Identification and Drug Sensitivity of Aerobic Bacterial Isolates from Diabetic Foot Ulcers of Sudanese Patients: a Cross sectional study

2020 ◽  
Author(s):  
saada Mohamed nour ◽  
Maowia Mukhtar ◽  
Mohamed Elmakk ◽  
Elshibli Mohamed Elshibli ◽  
Walyeldin Elnour Elfakey ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Diffusion Method ◽  
Foot Ulcers ◽  
Aerobic Bacteria ◽  
Diabetic Patients ◽  
Gram Negative Bacteria ◽  
Female Ratio ◽  
Gram Negative ◽  
The Mean ◽  
Grade 3

Abstract Background Diabetic foot ulcer infection cause great morbidity and mortality among diabetic patients and is a major cause of lower extremity amputation worldwide. This study aimed to determine the profile of aerobic bacteria and their antibiotic sensitivity patterns in diabetic foot infections (DFI) among different Wagner's grades. Methods This study was conducted during December 2017 - March 2018 in a Diabetic Center, Sudan. A total of 152 diabetic patients with different grades of foot ulcers were randomly enrolled in the study. The patients were grouped using Wagner's classification. Tissue biopsies and deep swabs were collected from the ulcers for aerobic cultures. The cultured isolates were identified using phenotypic and biochemical properties and their sensitivity to commonly used antibiotics, Colistin, Aikacin, Ciprofloxacin, Augmentin, Ceftazideme, Gentamicin, Clindamycin, Ceftriaxone Meropenum. Cotrimoxazole, Erythomycin, Oxacillin and Vancomycin. Fusidic acid, Imepenem, and Piperacillin was tested using the Kirby Bauer disk diffusion method. Results The mean age of the patients was 54.31 (SD ± 12.1) years, male to female ratio of 8: 1. The mean duration of diabetes was 14 (SD ± 8) years. The ulcers varied in duration from 1 day to 10 years. of 152 samples 181 aerobic bacteria were isolated. Cultures yielded 1-3 isolate per culture. The maximum number was isolated from grade 3 group followed by long standing ulcer LSU group 50.8% and 28% respectively. Polymicrobial infection was higher in LSU (30.4%). The isolates were mostly Gram-negative bacteria. The most frequent were proteus spp. (35.3%), S. aureus MRSA 14.4% and Coliform 12.2% respectively. The most common isolates in grade 3 were P. Mirablis, Staphylococcus and Coliform and in long standing ulcers were P. Mirablis, S. aureus MRSA and Coagulase negative staphylococcus respectively. Conclusion Gram-negative bacteria were more prevalent and the most frequent pathogens were Proteus spp. The most common polymicrobial infections were due to P. mirablis with; P. aerginosa, S. MRSA and Coliform respectively . Gram negative rods were sensitive to Amikacin, (80.6) %) while the highest sensitivity of Gram positive was to Imepnem (85%). Most of the isolates were sensitive to Meropenem. No significant relation between Wagner grades and neuropathy was detected.

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 Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

2020 ◽  
Author(s):  
Olufunmilayo O Adeleye ◽  
Ejiofor T Ugwu ◽  
Ibrahim D Gezawa ◽  
Innocent Okpe ◽  
Ignatius Ezeani ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Hospital Mortality ◽  
Cardiac Failure ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Diabetic Foot Ulcers ◽  
Grade 3

Abstract Background: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria.Methods:The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number.Results: Three hundred and twenty three type 2 DM subjects with mean age and mean duration of DM of 57.2 11.4 years and 8.7± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > one month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p <0.001), positive blood cultures (p<0.001), low HDL (p <0.001), shock at presentation (p<0.001), cardiac failure (p 0.027),and renal impairment (p <0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349 – 5.971) were significantly predictive of mortality independent of other variables.Conclusions: This study showed high intra-hospital mortality among patients with DFU, with majority of deaths occurring among those with advanced ulcers, bacteremia, cardiac failure and renal impairment. Prompt attention to these factors might be helpful in improving survival from DFU in Nigeria.

scholarly journals A Comparison of Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ying Huang ◽  
Ying Cao ◽  
Mengchen Zou ◽  
Xiangrong Luo ◽  
Ya Jiang ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Prospective Trial ◽  
Punch Biopsy ◽  
Gram Negative Bacteria ◽  
Deep Tissue ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
E Coli ◽  
Grade 3 ◽  
Tissue Specimens

Objective. To compare the efficacy of swabbing versus tissue biopsy for microbiological diagnosis of diabetic foot infection.Methods. This was a prospective trial. Fifty-six patients with diabetic foot infection were divided into the following 3 groups according to the PEDIS grading system: grade 2 (n=10), grade 3 (n=29), and grade 4 (n=17). Two specimens were collected from each wound for microbial culturing after debridement, including a superficial swab and a deep tissue punch biopsy specimen.Results. Swab culturing identified all of the microorganisms isolated from the corresponding deep tissue specimens in 9/10 of grade 2 wounds (90.0%), and this proportion decreased to 12/29 (41.4%) and 7/17 (41.2%) for grades 3 and 4 wounds, respectively (p=0.02). Moreover, the sensitivity for identifying Gram-negative bacteria, such asE. coliandCitrobacter, by swabbing was low (33.3%). In addition, some Gram-negative bacteria, such asSerratiaandRalstonia pickettii, were isolated from deep tissues but not from swabs.Conclusions. Swab culturing may be reliable for identification of pathogens in diabetic foot wounds classified as grade 2. However, it is advisable to culture deep tissue specimens for wounds of grade ≥3 because swab culturing is associated with a high risk of missing pathogens, especially Gram-negative bacteria.

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.

scholarly journals Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

2020 ◽  
Author(s):  
Olufunmilayo O Adeleye ◽  
Ejiofor T Ugwu ◽  
Ibrahim D Gezawa ◽  
Innocent Okpe ◽  
Ignatius Ezeani ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Low Hdl ◽  
Vascular Stenosis ◽  
Grade 3 ◽  
Peripheral Arterial

Abstract Background/Objective: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study is to document contributory factors that predict mortality in patients hospitalized for DFU in Nigeria. Methods: Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented. Co-morbid complications were documented. Results: Mean age 55.9 +/- 12.5 years. 96.1% had type 2 diabetes (DM), the mean duration of DM was 8.5 ± 5.7 years. The duration of ulcers was 39 days with a range of 28 to 54 days. 79.2% presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects (45-64 years) had significantly high mortality- odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252.Variables significantly associated with mortality with the respective p- values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis (< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anaemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (OR 5.128; 95% CI 2.614 – 10.060) followed by renal impairment (OR 2.831; 95% CI 1.346 – 5.953). Conclusions: Mortality among Nigerian diabetic patients admitted for DFU is high. The majority who died during hospitalization for DFU belong to the working-age population. Predictors of mortality were older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL- cholesterol, anaemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

scholarly journals Isolation and Antibiotic Susceptibility of the Microorganisms Isolated from Diabetic Foot Infections in Nemazee Hospital, Southern Iran

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Mojtaba Anvarinejad ◽  
Gholamreza Pouladfar ◽  
Aziz Japoni ◽  
Shahram Bolandparvaz ◽  
Zeinab Satiary ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Antibiotic Sensitivity ◽  
Empirical Therapy ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Public Health Issue ◽  
Gram Negative Bacteria ◽  
Cross Sectional ◽  
Gram Negative ◽  
Diabetic Foot Infections

Background. Diabetic foot infections (DFIs) are a major public health issue and identification of the microorganisms causing such polymicrobial infections is useful to find out appropriate antibiotic therapy. Meanwhile, many reports have shown antibiotic resistance rising dramatically. In the present study, we sought to determine the prevalence of microorganisms detected on culture in complicated DFIs in hospitalized patients and their antibiotic sensitivity profiles.Methods. A cross-sectional study was conducted for a period of 24 months from 2012 to 2014 in Nemazee Hospital, Shiraz, Iran. The demographic and clinical features of the patients were obtained. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method.Results. During this period, 122 aerobic microorganisms were isolated from DFIs. Among Gram-positive and Gram-negative bacteria,Staphylococcusspp. andE. coliwere the most frequent organisms isolated, respectively. Of the isolates, 91% were multidrug while 78% ofS. aureusisolates were methicillin resistant. 53% of Gram-negative bacteria were positive for extended-spectrumβ-lactamase.Conclusion. Given the involvement of different microorganisms and emergence of multidrug resistant strains, clinicians are advised to consider culture before initiation of empirical therapy.

scholarly journals A Bacteriological Study of Diabetic Foot Infection in an Urban Tertiary Care Hospital in Dhaka City

1970 ◽  
Vol 3 (2) ◽  
pp. 50-54
Author(s):  
Samir Paul ◽  
Lovely Barai ◽  
Ashraf Jahan ◽  
J Ashraful Haq
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Diffusion Method ◽  
Foot Ulcers ◽  
Care Hospital ◽  
Esbl Production ◽  
Bacteriological Study ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Gram Negative Organisms

Identification of organisms and effective antibiotic therapy is an important component of treatment of diabetic foot infections. This study was undertaken to determine the organisms associated with diabetic foot infection (DFI) and their antibiotic sensitivity pattern. A total of 75 patients having type 2 diabetes mellitus with Wagner's grade 1-5 foot ulcers attending BIRDEM hospital were included in the study. Specimens were processed for aerobic culture. The bacteriological isolation and antimicrobial sensitivity tests of the isolates were done by standard microbiological methods. Gram negative bacilli were tested for extended spectrum â lactamase (ESBL) production by double disc diffusion method. Culture was positive in 92% of the cases which yielded 135 pathogens. Of the positive culture, 75.3% had multiple organisms. Polymicrobial infection was more in higher grade of foot ulcers. Gram negative organisms were most frequently isolated (80%) bacteria. Pseudomonas (48%) and Proteus sp.(33%) was the most common Gram negative organisms isolated. Staphylococcus aureus was the most commonly isolated gram positive organism (21.3%). ESBL production was noted in 31.5% Gram negative bacilli and methicillin resistance was noted in 43.8% of Staphylococcus aureus. Most of the Gram negative bacilli were resistant to various classes of antibiotics. Imepenem was the most effective agent against Gram negative organisms, while vancomycin was for staphylococcus. The present study has shown that infection with multidrug resistant Gram negative bacilli is the most common cause of DFI in BIRDEM hospital. Ibrahim Med. Coll. J. 2009; 3(2): 50-54   DOI: 10.3329/imcj.v3i2.4216

scholarly journals Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

2019 ◽  
Author(s):  
OLUFUNMILAYO OLUBUSOLA ADELEYE ◽  
Ejiofor T Ugwu ◽  
Ibrahim D Gezawa ◽  
Innocent Okpe ◽  
Ignatius Ezeani ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Low Hdl ◽  
Vascular Stenosis ◽  
Grade 3 ◽  
Peripheral Arterial

Abstract Background/Objective : Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. We sought to document contributory factors which predict mortality in patients hospitalized for DFU. Methods : Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria ( MEDFUN ), one-year observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented. Co-morbid complications were documented. Results : Mean age 55.9 12.5 years.96.1% had type 2 diabetes (DM), mean duration of DM was 8.5 ± 5.7 years. Duration of ulcer was 39 days with a range of 28 to 54 days. 79.2% presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects ( 45-64 years) had significantly higher mortality- odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252, and P-value 0.022. Variables significantly associated with mortality with the respective p- values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality ; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis(< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (adjusted OR 5.128; 95% CI 2.614 – 10.060) followed by renal impairment (adjusted OR 2.831; 95% C.I. for OR 1.346 – 5.953). Conclusions : Mortality among Nigerian diabetic patients admitted for DFU is high, univariate predictors of mortality: older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL- cholesterol, anemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

Determination of the incidence of carbapenem-resistant pseudomonas aeruginosa in patients suffering with diabetic foot ulcers

2021 ◽  
Vol 7 (2) ◽  
pp. 85-89
Author(s):  
Sangeetha C Patil ◽  
Surekha Y A
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcers ◽  
Aerobic Bacteria ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Gram Stain ◽  
Sample Collection ◽  
Diabetic Ulcer ◽  
Carbapenem Resistant

The present study was undertaken to determine the incidence of carbapenem-resistant in patients suffering from diabetic foot ulcers. A total of one hundred patients with diabetic ulcer admitted in surgical wards, VIMS, Bellary were studied. Swabs were collected from the depth of the ulcers on the feet of the diabetic patients. From each patient, two swabs were collected. One swab was used for the isolation of aerobic bacteria and the other for preparation of smear for Gram stain. Debrided necrotic material was also collected. After sample collection, the specimens were processed immediately in the laboratory. Out of 100 cases, 40 (40%) patients presented with ulcer of 2-4 weeks duration. Out of 165 organisms isolated, most common isolate were 38(23.03%), followed by 34 (20.6%), 2(16.96%), 26(15.75%), 23(13.93%), 8(4.84%), 4(2.42%) and 4(2.42%) The carbapenems seem to be successful against the .

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