total of 122 pathogens were identified from 71 patients with male (63.38%) predominance over females (36.61%). Out of the 71 patients, 38 (53.52%) patients had monomicrobial infections and 33 (46.47%) patients had polymicrobial infections. Of the total 122 organisms, 79(64.75%) organisms were found to be gram negative organisms and 43(35.24%) were gram positive. Pseudomonas aeruginosa found in 22 (18.03%) patients was the predominant pathogen isolated followed by Klebsiella pneumonia found in 18 (14.75%) patients. The gram-positive organisms isolated showed maximum susceptibility towards antibiotics Teicoplanin and Linezolid while the gram-negative organisms showed susceptibility to Imipenem, Meropenem, and Piperacillin/Tazobactum combination. Conclusion:The study showed a preponderance of gram-negative bacilli among the isolates from the diabetic foot ulcers. It is recommended that antimicrobial sensitivity testing is necessary for initiating appropriate antibiotic regimen which will help to reduce the drug resistance and minimize the healthcare costs.

scholarly journals Assessment role of phagocytic neutrophil cells among different Wagner’s grades of diabetic foot ulcers infections

2020 ◽  
Author(s):  
Eidha Ali Bin-Hameed ◽  
Maryam Hamed Baras
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Control Group ◽  
Diabetic Patients ◽  
Gram Negative Bacteria ◽  
Diabetic Foot Ulcers ◽  
Bacterial Isolates ◽  
Gram Negative

Abstract Background: Foot ulcers complications in diabetes mellitus (DM) patients are one of the significant medical problems and an economic burden. The aim of this study is to assessment role of phagocytic neutrophil cells and its relationship with the incidence of diabetic foot ulcers (DFU) infection of diabetic patients. A total of 60 venipuncture blood samples collected from diabetes mellitus, diabetic foot ulcer patients and healthy persons as control group. 20 swabs from the DFU patients were collected and processed for culture and susceptibility test after the ulcers classified according to Wagner’s grades system. Phagocytic cells activity test was performed to determine the efficiency of phagocytic neutrophil cells in diabetic patients. Results: Gram positive bacteria were the most prevalent in the DFU patients 57.1% with statistical significant relationship between the type of bacteria and grades of Wagner’s classification followed by Gram negative bacteria in high grades of ulcers. Wagner’s ulcers grade 1 and 2 were the most prevalence in DFU patients 30%. There was a weak negative correlation between the efficiency of phagocytic neutrophil cells activity and grade ulcers classified (r = -0.323). Amikacin and ciprofloxacin were the most effective antibiotics against 90.5% and 81% of the bacterial isolates respectively, whereas ampicillin, cefepime and cefadroxil were less effective antibiotics against the bacterial isolates.Conclusion: When the grade of ulcer increased, the bacterial resistance to antibiotics increased, and this was emphasis the correlation with prevalent of Gram negative bacteria in the high grade of ulcers with high resistance of antibiotics. In contrast, the grade of ulcer increased, the efficiency of phagocytic neutrophil cells decreased.

scholarly journals DIABETIC FOOT ULCERS

2009 ◽  
Vol 16 (01) ◽  
pp. 53-60
Author(s):  
HAJI KHAN KHOHARO ◽  
SHUAIB ANSARI ◽  
FATIMA QURESHI
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Clinical Laboratory ◽  
Diffusion Method ◽  
Foot Ulcers ◽  
National Committee ◽  
Diabetic Foot Ulcers ◽  
Gram Positive ◽  
College Hospital ◽  
Bacteriological Study

(SUMMARY) Aim: To determine common pathogens isolated in diabetic foot ulcers & in vitro antimicrobial activity. Setting:Muhammad Medical College Hospital, Mirpurkhas and Liaquat University of Medical & Health Sciences Jamshoro. Period: 1s t November2007 to 30th June 2008. Research Methodology: Pus samples for bacterial culture were collected from 60 patients admitted with diabeticfoot infections. Anti-microbial susceptibility testing of aerobic isolates was performed by the standard disc diffusion method as recommendedby the National Committee for Clinical Laboratory Standards. Microbroth dilution test was arranged for susceptibility of anaerobic organismsto metronidazole and amoxicillin/clavulanate. A vancomycin screen agar (6 Lig/ml) was used to detect vancomycin intermediate isolatesof Staphylococci. Results: Clinical grading and bacteriological study of 60 patients revealed, 44 (73.33%) patients had gram-negativeorganisms, & Pseudomonas aeruginosa was the most common. While 16 (26.66%) patients had gram-positive organisms & Staphylococciwas the most common organism. Infection with anaerobes was observed in one patient (1.66%). Both gram-positive and -negative organismswere seen in 8 (13.33%). Pseudomonas aeruginosa & S.aureus exhibited a high frequency of resistance to the antibiotics tested. All theisolates were uniformly susceptible to fosfomycin, levofloxacin, amikacin and vancomycin. Conclusions: Pseudomonas aeruginosa,Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis and Proteus were the most common causes of diabetic foot infectionsin this study. And the rate of antibiotic resistance was 66.66% among the isolates. All the isolates were uniformly susceptible to fosfomycin,levofloxacin, amikacin and vancomycin.

scholarly journals Genetic parameters of wound healing in patients with neuropatic diabetic foot ulcers

2017 ◽  
Vol 20 (5) ◽  
pp. 344-349
Author(s):  
Ekaterina L. Zaitseva ◽  
Alla Y. Tokmakova ◽  
Iya A. Voronkova ◽  
Vasily M. Petrov ◽  
Anatoly N. Tiulpakov ◽  
...  
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Inflammatory Infiltration ◽  
Tissue Samples ◽  
Clinical Pictures ◽  
Collagen Genes

Background. Tissue repair processes are impaired in diabetic foot ulcers (DFUs). Previous research has shown that glycaemic control, cytokines and growth factors play an important role in wound healing. Emerging evidence also suggests that genes play a role via their regulation of cell proliferation, collagen synthesis and granulation tissue formation. Aim. To evaluate collagen genes expression in different stages of wound healing in patients with DFUs. Materials and methods. Prospective study included four patients with neuropathic DFUs after surgical debridement. Tissue samples were taken for morphological and genetic tests on days 0, 10 and 15 of local treatment to evaluate expression of collagen genes (i.e. COL1A1, COL1A2, COL3A1) and to perform morphological tests. Results. The present study confirmed that the size of wounds decreased by 8.8 7% after 10 days of local treatment and by 18.3 8% after 15 days of local treatment. According to histological examination of wound biopsies at day 10, all patients showed a tendency for lower levels of inflammatory infiltrate, increased number of fibroblast-like cells, presence of maturing granulation tissue and emergence of connective tissue fibres. After 15 days, we detected inflammatory infiltration in the wounds, despite the formation of mature granulation tissue. According to results of genetic analysis on day 10 of local wound treatment, we found a tendency for increased expression of collagen genes relative to the baseline: COL1A1 increased by 3.2 1.3 times, COL1A2 by 2.0 1.0 times and COL3A1 by 1.25 1.1 times. On day 15 of local treatment, in contrast, we found a tendency for decreased expression of COL1A1, COL1A2 and COL3A1 relative to the baseline (1.7 0.6, 2.5 2 and 20.0 3 times, respectively). Conclusions. The expression of collagen genes (COL1A1, COL1A2, COL3A1) is more pronounced in proliferation phase and is subsequently reduced towards the end. These data were confirmed by morphological study and clinical pictures.

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