Study the susceptibility pattern of bacteria isolated from infected wounds and determine various risk factors associated with foot ulcer

2020 ◽  
Vol 10 (3) ◽  
pp. 52-58
Author(s):  
Divya C Reddy ◽  
Ashin Vareeth ◽  
Bonnie Ascah Joseph ◽  
Anu Thomas ◽  
Sheba Baby John ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Susceptibility ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Previous History ◽  
Foot Ulcer ◽  
College Teaching ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Factors Associated

Studying of bacteria prevalence and antimicrobial susceptibility in samples from foot ulcer patients with chronic wounds will provide the epidemiological information on chronic wound infections, representing support for diagnosis, treatment and management of this pathology, thus preventing further complications of foot infection. There are many risk factors associated with a foot ulcer, so identifying those risk factors and preventing them will help in reducing the incidence of the disease to a certain extend.  Identifying the type of organisms causing the chronic wound infection, antibiotic sensitivity and resistance representing support for diagnosis, treatment and management thus preventing further complications of foot infection, and to understand the significant risk factors associated with the development of foot ulcers. An interventional study was conducted among the 80 patients with foot ulcers admitted in General surgery ward of a medical college teaching hospital from Dec 2018 to May 2019. Antimicrobial susceptibility results showed that gram-negative organism was more prevalent and among the species, the isolated majority was found to be Staphylococcus aureus 28 (0.35%) followed by Klebsiella 16(20%) and E.coli15(18.75%). The most sensitive antibiotic found was Meropenam70 (87.5%) followed by Imipenam 67(83.75%) and Linezolid 65(81.25%) The most resistant antibiotic was Cotrimoxazole 66(82.5%). This study concludes that high proportion of foot ulcers were found amongst diabetic patients than non-diabetic patients, and were often associated with trauma, cellulitis, gangrene. Some of the critical risk factors for foot ulcers included low educational status, previous history of foot ulcer, previous amputation was done, duration of ulcers, smoking, peripheral neuropathy, infection and HbA1c levels of patients.

scholarly journals Risk factors for the diabetic foot infection with multidrug-resistant microorganisms in South India

2018 ◽  
Vol 5 (2) ◽  
pp. 675 ◽  
Author(s):  
Manikandan Kathirvel ◽  
Viswakumar Prabakaran ◽  
Jayalakshmi Jayarajan ◽  
Ajay Sivakumar ◽  
Vimalkumar Govindan
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Previous History ◽  
Multidrug Resistant ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Recurrent Ulcer ◽  
Multidrug Resistant Organisms ◽  
Recurrent Ulcers

Background: To analyse the risk-factors contributing to infection with multidrug-resistant organisms.Methods: 150 diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. The microbiological profile was analyzed for each patient. Using internationally accepted criteria, the multidrug-resistant organisms were identified. Risk factors for acquiring MDRO infection were identified using appropriate statistical tools.Results: MDRO were isolated from 99 patients of 150 (66%). 54.8% (153 out of 279) of isolated organisms were multidrug-resistant organisms. By univariate analysis poor glycaemic control, previous hospitalisation, previous history of amputation, previous antibiotic usage, size of the ulcer, necrotic ulcer, recurrent ulcers, higher grade of ulcer, the presence of osteomyelitis, the presence of retinopathy, peripheral vascular disease, neuropathy and polymicrobial culture, were significantly associated with MDRO infected foot ulcers. Analysis by logistic regression indicated that only two factors significantly increased the risk of acquiring MDRO infection. They are recurrent ulcer (OR = 3.39, p <0.05, 95% CI = 1.081-10.664) and higher grade of ulcer (OR = 13.44, p <0.001, 95 % CI =3.595-50.278).Conclusions: The prevalence of MDRO is alarmingly high in infected diabetic foot ulcers. Recurrent ulcers and higher grade of ulcers are more prone to acquire MDROs.

Reducing the burden of chronic wounds: Prevention and management of the diabetic foot in the context of clinical guidelines

2008 ◽  
Vol 13 (3_suppl) ◽  
pp. 82-91 ◽  
Author(s):  
Aidan Searle ◽  
Lone Gale ◽  
Rona Campbell ◽  
Mark Wetherell ◽  
Karen Dawe ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Diabetic Foot ◽  
Clinical Guidelines ◽  
Chronic Wounds ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Shared Decision ◽  
Behavioural Factors

Objectives: Chronic wounds such as diabetic foot and venous leg ulcers are a major burden for health services. Our programme was developed to explore the psychological and behavioural factors that may influence both the incidence of chronic wounds and their progression. The present article focuses on two particular aspects of the programme: patient knowledge of diabetic foot ulceration and factors influencing foot-related behaviour in patients with and without foot ulcers; and patient and podiatrist perspectives of consultations for diabetic foot ulcers. Methods: Two independent qualitative studies were undertaken: one with diabetic patients without a history of ulceration; and the other with diabetic patients with active ulceration and podiatrists treating these patients. Results: We found that patients may find it difficult understanding the rationale underlying prevention and treatment of foot ulcers; ulcerated patients may find it difficult to engage in the management of their foot ulcer outside consultations; and some podiatrists feel frustrated and unsupported in their attempts at empowering and building partnerships with patients. Conclusion: Patient and practitioner factors may contribute to the effective implementation of clinical guidelines regarding education, partnership building and shared decision-making. These findings are discussed in relation to patient education, partnership building and shared decision-making as recommended in NICE guidelines.

scholarly journals Risk Factors for Diabetic Foot Ulcers in Metreleptin Naïve Patients With Lipodystrophy

2021 ◽  
Author(s):  
Onur Saydam ◽  
Basak Ozgen Saydam ◽  
Suleyman Cem Adiyaman ◽  
Melda Sonmez Ince ◽  
Mehmet Ali Eren ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Partial Lipodystrophy ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract AimPatients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population.MethodsNinety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers).Results Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95%CI: 3.31 - 503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95%CI: 2.97 - 246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95%CI: 1.96 - 90.67, p = 0.008).ConclusionOur study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

scholarly journals Risk factors of amputation in diabetic foot infections

2018 ◽  
Vol 5 (4) ◽  
pp. 1399 ◽  
Author(s):  
Quraysh Shabbir Sadriwala ◽  
Bapuji S. Gedam ◽  
Murtaza A. Akhtar
Keyword(s):  
Risk Factors ◽  
Peripheral Neuropathy ◽  
Glycemic Control ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Factors Associated ◽  
Diabetic Foot Infections

Background: Diabetes is the most common underlying cause of foot ulcers, infection, and ischemia, leading to hospitalization and the most frequent cause of non-traumatic lower extremity amputation. Despite well-defined risk factors for diabetic foot ulcer development, limited data are available as to which factors predict amputation in a diabetic foot ulcer episode. Therefore, to predict lower limb amputation occurrence and to determine the factors associated with the risk of amputation in diabetic patients, we conducted this study.Methods: A hospital based longitudinal study was carried out to assess the risk factors associated with amputation in diabetic foot infection. Patients with foot infections, who were either a diagnosed case of diabetes mellitus or were diagnosed at the institute were included in the study. We excluded patients receiving immunosuppressive therapy or radiotherapy, and infections at or above the ankle joint. Study factors were demographic details, biochemical parameters, Wagner grading, peripheral neuropathy as evaluated by nerve conduction test and vasculopathy as assessed by Ankle brachial index. The primary outcome factor was amputation. The data was presented as descriptive statistics and analyzed by dividing the patients into amputation and non-amputation group, and univariate and multivariate analysis was done.Results: A total of 64 patients were included in the study, out of which the amputation rate was 39.1%. Poor glycemic control, osteomyelitis, vasculopathy, peripheral neuropathy and Wagner grading were statistically significant.Conclusions: In the present study, poor glycemic control, vasculopathy, peripheral neuropathy and higher Wagner grade are significant risk factors for amputation in diabetic foot infections.

scholarly journals Frequency of Most Prevalent Bacteria in Wound of Diabetic Foot Ulcers and their Antimicrobial Susceptibility to Antibiotics

2021 ◽  
Vol 15 (9) ◽  
pp. 2223-2225
Author(s):  
Ashfaq Nasir ◽  
Muhammad Najam Iqbal ◽  
Ghulam Hassan ◽  
Muhammad Arshad Abbas ◽  
Hafiz Jawad Abdul Raheem ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antimicrobial Susceptibility ◽  
Diabetic Foot ◽  
Antibiotic Susceptibility ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Cross Sectional

Background: Most of the diabetic patients present as diabetic foot in surgical outdoor and emergency department. Diabetic Foot infections are common and take long duration to be treated. Both Gram positive and Gram negative aerobic bacteria are involved in diabetic foot infection. Aim: To determine the frequency of most prevalent bacteria in wound of diabetic foot ulcers and to determine the antimicrobial susceptibility of isolated bacteria from diabetic foot ulcers so that an empirical antibiotics can be started before the report of culture and sensitivity. Methods: This cross sectional study was conducted in surgical unit 1 of Bahawal Victoria Hospital (BVH) Bahawalpur from 01-08-2020 to 31-07-2021. This study was conducted on 145 patients with diabetic foot ulcer from outdoor and emergency department of BVH. Data about patient’s demography, duration of diabetes, duration of DFUs, type of pathogen and its antibiotic susceptibility was entered on a proforma. Pus sample was obtained from wound under aseptic measures. Culture sensitivity to assess presence of type of pathogen and its antibiotic susceptibility of all the samples was done from the pathology department of the hospital. Results: The mean age of patients was 52.02±10.14 years. There were 77(53.1%) males and 68(46.9%) females. The foot ulcer’s mean duration was 3.81±1.43 months. There were 15(10.3%) patients with St. aureus, 12(8.3%) with E.coli, 12(8.3%) with Proteus mirabilis, 15(10.3%) with P. aeruginosa, 12(8.3%) with Enterobacter spp., 9(6.2%) with Morganella spp., 19(13.1%) with P. vulgaris, 18(12.4%) with P. Mirabilis, 16(11%) with K. pneumonia and 17(11.75) with Morganella pathogen in this study. There were 74(51%) patients sensitive to Amikacin, 73(50.3%) sensitive to Amoxicillin, 66(45.5%) sensitive to Aztreonam, 74(51%) sensitive to Ceftriaxone, 75(51.7%) sensitive to Cefuroxime and 68(49.6%) sensitive to Cephazolin. Conclusion: The most frequent organisms in DFUs, regardless of age, gender and comorbidity, were P. vulgaris, St. aureus and P. aeruginosa. The most sensitive antibiotic in these ulcers was Piperacillin and Meropenem and the most resistant was Cephazolin. Keywords: Diabetic Foot Ulcers, Antimicrobial Susceptibility, St. aureus, P. vulgaris, P. aeruginosa, Piperacillin

scholarly journals Redefining the Chronic-Wound Microbiome: Fungal Communities Are Prevalent, Dynamic, and Associated with Delayed Healing

mBio ◽  
2016 ◽  
Vol 7 (5) ◽  
Author(s):  
Lindsay Kalan ◽  
Michael Loesche ◽  
Brendan P. Hodkinson ◽  
Kristopher Heilmann ◽  
Gordon Ruthel ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
High Throughput Sequencing ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Fungal Communities ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Antibiotic Administration ◽  
Impaired Wound Healing ◽  
Over Time

ABSTRACTChronic nonhealing wounds have been heralded as a silent epidemic, causing significant morbidity and mortality especially in elderly, diabetic, and obese populations. Polymicrobial biofilms in the wound bed are hypothesized to disrupt the highly coordinated and sequential events of cutaneous healing. Both culture-dependent and -independent studies of the chronic-wound microbiome have almost exclusively focused on bacteria, omitting what we hypothesize are important fungal contributions to impaired healing and the development of complications. Here we show for the first time that fungal communities (the mycobiome) in chronic wounds are predictive of healing time, associated with poor outcomes, and form mixed fungal-bacterial biofilms. We longitudinally profiled 100, nonhealing diabetic-foot ulcers with high-throughput sequencing of the pan-fungal internal transcribed spacer 1 (ITS1) locus, estimating that up to 80% of wounds contain fungi, whereas cultures performed in parallel captured only 5% of colonized wounds. The “mycobiome” was highly heterogeneous over time and between subjects. Fungal diversity increased with antibiotic administration and onset of a clinical complication. The proportions of the phylumAscomycotawere significantly greater (P= 0.015) at the beginning of the study in wounds that took >8 weeks to heal. Wound necrosis was distinctly associated with pathogenic fungal species, while taxa identified as allergenic filamentous fungi were associated with low levels of systemic inflammation. Directed culturing of wounds stably colonized by pathogens revealed that interkingdom biofilms formed between yeasts and coisolated bacteria. Combined, our analyses provide enhanced resolution of the mycobiome during impaired wound healing, its role in chronic disease, and impact on clinical outcomes.IMPORTANCEWounds are an underappreciated but serious complication for a diverse spectrum of diseases. High-risk groups, such as persons with diabetes, have a 25% lifetime risk of developing a wound that can become chronic. The majority of microbiome research related to chronic wounds is focused on bacteria, but the association of fungi with clinical outcomes remains to be elucidated. Here we describe the dynamic fungal communities in 100 diabetic patients with foot ulcers. We found that communities are unstable over time, but at the first clinical presentation, the relative proportions of different phyla predict healing times. Pathogenic fungi not identified by culture reside in necrotic wounds and are associated with a poor prognosis. In wounds stably colonized by fungi, we identified yeasts capable of forming biofilms in concert with bacteria. Our findings illuminate the associations of the fungal mycobiome with wound prognosis and healing.

scholarly journals Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study

2020 ◽  
Author(s):  
Baha Zantour ◽  
Soumaya Bouchareb ◽  
Zohra El Ati ◽  
Fadia Boubaker ◽  
Wafa Alaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Foot Ulcer ◽  
Risk Groups ◽  
School Level ◽  
Foot Deformities ◽  
Diabetic Patients ◽  
Foot Ulceration ◽  
Factors Associated

Abstract BackgroundDiabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk gradeMethodsCross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. ResultsAmong 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher–risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR=2.529, CI95 [1.131-5.655], p=0.024), hyperkeratosis (OR=2.658, CI95 [1.222-5.783], p=0.014) and school level (OR=0.489, CI95 [0.253-9.44], p=0.033)Conclusions Risk factors for foot ulceration were rather common in diabetic outpatients. The screening of diabetic patients at risk for foot ulceration should start early, integrated with sustainable patient education

scholarly journals Risk factors for diabetic foot ulcers in metreleptin naïve patients with lipodystrophy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
O Saydam ◽  
B Ozgen Saydam ◽  
SC Adiyaman ◽  
M Sonmez Ince ◽  
MA Eren ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Partial Lipodystrophy ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Aim Patients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population. Methods Ninety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers). Results Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95% CI: 3.31–503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95% CI: 2.97–246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95% CI: 1.96–90.67, p = 0.008). Conclusions Our study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

The Feasibility and Effectiveness of Wearable Sensor Technology in the Management of Elderly Diabetics with Foot Ulcer Remission: A Proof-Of-Concept Pilot Study with Six Cases

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Chenzhen Du ◽  
Hongyan Wang ◽  
Heming Chen ◽  
Xiaoyun Fan ◽  
Dongliang Liu ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Stride Length ◽  
Wearable Sensors ◽  
Foot Ulcer ◽  
Wearable Devices ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Wearable Sensor ◽  
Double Support ◽  
Gait Parameters

Aims: Using specials wearable sensors, we explored changes in gait and balance parameters, over time, in elderly patients at high risk of diabetic foot, wearing different types of footwear. This assessed the relationship between gait and balance changes in elderly diabetic patients and the development of foot ulcers, in a bid to uncover potential benefits of wearable devices in the prognosis and management of the aforementioned complication. Methods: A wearable sensor-based monitoring system was used in middle-elderly patients with diabetes who recently recovered from neuropathic plantar foot ulcers. A total of 6 patients (age range: 55–80 years) were divided into 2 groups: the therapeutic footwear group (n = 3) and the regular footwear (n = 3) group. All subjects were assessed for gait and balance throughout the study period. Walking ability and gait pattern were assessed by allowing participants to walk normally for 1 min at habitual speed. The balance assessment program incorporated the “feet together” standing test and the instrumented modified Clinical Test of Sensory Integration and Balance. Biomechanical information was monitored at least 3 times. Results: We found significant differences in stride length (p < 0.0001), stride velocity (p < 0.0001), and double support (p < 0.0001) between the offloading footwear group (OG) and the regular footwear group on a group × time interaction. The balance test embracing eyes-open condition revealed a significant difference in Hip Sway (p = 0.004), COM Range ML (p = 0.008), and COM Position (p = 0.004) between the 2 groups. Longitudinally, the offloading group exhibited slight improvement in the performance of gait parameters over time. The stride length (odds ratio 3.54, 95% CI 1.34–9.34, p = 0.018) and velocity (odds ratio 3.13, 95% CI 1.19–8.19, p = 0.033) of OG patients increased, converse to the double-support period (odds ratio 6.20, 95% CI 1.97–19.55, p = 0.002), which decreased. Conclusions: Special wearable devices can accurately monitor gait and balance parameters in patients in real time. The finding reveals the feasibility and effectiveness of advanced wearable sensors in the prevention and management of diabetic foot ulcer and provides a solid background for future research. In addition, the development of foot ulcers in elderly diabetic patients may be associated with changes in gait parameters and the nature of footwear. Even so, larger follow-up studies are needed to validate our findings.

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