Bacteriological profile and antimicrobial sensitivity pattern of isolates from diabetic foot of patients attending a teaching hospital in Northern India

Background: Diabetic foot ulcer is a major cause for diabetes related morbidity and hospitalization. Up to one-third of people with diabetes develop diabetic foot ulceration (DFU) during their lifetime and over 50% of these ulcerations become infected. Diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, high costs, increased risk of lower extremity amputation (LEA), and reduced quality of life. Aims and Objective: The current study was conducted to determine the microbiological profile and antibiotic susceptibility pattern of organisms in diabetic foot ulcers patients at a tertiary care center in Srinagar province. Material and Methods: This was a Cross-sectional, observational study conducted in diabetic patients with diabetic foot infection, randomly selected from outpatient departments (OPDs) and wards of Surgery and Medicine department, with Wagner grade 1-5 ulcers and irrespective of anti-diabetic treatment and diabetic foot injury treatment. Samples were processed and bacterial isolates were identified by standard microbiological procedures. Results: After following inclusion and exclusion criteria, 120 patients were considered for this study. In present study most common age group was 51-60 years age group (44%) followed by 41-50 years (32%). 66% of participants were males. 55% patients had diabetes for more than 10 years. 43% patients had ulcer size less than 5 cm2. The most common category as per Wagner’s classification was Grade 1, which comprised of 48% of study participants, followed by Grade 0 (28%) and Grade 2 (18%). Grade 3 and above comprised 7% of cases. Of the 120 study participants, 103 (86%) showed growth on culture. Among these 62 (60%) showed mono-microbial growth with 41 cases showing mixed growth. The most commonly isolated bacteria were Methicillin Resistant Staphylococcus aureus (MRSA) (23%), Coagulase Negative Staphylococci (CoNS) (18%), pseudomonas aeruginosa (18%), Methicillin Sensitive-Staphylococci Aureus (9%), Klebsiella Pneumoniae (9%), and Escherichia Coli (8%). Linezolid, vancomycin, clindamycin, gentamicin were most effective antimicrobial agents against gram positive bacteria. Iimipenem, piperacillin tazobactam, cefoperazone sulbactam & gentamicin were most effective antimicrobial agents against gram negative bacteria. Conclusion: Early microbiological evaluation for bacteriological profile, the nature of the infection either monomicrobial or polymicrobial and antibiotic sensitivity testing can improve treatmentoutcome, reduces complications, morbidity as well as multidrug resistance.

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Multidisciplinary Approach for the Management and Treatment of Diabetic Foot Infections with a Resorbable, Gentamicin-Loaded Bone Graft Substitute

Journal of Clinical Medicine ◽

10.3390/jcm9113586 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3586

Author(s):

Christine Whisstock ◽

Antonio Volpe ◽

Sasa Ninkovic ◽

Mariagrazia Marin ◽

Marco Meloni ◽

...

Keyword(s):

Bone Graft ◽

Diabetic Foot ◽

Multidisciplinary Approach ◽

Calcium Sulphate ◽

Bone Graft Substitute ◽

Diabetic Patients ◽

Ulcer Formation ◽

Adequate Treatment ◽

Diabetic Foot Infections ◽

Increased Risk

Diabetic patients are at increased risk of developing foot ulcers which may cause bone infections associated with a high probability of both amputation and mortality. Therefore, prompt diagnosis and adequate treatment are of key importance. In our Diabetic Foot Unit, effective multidisciplinary treatment of osteomyelitis secondary to diabetes involves the application of a gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute to fill residual bone voids after debridement. The data of all patients treated with the gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute for diabetic foot infections with ulcer formation and osteomyelitis at metatarsals, calcaneus and hindfoot at our institute from July 2013 to September 2016 were retrospectively collected and evaluated. A total of 35 patients were included in this retrospective single-arm case series and were either continuously followed up for at least one year or until healing was confirmed. Nineteen lesions affected the distal row of tarsus/talus, ten the calcaneus and a further six were located at the metatarsals. While all of the metatarsal lesions had healed at 1-year follow-up, the healing rate in the hindfoot region was lower with 62.5% at the calcaneus and 72.2% at the distal tarsus and talus at 12 months, respectively. The overall cure rate for ulcerous bone infection was 81.3%. In two calcaneal lesions (25%) and two lesions of distal tarsus/talus (11.1%) amputation was considered clinically necessary. Promising results were achieved in the treatment of diabetic foot infections with soft tissue ulcers by a multidisciplinary approach involving extensive debridement followed by adequate dead space management with a resorbable gentamicin-eluting bone graft substitute.

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A study to assess anemia and hypoalbuminemia in diabetic patients with ulcers

International Surgery Journal ◽

10.18203/2349-2902.isj20213123 ◽

2021 ◽

Vol 8 (8) ◽

pp. 2324

Author(s):

Devaprashanth M. ◽

B. S. Ramesh ◽

Pushpa Satish Kumar

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Nutritional Deficiencies ◽

Foot Ulcers ◽

Public Health Issue ◽

Diabetic Patients ◽

Age Group ◽

Diabetic Foot Ulcers ◽

Female Patients ◽

Male Patients

Background: Diabetic foot is a severe public health issue. Nutrition is important in the repair of soft tissue injuries and wound healing and specific nutrients have been shown to enhance wound healing. Anemia and hypoalbuminemia are among the commonly encountered deficiencies in patients. Early detection of nutritional deficiencies and their prompt treatment is imperative for the effective management of diabetic foot ulcers. The aim of the study was to investigate the prevalence of anemia and hypoalbuminemia in diabetic foot patients presenting at our institution.Methods: Hemoglobin and albumin levels of 175 patients with diabetic foot were collected. Data was tabulated and analysed with descriptive statistics.Results: Hemoglobin varied from 6.5 g/dl to15 g/dl (10.5±2.3 g/dl). 116 (66.28%) patients had anemia. Among the 66 female patients, 43 (65.15%) had anemia. Among the 109 male patients, 73 (66.97%) had anemia. 11 of the 29 patients aged less than 40 had anemia (37.93%), while 105 of the 146 (71.91%) patients above 40 years had anemia. Albumin levels ranged from 1.6 g/dl to 5.4 g/dl (3.3±1.06 g/dl). 93 (53.14%) patients had hypoalbuminemia. 33 of the 66 female patients (50%) had hypoalbuminemia. 60 (55.04%) of the 109 male patients had hypoalbuminemia. 4 of the 29 (13.79%) patients below 40 years had hypoalbuminemia 89 of the 146 patients (60.9%) above 40 years had hypoalbuminemia.Conclusions: Anemia and hypoalbuminemia are common in patients with diabetic foot ulcers, with males being more commonly affected by both than females and older age group being more commonly affected than younger age group.

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A prospective observation study on diabetic foot ulcer using diabetic ulcer severity score at tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20214744 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3553

Author(s):

Bharti Saraswat ◽

Kapil Kumar Gill ◽

Ashok Yadav ◽

Krishan Kumar

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Scoring Systems ◽

Foot Ulcers ◽

Diabetic Patients ◽

Care Hospital ◽

Age Group ◽

Diabetic Foot Ulcers ◽

Diabetic Ulcer

Background: A number of scoring systems and classifications are available for diabetic foot ulcers with intention to compare the treatment modalities and future outcomes. Many of them are complex and don’t predict future outcome within the patients. Aim and objectives of current study were to establish a wound-based clinical scoring systems (DUSS) as daily clinical practice by assessing the efficacy of diabetic ulcer severity score.Methods: A total of 73 diabetic patients with foot ulcers were included in this prospective observational study conducted at Dr. S.N. Medical college, Jodhpur and attached hospitals from July 2018 to August 2020. Ulcers were assessed and DUSS score created. Patients were followed up for six months or until healing or amputation if either.Results: In this prospective study of 73 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean age group was 58.57±12.66 years. Mean duration of diabetes was 7.61±5.72 years. Most commonly ulcers were of DUSS score 2. Mean DUSS score was 1.97±1.15. Majority of diabetic foot ulcer patients (37 out of 51) with DUSS score 0, 1 and 2 healed by primary intention after wound debridement. Those with score 3 & 4 majority of them (20 out of 22) had amputation.Conclusions: This is a very simple scoring system that provides an easily accessible and a streamlined approach in the clinical setting without need of any advanced investigative equipment. Hence this can be applied in any set up.

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Asymptomatic bacteriuria in pregnancy

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v14i2.28433 ◽

2019 ◽

Vol 14 (2) ◽

pp. 31-35

Author(s):

Tripti Shrestha ◽

Gehanath Baral

Keyword(s):

Pregnant Women ◽

Antimicrobial Agents ◽

Asymptomatic Bacteriuria ◽

Urine Samples ◽

Urine Specimen ◽

Sensitivity Testing ◽

Microbiological Methods ◽

Sensitivity Pattern ◽

Significant Difference ◽

In Pregnancy

Aims: To estimate the prevalence of asymptomatic bacteriuria, its causative agents and their antimicrobial susceptibility pattern; and to determine the relationship of asymptomatic bacteriuria and pyuria in pregnant women. Methods: A cross sectional study was conducted in a total of 240 asymptomatic pregnant women in Paropakar Maternity and Women’s Hospital from August 2016 to January 2017. Clean catch midstream urine samples were collected from each participant. Urine samples were cultured using standard microbiological methods. Identification of isolates and antibiotic sensitivity testing were done. Results: Out of 240 pregnant women, 17 (7.1%) were positive for asymptomatic bacteriuria [colony forming unit (CFU) >10 5 /ml]. There was no any significant difference in the prevalence of asymptomatic bacteriuria with respect to age, gestational age and parity. The prevalence of asymptomatic bacteriuria was significantly different with respect to education level (p=0.01) and number of pus cells in urine specimen (p=0.04). The most frequently isolated microorganisms were E.coli (70.6 %) followed by Klebsiella spp (11.8%). Ciprofloxacin followed by Nitrofurantoin and Norfloxacin had the highest sensitivity to all the isolates. Conclusions: Asymptomatic bacteriuria is common in pregnancy. Routine urine culture should be done on all pregnant women to detect asymptomatic bacteriuria. Treatment should be based on antimicrobial sensitivity pattern due to increased antibiotic resistance to commonly used antimicrobial agents.

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A Cross Sectional Study to Evaluate Cutaneous Manifestations in Diabetic Patients and their Correlation with Sugar Control at Tertiary Care Center in Western Maharashtra

VIMS Health Science Journal ◽

10.46858/vimshsj.8304 ◽

2021 ◽

Vol 8 (3) ◽

pp. 104-108

Author(s):

Dr. Ashutosh Chate ◽

Dr. Amrut Swami ◽

Ms. Sakshi Rane ◽

Dr. Ramesh Gosavi

Keyword(s):

Skin Diseases ◽

Care Center ◽

Tertiary Care ◽

Diabetic Patients ◽

Age Group ◽

Cross Sectional ◽

Cutaneous Manifestations ◽

Skin Manifestations ◽

Significant Difference ◽

Study Participants

Introduction: Diabetes is a leading chronic disease in world and number of cases are significantly increasing each year in India also. Out of many associated conditions, skin involvement in diabetes also needs to be evaluated. We conducted this study to study relation between the sugar control and skin manifestations in diabetic patients. Methodology: We studied total 100 diabetic patients visiting our dermatology OPD over a period of 1 year from January to December 2020. All skin diseases in diabetic patients were studied. We studied association of these diseases with sugar control in our study participants. Results: Mean age of our study participants was 63.48 ± 18.12 years, Majority of the males were from the age group of 61 and above, 34 (62.96%) while majority of the females were from the age group of 41-60 years 25 (54.35%). Majority of the patients had diabetes for 5-10 years (52%) followed by more than 10 years (36%) and less than 5 years in 24% cases. Out of 100 participants, 44% had controlled diabetes while rest 56% had uncontrolled diabetes with HbA1c > 6. We observed a significant difference in skin manifestations of controlled and uncontrolled sugars in diabetic patients. (p = 0.007). Conclusion: From this study, we conclude that the skin is involved in diabetes quite often. Early diagnosis and treatment of skin manifestations in diabetic patients is important to reduce unwanted morbidity and further complications in the diabetic patients.

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Bacteriology of the burn wound at the Bai Jerbai Wadia Hospital for children, Mumbai, India-A 13-year study, Part I-Bacteriological profile

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699346 ◽

2009 ◽

Vol 42 (02) ◽

pp. 213-218

Author(s):

Shankar Srinivasan ◽

Arvind M. Vartak ◽

Aakanksha Patil ◽

Jovita Saldanha

Keyword(s):

Antibiotic Sensitivity ◽

Age Group ◽

Treatment Facility ◽

Burn Wound ◽

Bacteriological Profile ◽

Sensitivity Pattern ◽

Burn Unit ◽

Set Up ◽

Burns Unit ◽

Microbiological Data

ABSTRACT Aim: To study which organisms were prevalent in our burn unit and their antibiotic sensitivity pattern in brief. Method: Microbiological data of 1534 patients admitted to the burns unit of the Bai Jerbai Wadia Hospital for Children, Mumbai over a period of 13 years (1994-2006) was reviewed retrospectively. A total of 9333 swabs were cultured and antibiotic sensitivities to the isolated organisms determined. The age group of patients admitted to our facility ranged from one month to 15 years. Result: Klebsiella was the predominant organism in our set-up (33.91%), closely followed by Pseudomonas (31.84%). The antibiotic sensitivities of the isolated organisms are discussed in detail in the text. Conclusion: Every treatment facility has microorganisms unique to it and these change with time. It is therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity pattern so that infection-related morbidity and mortality are improved.

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Epidemiology of Diabetic Foot Ulcers and Amputations in Romania: Results of a Cross-Sectional Quality of Life Questionnaire Based Survey

Journal of Diabetes Research ◽

10.1155/2016/5439521 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Cosmina I. Bondor ◽

Ioan A. Veresiu ◽

Bogdan Florea ◽

Etta J. Vinik ◽

Aaron I. Vinik ◽

...

Keyword(s):

Quality Of Life ◽

Diabetic Foot ◽

High Rate ◽

Foot Ulcers ◽

Diabetic Patients ◽

Life Questionnaire ◽

Age Group ◽

Cross Sectional Survey ◽

Cross Sectional

This is a post hoc analysis of quality of life in diabetic neuropathy patients in a cross-sectional survey performed in 2012 in Romania, using the Norfolk QOL-DN in which 21,756 patients with self-reported diabetes were enrolled. This current analysis aims to expand research on the diabetic foot and to provide an update on the number of foot ulcers found in Romania. Of the 21,174 patients included in this analysis, 14.85% reported a history of foot ulcers and 3.60% reported an amputation. The percentage of neuropathy patients with foot ulcers increased with age; the lowest percentage was observed in the 20–29-year age group (6.62%) and the highest in the 80–89-year age group (17.68%). The highest number of amputations was reported in the 70–79-year age group (largest group). Compared to patients without foot ulcers, those with foot ulcers had significantly higher scores for total DN and all its subdomains translating to worse QOL (p<0.001). This analysis showed a high rate of foot ulcers and amputations in Romanian diabetic patients. It underscores the need for implementation of effective screening and educational programs.

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The Visualization of Biofilms in Chronic Diabetic Foot Wounds Using Routine Diagnostic Microscopy Methods

Journal of Diabetes Research ◽

10.1155/2014/153586 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 20

Author(s):

Angela Oates ◽

Frank L. Bowling ◽

Andrew J. M. Boulton ◽

Philip G. Bowler ◽

Daniel G. Metcalf ◽

...

Keyword(s):

Diabetic Foot ◽

Antimicrobial Agents ◽

Chronic Wounds ◽

Environmental Scanning Electron Microscopy ◽

Environmental Scanning ◽

Diabetic Patients ◽

Gram Stain ◽

Bright Field ◽

Planktonic Bacteria ◽

Biofilm Matrix

Diabetic foot wounds are commonly colonised by taxonomically diverse microbial communities and may additionally be infected with specific pathogens. Since biofilms are demonstrably less susceptible to antimicrobial agents than are planktonic bacteria, and may be present in chronic wounds, there is increasing interest in their aetiological role. In the current investigation, the presence of structured microbial assemblages in chronic diabetic foot wounds is demonstrated using several visualization methods. Debridement samples, collected from the foot wounds of diabetic patients, were histologically sectioned and examined using bright-field, fluorescence, and environmental scanning electron microscopy and assessed by quantitative differential viable counting. All samples (n= 26) harboured bioburdens in excess of 5 log10CFU/g. Microcolonies were identified in 4/4 samples by all three microscopy methods, although bright-field and fluorescence microscopy were more effective at highlighting putative biofilm morphology than ESEM. Results in this pilot study indicate that bacterial microcolonies and putative biofilm matrix can be visualized in chronic wounds using florescence microscopy and ESEM, but also using the simple Gram stain.

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Bioactive Antimicrobial Peptides as Therapeutic Agents for Infected Diabetic Foot Ulcers

Biomolecules ◽

10.3390/biom11121894 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1894

Author(s):

Jessica Da Silva ◽

Ermelindo C. Leal ◽

Eugénia Carvalho

Keyword(s):

Wound Healing ◽

Antimicrobial Peptides ◽

Broad Spectrum ◽

Diabetic Foot ◽

Molecular Mechanisms ◽

Antimicrobial Agents ◽

Chronic Wounds ◽

Foot Ulcer ◽

Wound Management ◽

Diabetic Patients

Diabetic foot ulcer (DFU) is a devastating complication, affecting around 15% of diabetic patients and representing a leading cause of non-traumatic amputations. Notably, the risk of mixed bacterial–fungal infection is elevated and highly associated with wound necrosis and poor clinical outcomes. However, it is often underestimated in the literature. Therefore, polymicrobial infection control must be considered for effective management of DFU. It is noteworthy that antimicrobial resistance is constantly rising overtime, therefore increasing the need for new alternatives to antibiotics and antifungals. Antimicrobial peptides (AMPs) are endogenous peptides that are naturally abundant in several organisms, such as bacteria, amphibians and mammals, particularly in the skin. These molecules have shown broad-spectrum antimicrobial activity and some of them even have wound-healing activity, establishing themselves as ideal candidates for treating multi-kingdom infected wounds. Furthermore, the role of AMPs with antifungal activity in wound management is poorly described and deserves further investigation in association with antibacterial agents, such as antibiotics and AMPs with antibacterial activity, or alternatively the application of broad-spectrum antimicrobial agents that target both aerobic and anaerobic bacteria, as well as fungi. Accordingly, the aim of this review is to unravel the molecular mechanisms by which AMPs achieve their dual antimicrobial and wound-healing properties, and to discuss how these are currently being applied as promising therapies against polymicrobial-infected chronic wounds such as DFUs.

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SCORING SYSTEM FOR ASSESSING RISK OF AMPUTATION IN PATIENT'S WITH DIABETIC FOOT

10.36106/ijar/4201781 ◽

2021 ◽

pp. 46-48

Author(s):

Seelam Srinivasa Reddy ◽

Ravipati Sai Krishna ◽

Sai Krishna Bendi ◽

Baratam Grace Evangeline

Keyword(s):

Lower Extremity ◽

Diabetic Foot ◽

Scoring System ◽

Ankle Brachial Index ◽

Lower Extremity Amputation ◽

Diabetic Patients ◽

Acute Phase Reactants ◽

Increased Risk ◽

Peripheral Arterial Diseases ◽

Extremity Amputation

Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Our aim is “To formulate a risk scoring system that can predict the risk of amputation in a patient with an infected diabetic foot”. Previously published studies aimed at identifying independent risk factors for lower-extremity amputation in patients with a DFI have noted an association with older age, the presence of fever, elevated acute-phase reactants, higher HbA1c levels, and renal insufciency. In the current study, we have identied that Age, Duration of diabetes, History of amputations, Ulcer depth, Ankle-brachial index, Severity of infection, and Peripheral neuropathy, Peripheral arterial diseases are signicantly associated with Lower Extremity amputation. Peripheral vascular disease and infection were the most powerful predictors, as 65% of patients who underwent amputations in our study belonged to Rutherford grade 3 and grade 4. We developed a New Risk score for predicting amputation in diabetic patients with an infected foot ulcer, which can be readily used in daily clinical practice without the necessity of extensive lab investigations. Patients with a score of >16.5 are at increased risk of lower extremity amputation. 66.6% of our follow up cases who underwent reamputations belonged to the group with a score of >16.5. Risk of amputation increases as the score increases

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