scholarly journals Sonication of Kirschner Wire as a Tool for the Microbiological Diagnosis of Diabetic Foot Infection – Preliminary Results

Author(s):  
Rodrigo Paes Cuiabano Leme ◽  
Jéssica Chaves ◽  
Luiz Carlos Gonçalves ◽  
Leonardo César Alvim ◽  
João Roberto Chaves de Almeida ◽  
...  

Background: Diabetic foot infection (DFI) is the commonest diabetic problem requiring hospital admission. Culture yield can be challenging, particularly in the presence of biofilms. Literature confirms biofilms are ubiquitous in diabetic foot ulcer, although, there is not a microbiologic diagnostic approach regarding biofilm disruption on DFI. We postulated sonicating a stainless-steel wire along with tissue samples into the thioglycollate broth media (TBM) may improve the diagnosis of DFI. Method: Pro-spective unicentric study that assessed patients with DFI who underwent surgical debridement. The vascular surgery team collected tissue fragments and inoculated the specimens into three TBM to execute the conventional culture method (CCM), and ad-ditional fragments to place into other TBM along with a Kirschner wire (K-wire – Kw method). The microbiologist processed the samples and the resultant sonication fluid in aerobic sheep-blood agar after 24 hours, 5 and 10 days of incubation. Both methods were compared (Wilcoxon test; p < 0.05). Results: The number of pathogens isolated in each method was not statistically significant (p = 0.414): CM = 1.67 (± 0.92); KwM = 1.75 (± 0.94). The KwM was not inferior to CCM. In addition, despite the absence of statistical significance, the KwM detected more pathogens than CCM.

2020 ◽  
Vol 16 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Mutasem Ababneh ◽  
Mousab Y. Al Ayed ◽  
Asirvatham A. Robert ◽  
Mohamed A. Al Dawish

Background: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. Materials and Methods: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients’ medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the “χ2” test. Results: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. Conclusion: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.


2019 ◽  
Vol 28 (9) ◽  
pp. 601-607 ◽  
Author(s):  
Fatma Aybala Altay ◽  
Semanur Kuzi ◽  
Mustafa Altay ◽  
İhsan Ateş ◽  
Yunus Gürbüz ◽  
...  

Objective: To investigate whether the neutrophil-to-lymphocyte ratio (NLR) may be used in the early stage risk assessment and follow-up in diabetic foot infection Methods: Over a five-year study, NLR values on admission and day 14 of treatment were matched with their laboratory and clinical data in a cohort study. Patients were followed-up or consulted in several clinics or polyclinics (infectious diseases). Results: Admission time NLR was higher, in severe cases as indicated by both Wagner and PEDIS infection scores (severe versus mild Wagner score NLR 6.7 versus 4.2; p=0.04; for PEDIS score NLR 6.3 versus 3.6; p=0.03, respectively). In patients who underwent vascular intervention (12.6 versus 4.6; p=0.02); amputation indicated (9.2 versus 4.1; p=0.005) and healed afterwards (6.9 versus 4.3; p<0,001), when matched with others. NLR was also found to be correlated with duration of both IV antibiotic treatment (r=0.374; p=0.005) and hospitalisation (r=0.337; p=0.02). Day 14 NLR was higher in patients who underwent vascular intervention (5.1 versus 2.9; p=0.007) when matched to others. Conclusion: Patients with higher NLR values at admission had more severe diabetic foot infection, higher risk for amputation, need for long-term hospitalisation and aggressive treatment. However, they also have more chance of benefit from treatment.


Perfusion ◽  
2020 ◽  
pp. 026765912095784
Author(s):  
Pasha Normahani ◽  
Rishi Agrawal ◽  
Viknesh Sounderajah ◽  
Prodromos Tsinaslanidis ◽  
Patrick Musonda ◽  
...  

Objective: We assessed the association between (1) severity of vessel wall calcification, (2) number of patent vessels at the ankle and (3) arterial spectral waveform features, as assessed on a focused ankle Duplex ultrasound (DUS), and healing at 12-months in a cohort of patients who had their diabetic foot ulcers conservatively managed. Research design and methods: Scans performed on 50 limbs in 48 patients were included for analysis. Patient health records were prospectively reviewed for 12-months to assess for the outcome of ulcer healing. Results: We identified that the number of waveform components, peak systolic velocity, systolic rise time and long forward flow as well as the number of vessels patent at the ankle on DUS, may be useful independent predictors of healing, as noted by the trend towards statistical significance. Conclusion: Arterial spectral waveform features may be useful in predicting the chance of diabetic foot ulcer healing.


PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254921
Author(s):  
Sivakamasundari Pichu ◽  
Selvaraj Vimalraj ◽  
Vijay Viswanathan

Aim Diabetic foot ulcer (DFU) is a major concern in diabetes and its control requires in-depth molecular investigation. The present study aimed to screen the expression of microRNA-210 (miR-210) and its association in hypoxic pathway in DFU patients. Methods The study consists of 3 groups of circulation samples (50 in each group of: healthy volunteers, T2DM and T2DM with DFU) and 2 groups of tissue samples (10 in each group of: control and T2DM with DFU). Expression of miR-210 and hypoxia inducible factor-1 alpha (HIF-1α), and its responsive genes such as VEGF, TNF-α, IL-6, BCl2, Bax and Caspase 3 were analyzed by RT-PCR, Western blot and ELISA analyses. Results The HIF-1α expression decreased in DFU patients with increased miR-210 expression in both circulation and tissue biopsies. The circulatory IL-6 and inflammatory gene TNF-α expression was increased in DFU compared to healthy controls and T2DM subjects. Further, we found there was no alteration in the angiogenic marker, VEGF expression. In comparison, anti-apoptotic BCl2 was decreased and Bax and Caspase 3 was increased in DFU tissues relative to control. Conclusions The study showed that there was an inverse relationship between miR-210 and HIF-1α expression in patients with DFU, indicating that miR-210 may regulate the expression of the hypoxic gene.


2016 ◽  
Vol 3 (2) ◽  
pp. 88-91
Author(s):  
Radhika Jindal ◽  
Subhash K Wangnoo ◽  
Mohammad A Siddiqui

ABSTRACT Diabetic foot complications continue to be the main reason for diabetes-related hospitalization and lower extremity amputations. Most can be cured if managed properly. But improper diagnostic and therapeutic approaches result in many patients needlessly undergoing amputations. There are many other conditions “imposing” as a diabetic foot, which may mislead the diagnosis and management. One should be aware of these conditions and keep a watchful eye for them as well in a diabetic patient. Every ulcer in a diabetic need not be a diabetic foot ulcer. Some of these diabetic foot infection imposters are discussed herewith and these include pyoderma gangrenosum, squamous cell carcinoma in a chronic ulcer, venous ulcer, bullosis diabeticorum, necrobiosis lipoidica diabeticorum, malignant melanoma, thromboangiitis obliterans (TAO), superficial thrombophlebitis, erythema nodosum, and granuloma annulare. How to cite this article Wangnoo SK, Jindal R, Siddiqui MA. Diabetic Foot Infection Impostors. J Foot Ankle Surg (Asia- Pacific) 2016;3(2):88-91.


2018 ◽  
Vol 5 (11) ◽  
Author(s):  
Oryan Henig ◽  
Jason M Pogue ◽  
Raymond Cha ◽  
Paul E Kilgore ◽  
Umar Hayat ◽  
...  

Abstract Background The polymicrobial nature of diabetic foot infection (DFI) and the emergence of antimicrobial resistance have complicated DFI treatment. Current treatment guidelines for deep DFI recommend coverage of methicillin-resistant Staphylococcus aureus (MRSA) and susceptible Enterobacteriaceae. This study aimed to describe the epidemiology of DFI and to identify predictors for DFI associated with multidrug-resistant organisms (MDROs) and pathogens resistant to recommended treatment (PRRT). Methods Adult patients admitted to Detroit Medical Center from January 2012 to December 2015 with DFI and positive cultures were included. Demographics, comorbidities, microbiological history, sepsis severity, and antimicrobial use within 3 months before DFI were obtained retrospectively. DFI-PRRT was defined as a DFI associated with a pathogen resistant to both vancomycin and ceftriaxone. DFI-MDRO pathogens included MRSA in addition to PRRT. Results Six-hundred forty-eight unique patients were included, with a mean age of 58.4 ± 13.7 years. DFI-MDRO accounted for 364 (56%) of the cohort, and 194 (30%) patients had DFI-PRRT. Independent predictors for DFI-PRRT included history of PRRT in a diabetic foot ulcer, antimicrobial exposure in the prior 90 days, peripheral vascular disease, and chronic kidney disease. Long-term care facility residence was independently associated with DFI due to ceftriaxone-resistant Enterobacteriaceae, and recent hospitalization was an independent predictor of DFI due to vancomycin-resistant Enterococcus. Conclusions An unexpectedly high prevalence of DFI-PRRT pathogens was identified. History of the same pathogen in a prior diabetic foot ulcer and recent antimicrobial exposure were independent predictors of DFI-PRRT and should be considered when selecting empiric DFI therapy.


BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019437 ◽  
Author(s):  
Andrea Nelson ◽  
Alexandra Wright-Hughes ◽  
Michael Ross Backhouse ◽  
Benjamin A Lipsky ◽  
Jane Nixon ◽  
...  

ObjectiveTo determine the extent of agreement and patterns of disagreement between wound swab and tissue samples in patients with an infected diabetic foot ulcer (DFU).DesignMulticentre, prospective, cross-sectional study.SettingPrimary and secondary care foot ulcer/diabetic outpatient clinics and hospital wards across England.ParticipantsInclusion criteria: consenting patients aged ≥18 years; diabetes mellitus; suspected infected DFU. Exclusion criteria: clinically inappropriate to take either sample.InterventionsWound swab obtained using Levine’s technique; tissue samples collected using a sterile dermal curette or scalpel.Outcome measuresCoprimary: reported presence, and number, of pathogens per sample; prevalence of resistance to antimicrobials among likely pathogens. Secondary: recommended change in antibiotic therapy based on blinded clinical review; adverse events; sampling costs.Results400 consenting patients (79% male) from 25 centres.Most prevalent reported pathogens wereStaphylococcus aureus(43.8%),Streptococcus(16.7%) and other aerobic Gram-positive cocci (70.6%). At least one potential pathogen was reported from 70.1% of wound swab and 86.1% of tissue samples. Pathogen results differed between sampling methods in 58% of patients, with more pathogens and fewer contaminants reported from tissue specimens.The majority of pathogens were reported significantly more frequently in tissue than wound swab samples (P<0.01), with equal disagreement forS. aureusandPseudomonas aeruginosa.Blinded clinicians more often recommended a change in antibiotic regimen based on tissue compared with wound swab results (increase of 8.9%, 95% CI 2.65% to 15.3%). Ulcer pain and bleeding occurred more often after tissue collection versus wound swabs (pain: 9.3%, 1.3%; bleeding: 6.8%, 1.5%, respectively).ConclusionReports of tissue samples more frequently identified pathogens, and less frequently identified non-pathogens compared with wound swab samples. Blinded clinicians more often recommended changes in antibiotic therapy based on tissue compared with wound swab specimens. Further research is needed to determine the effect of the additional information provided by tissue samples.Trial registration numberISRCTN52608451.


Author(s):  
Dr. Devi Das Verma ◽  
Dr. Anil Kumar Saxena

Introduction:  Diabetes is one of the most prevalent metabolic chronic diseases due to the imbalance production of insulin. One of the studies reported that in 2010 worldwide 285 million adults had diabetes and this figure may be increase to 439 million by the year 2030. Globally Diabetic foot ulcers (DFUs) constitute major health problem in people that significantly contribute to morbidity and mortality in diabetes patients. Approximate 1.0% to 4.1% of the annual population-based incidences of a diabetic foot ulcer (DFU) were reported. Due to this the lifetime may be as high as 25%. In Asian countries diabetic foot ulcer are major problems which are different from European countries or developing countries.  From many studies reported diabetic foot problems in India are infectious and neuropathic in nature as compared to developed countries. According to World Health Organization (WHO) diabetic foot is defined as lower limb of a diabetic patient characterized by infection, potential risk of pathologic consequences ulceration or destruction of deep tissues associated with neurological abnormalities, various changes in peripheral neuropathy vasculopathy and superimposed infection that are mainly responsible foot ulceration. Ulcers are one kind of abscess which is difficult to treat because of poor wound healing that result from a combination of neuropathy, ischemia and hyperglycemia.  Aim: The main objective was to study the outcome of treatment modalities and it’s relating factors to complication in diabetic foot ulcer.  Material and method:  Total 60 diabetic foot ulcer patients with the age range from 20 to 70 years were included.  From all the patients’ detailed past and present history were recorded.  For all the patients, general, physical and local and systemic examinations were also done. Detail   laboratory examination like Fasting and Post Prandial Blood sugar levels, blood count, ECG, ESR, complete urine examination for the presence of ketone bodies and sugar, x-ray as well as culture and sensitivity of the discharge from ulcer were also done. Patients were treated with various treatment methods like conservative treatment, split skin grafting and amputation. Result: In this study male patients were more in proportion as compared to female. This study showed that maximum with the age group 14 -50 (43.3%) years old followed by 18.3% in 31-40 years old, 16.7% in 61-70 years old.  6.7% showed the least age group as 20 -30 years old.  Out of total 60 patients, 38.3% of the patients showed diabetic ulcer foot which was more whereas 15% showed diabetic gangrene foot which was least. 25% showed diabetic cellulites foot and 21.7% showed as diabetic abscess foot.  Conclusion: Globally as diabetes mellitus cases are increasing and it became rapidly the public health problem. This may be due to burden on economy, health system and on society to manage the diabetic foot problems. Diabetic foot management guidelines must be made into our practice protocols which may preventing limb loss, and decrease mortality and increase the quality of life of the patient. Hence for this it is only possible with the help of foot care education and health care workers.  Hence, foot infection is to put first and care for it like hands. Keywords: Diabetes, foot ulcers, infections, amputations.


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