scholarly journals Drug Utilisation Pattern for Diabetic Foot

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Girish Gowda A ◽  
M Kumarswamy ◽  
Rajesh Venkataramn ◽  
Mary Cheriyan ◽  
Asha Shaji
Keyword(s):  
Public Health ◽  
Health Problem ◽  
Diabetic Foot ◽  
Drug Utilisation ◽  
Foot Ulcer ◽  
Antibiotic Sensitivity ◽  
Public Health Problem ◽  
Diabetic Foot Ulcer ◽  
Therapeutic Outcome ◽  
Study Population

Introduction: Diabetic mellitus is a chronic disorder which is rapidly raising, major public health problem. Having DM are more prone to multifarious complication like diabetic foot ulcer, which is highly susceptible to infection. Prevalence of bacterial flora in foot ulcer of this study population indicate current medical scenario of increased multidrug resistant diabetic foot infection, appropriate selection of antibiotic plays important role in DFU management increasing prevalence of antibiotic resistance is a major factor for morbidity or mortality in DFU. The main objective of this study was to asses microbial sensitive resistance to antibiotic and also to know the drug utilisation of antibiotics in DFU. Method: A prospective observational study was carried out in 123 inpatients, after taking written informed consent from those met the study criteria. The study was done from October 2017 to march 2018 in surgery department. Patient case sheet were reviewed and assessed on daily basis. Culture report form and all other relevant data were collected to assess the utilisation of antibiotic, it’s sensitivity and resistant interaction, drug interactions and ADR were assessed by using Micromedex and other resources available in the department Result: In this study population, about 87(70.3%) patients were male and 36(29.27%) female. Mainly patients of age range 41-50 is 47(38.21%)followed by 51-60 is 33(26.83%)then 61-70 is 23(18.70%).Hospital Conclusion: Diabetic foot infections are real public health problem and early diagnosis along with appropriate treatments are essential. Different bacterial profiles and antibiotic sensitivity were found in different DFU. Clinician should try to stay updated in antibiotic sensitivity and resistant pattern of common pathogen in their area for better therapeutic outcome and to minimize medication errors. Keywords: Diabetic foot ulcer, sensitivity, resistant, utilization of antibiotics, therapeutic outcome.  

STUDY OF SURGICAL MANAGEMENT AND COMPLICATIONS OF DIABETIC FOOT ULCER

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Dr. Devi Das Verma ◽  
Dr. Anil Kumar Saxena
Keyword(s):  
Health Problem ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
World Health ◽  
Foot Ulcers ◽  
Age Group ◽  
Major Health Problem ◽  
Split Skin Grafting ◽  
Foot Problems

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.

Empirical Antibiotic Treatment in Diabetic Foot Infection: A Study Focusing on the Culture and Antibiotic Sensitivity in a Population From Southern China

2017 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Wen-xia Wu ◽  
Dan Liu ◽  
Yi-wen Wang ◽  
Chuan Wang ◽  
Chuan Yang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Southern China ◽  
Foot Ulcer ◽  
Antibiotic Sensitivity ◽  
Diabetic Foot Ulcer ◽  
Severe Infection ◽  
Third Generation ◽  
Diabetic Ulcer ◽  
Significant Difference

Diabetic foot and subsequent diabetic ulcer infections are the most devastating complication of diabetes. This study was conducted to explore the bacterial spectrum, sensitivity of microbials, and analysis of the empirical antibiotic regimens in our health center. The study included patients with diabetic foot ulcer infection (DFI) seen from 2009 to 2014. The patients included had all information covering the physical examination, laboratory tests, and image examinations. We sent appropriately obtained specimens for culture prior to starting empirical antibiotic therapy in all participants. A total of 312 patients were included: 52, 112, 95 and 53 patients within uninfected, mild, moderate, and severe infection groups. The total percentages of Gram-positive cocci (GPCs) and Gram-negative rods (GNRs) were 54% and 48.8% ( P = 0.63). The most common GPC was Staphylococcus aureus (22.4%) and GNR was Pseudomonas aeruginosa (11.9%). Methicillin-resistant Staphylococcus aureus was isolated from 21 patients (6.7%). Even in the mild infection group, there was no significant difference between GPC and GNR infection, irrespective of recent antibiotic use ( P = 0.053). The most frequently used empirical antibiotics in our center were second-/third-generation cephalosporin ± clindamycin, both in the mild and moderate/severe infection groups. In our center, the amoxicillin/clavulanate or ampicillin/sulbactam (β-L-ase 1) and second-/third-generation cephalosporins were highly resistant to the common GNR (30%-60%). The ticarcillin/clavulanate, piperacillin/tazuobactam (β-L-ase 2), fluoroquinolone, and group 2 carbapenem had good sensitivity. This study presents a comprehensive microbiological survey of diabetic foot ulcers in inpatients and provides reliable evidence of the local microbial epidemiology and sensitivity of antibiotics, which may help us improve clinical outcomes in DFI patients.

scholarly journals Low dietary calcium in European postmenopausal osteoporotic women

2009 ◽  
Vol 12 (1) ◽  
pp. 111-114 ◽  
Author(s):  
Olivier Bruyere ◽  
Caroline De Cock ◽  
Catherine Mottet ◽  
Audrey Neuprez ◽  
Olivier Malaise ◽  
...  
Keyword(s):  
Public Health ◽  
Dietary Intake ◽  
Postmenopausal Women ◽  
Health Problem ◽  
Public Health Problem ◽  
European Countries ◽  
Study Population ◽  
The Mean ◽  
The Difference ◽  
The Uk

AbstractObjectiveThe WHO recommends a daily Ca intake for postmenopausal women of 1300 mg. The objective of the present study was to assess the dietary Ca intake in European postmenopausal osteoporotic women.Design, setting and subjectsAssessment of dietary Ca intake (food and supplements) was performed with a validated self-questionnaire in 8524 osteoporotic women from nine European countries (Belgium, Denmark, France, Germany, Hungary, Italy, Poland, Spain and the UK).ResultsMean age of the patients was 74·2 (sd 7·1) years, mean BMI was 25·7 (sd 4·2) kg/m2. Of the study population, 37·2 % of the women took Ca supplements. The mean dietary intake of Ca was 930·7 (sd 422·9) mg/d. The lowest Ca intake was found in Hungary (586·7 (sd 319·1) mg/d) and the highest in Denmark (1145·6 (sd 463·0) mg/d). In the whole study population, only 19·1 % of the women had a dietary Ca intake >1300 mg/d. Only 17·1 % of women aged over 75 years achieved 1300 mg/d compared with 20·5 % of women aged less than 75 years (P = 0·0001 for the difference between the two groups).ConclusionDietary intake of Ca is very low in European postmenopausal women. A greater awareness is needed to resolve this public health problem.

scholarly journals A clinical study of commonly isolated organism and its antibiotic sensitivity in diabetic foot ulcers in Sri Manakula Vinayagar Medical College and Hospital, Pondicherry

2020 ◽  
Vol 7 (8) ◽  
pp. 2512
Author(s):  
Anand Shanmugaiah ◽  
Saravanan Pandian ◽  
Sudha Selvam
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Sugar ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Antibiotic Sensitivity ◽  
Diabetic Foot Ulcer ◽  
Empirical Therapy ◽  
Gram Negative ◽  
Medical College ◽  
Diabetic Foot Infections

Background: Diabetic foot ulcer is one of the major surgical problem leading to hospital admission. Diabetic foot ulcer patients with uncontrolled diabetes may end up in forefoot amputation. Early aggressive debridement, control of blood sugar and empirical antibiotic therapy would reduce the morbidities in patients with diabetic foot ulcer. Further the knowledge of commonly isolated microbes and their antibiotic sensitivity pattern would be helpful to start empirical therapy. The purpose of this study was to determine the microbiological profile of diabetic foot infections (DFIs) and assess the antibiotic susceptibility of the causative agents.Methods: This cross-sectional study was conducted in 115 patients admitted with diabetic foot ulcer over a period of 9 months from October 2015 to June 2016 at the department of general surgery, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. Tissue scrapping samples were collected and processed as per standard guidelines.Results: 167 organisms were isolated from 115 patients. 52% of culture showed polymicrobial growth. There was increased prevalence of gram-negative organisms 53% compared to gram positive organisms 47%. When comes to individual isolate, Staphylococcus aureus was the most common organism isolated 24.6% followed by Pseudomonas aeruginosa 21%. All gram-positive aerobes were sensitive to vancomycin and gram-negative isolates were sensitive to amikacin, piperacillin-tazobactum, gentamycin and cefotaxime.Conclusions: Staphylococcus aureus and Pseudomonas were the common pathogens isolated. This study recommends use of vancomycin along with piperacillin-tazobactum as an empirical therapy along with adequate blood sugar control and early debridement of devitalized tissues in patients with diabetic foot infections.

scholarly journals Amit Jain’s system of practice for diabetic foot: the new religion in diabetic foot field

2018 ◽  
Vol 5 (2) ◽  
pp. 368
Author(s):  
Amit Kumar C. Jain
Keyword(s):  
Public Health ◽  
Health Problem ◽  
Diabetic Foot ◽  
Public Health Problem ◽  
New Developments ◽  
New Concepts ◽  
Separate System ◽  
New Religion

Diabetic foot is a known public health problem and a devastating complication of diabetes that is known to lead to amputation. Past decade has seen various new developments in field of diabetic foot. Amit Jain’s system of practice for diabetic foot is one new such development that was developed for improvising and standardization of diabetic foot. Various new concepts were laid down under this system, thereby creating a separate system that can be equated or considered to be a new religion in diabetic foot field.

scholarly journals Bacterial Profile and Antibiotic Resistance in Patients with Diabetic Foot Ulcer in Guangzhou, Southern China: Focus on the Differences among Different Wagner’s Grades, IDSA/IWGDF Grades, and Ulcer Types

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Xiaoying Xie ◽  
Yunwen Bao ◽  
Lijia Ni ◽  
Dan Liu ◽  
Shaona Niu ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Diabetic Foot ◽  
Southern China ◽  
Foot Ulcer ◽  
Antibiotic Sensitivity ◽  
Diabetic Foot Ulcer ◽  
Resistance Pattern ◽  
Ischemic Ulcer ◽  
Resistance Patterns ◽  
Resistance Rates

Objective. To understand the bacterial profile and antibiotic resistance patterns in diabetic foot infection (DFI) in different Wagner’s grades, IDSA/IWGDF grades, and different ulcer types in Guangzhou, in order to provide more detailed suggestion to the clinician about the empirical antibiotic choice. Methods. 207 bacteria were collected from 117 DFIs in Sun Yat-sen Memorial Hospital from Jan.1, 2010, to Dec.31, 2015. The clinical data and microbial information were analyzed. Results. The proportion of Gram-negative bacteria (GNB) was higher than Gram-positive bacteria (GPB) (54.1% versus 45.9%), in which Enterobacteriaceae (73.2%) and Staphylococcus (65.2%) were predominant, respectively. With an increasing of Wagner’s grades and IDSA/IWGDF grades, the proportion of GNB bacterial infection, especially Pseudomonas, was increased. Neuro-ischemic ulcer (N-IFU) was more susceptible to GNB infection. Furthermore, with the aggravation of the wound and infection, the antibiotic resistance rates were obviously increased. GPB isolated in ischemic foot ulcer (IFU) showed more resistance than the N-IFU, while GNB isolates were on the opposite. Conclusions. Different bacterial profiles and antibiotic sensitivity were found in different DFU grades and types. Clinician should try to stay updated in antibiotic resistance pattern of common pathogens in their area. This paper provided them the detailed information in this region.

scholarly journals A study on clinical grading and bacteriological profile of diabetic foot ulcers in tertiary care centre

2020 ◽  
Vol 7 (7) ◽  
pp. 2342 ◽  
Author(s):  
Mohammed Hamza ◽  
Thomas K. Thomas
Keyword(s):  
Treatment Outcome ◽  
Diabetic Foot ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Antibiotic Sensitivity ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Tertiary Care Centre ◽  
Wagner’S Grade

Background: Diabetes is one of the commonest diseases worldwide and diabetic foot ulcer and its complications are associated with significant morbidity and even amputation. Early detection of colonizing agent of these ulcers help in reduced morbidity and hospital stay. We targeted this subgroup of patients to study Wagner’s grade, identify the bacterial agent and its antibiotic sensitivity and ankle-brachial pressure index (ABPI) assessment to detect PAD, for the best treatment outcome of diabetic foot ulcers.Methods: The present study was conducted in the Department of Surgery of SGMCRF, Venjaramoodu on 210 patients with diabetic foot ulcers between November 2017 and May 2019. Wagner’s grading of ulcer, culture and antibiotic sensitivity of microbe were done as well as ABPI was measured. Outcome of ulcers was compared to ABPI and ABPI was compared to time of healing.Results: Out of 210 patients 122 were males and 88 females, 62.9% had neuropathy and 66.7% had vasculopathy. Most patients presented with Wagner’s grade-II ulcers.  Most common microbe isolated was pseudomonas aeruginosa which was most sensitive to piperacillin and tazobactam combination. Majority of lesions 62.9% had ABPI in range of 0.5-0.89.Conclusions: Wagner’s grading and presence of neuropathy are predictors of major amputation. Piperacillin and tazobactam should be empirical choice of antibiotic. ABPI was inversely related to time of healing and has got significant association with treatment outcome.

scholarly journals Bacteriological Profile and Antibiotic Sensitivity Pattern in Infected Diabetic Foot Ulcers

Esculapio ◽  
2020 ◽  
Vol 16 (03, july 2020-Septmber 2020) ◽  
Author(s):  
Afshan Zia
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Antibiotic Sensitivity ◽  
Diabetic Foot Ulcer ◽  
Empiric Therapy ◽  
Sensitivity Pattern ◽  
Pseudomonas Species ◽  
Third Generation Cephalosporins ◽  
Proteus Species

Objectives: To identify the common bacterial pathogens responsible for infection in diabetic foot ulcer and their sensitivity pattern to different antibiotics. Methods: This prospective observational study was conducted from 24th June 2019 to 27th December 2019 at Services Institute of Medical Sciences Lahore. Specimens of discharge from diabetic foot ulcers (DFU) were received from Diabetes Management Centre (DMC). Cultures were put up and bacteria isolated were identified by standard methods. Antibiotic sensitivity was determined by Kirby-Bauer disc diffusion method. Results: Samples from DFU of 50 patients were processed. Thirty-six (72%) samples were from males and 14(28%) were from females; mean age of patients was 53±9.5 years. Forty-nine (98%) patients had unsatisfactory glycemic control. Forty three (86%) samples were growth positive while 07(14%) were bacteriologically sterile. Monomicrobial infection was observed in 38 (76%) cases while polymicrobial infection was seen in 12 cases (24%). The most common isolates were Staphylococcus aureus 14(28%), Pseudomonas species 11 (22%) and Proteus species 10 (20%). Forty three percent of Staphylococcus aureus, were methicillin resistant (MRSA). All MRSA remained sensitive to vancomycin and linezolid. In Pseudomonas species, resistance to third generation cephalosporins, ceftazidime , was 27%, while resistance to imipenem was seen in 3 (9%) of isolates. In Proteus species, resistance to third generation cephalosporins was 90% while to imipenem resistance was 60%. Resistance to commonly prescribed quinolones was more than 70% among all the bacterial isolates. Conclusions: Common Gram positive and Gram negative organisms responsible for infection in DFU were Staphylococcus aureus, Pseudomonas species and Proteus species. The isolates were multi-drug resistant (MDR). Resistance to antibiotics used as empiric therapy was high. Keywords: Diabetic foot ulcer, antibiotic resistance, empiric therapy

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