scholarly journals The Profile of Microbiological Pathogens in Diabetic Foot Ulcers

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei Chai ◽  
Yuqing Wang ◽  
Huancheng Zheng ◽  
Song Yue ◽  
Yan Liu ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Antibiotic Resistant ◽  
Resistant Strains ◽  
Pathogen Spectrum ◽  
Main Complication

Diabetic foot, a main complication of diabetes mellitus, renders the foot susceptible to infection, and may eventually lead to non-traumatic limb amputation due to the deterioration of diabetic foot ulcers (DFUs). Characterizing the pathogen spectrum and antibiotic susceptibility is critical for the effective treatment of DFUs. In the current study, the characteristics and antibiotic susceptibility of the pathogen spectrum were analyzed. Secretions from the DFUs of 102 patients were cultured, and dominant pathogens were identified by using test cards. Antibiotic susceptibility of dominant pathogens was assayed by the Kirby–Bauer assay. We found that the dominant pathogens varied with age, duration of diabetes, blood sugar control, and the initial cause of ulcers. Moreover, the dominant pathogens were susceptible to at least one antibiotic. However, the antibacterial efficacy of several commonly used antibiotics decreased from 2016 to 2019. Our study indicates that the identification of dominant pathogens and antibiotic susceptibility testing is essential for the treatment of DFUs with effective antibiotics, while the abuse of antibiotics should be strictly restrained to reduce the generation of antibiotic-resistant strains.

scholarly journals Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Shabhay ◽  
Pius Horumpende ◽  
Zarina Shabhay ◽  
Andrew Mganga ◽  
Jeff Van Baal ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Random Blood Glucose ◽  
North Eastern ◽  
The Mean

Abstract Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

scholarly journals Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance

2020 ◽  
Vol 8 (10) ◽  
pp. 1580
Author(s):  
Cassandra Pouget ◽  
Catherine Dunyach-Remy ◽  
Alix Pantel ◽  
Sophie Schuldiner ◽  
Albert Sotto ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Biofilm Formation ◽  
Chronic Infection ◽  
Current Knowledge ◽  
Bacterial Species ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Main Role ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes

Foot infections are the main disabling complication in patients with diabetes mellitus. These infections can lead to lower-limb amputation, increasing mortality and decreasing the quality of life. Biofilm formation is an important pathophysiology step in diabetic foot ulcers (DFU)—it plays a main role in the disease progression and chronicity of the lesion, the development of antibiotic resistance, and makes wound healing difficult to treat. The main problem is the difficulty in distinguishing between infection and colonization in DFU. The bacteria present in DFU are organized into functionally equivalent pathogroups that allow for close interactions between the bacteria within the biofilm. Consequently, some bacterial species that alone would be considered non-pathogenic, or incapable of maintaining a chronic infection, could co-aggregate symbiotically in a pathogenic biofilm and act synergistically to cause a chronic infection. In this review, we discuss current knowledge on biofilm formation, its presence in DFU, how the diabetic environment affects biofilm formation and its regulation, and the clinical implications.

scholarly journals Alternative Approaches for the Management of Diabetic Foot Ulcers

2021 ◽  
Vol 12 ◽  
Author(s):  
Cassandra Pouget ◽  
Catherine Dunyach-Remy ◽  
Alix Pantel ◽  
Adeline Boutet-Dubois ◽  
Sophie Schuldiner ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Current Knowledge ◽  
Healing Process ◽  
Public Health Problem ◽  
Skin Surface ◽  
Multidrug Resistant ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Alternative Approaches

Diabetic foot ulcers (DFU) represent a growing public health problem. The emergence of multidrug-resistant (MDR) bacteria is a complication due to the difficulties in distinguishing between infection and colonization in DFU. Another problem lies in biofilm formation on the skin surface of DFU. Biofilm is an important pathophysiology step in DFU and may contribute to healing delays. Both MDR bacteria and biofilm producing microorganism create hostile conditions to antibiotic action that lead to chronicity of the wound, followed by infection and, in the worst scenario, lower limb amputation. In this context, alternative approaches to antibiotics for the management of DFU would be very welcome. In this review, we discuss current knowledge on biofilm in DFU and we focus on some new alternative solutions for the management of these wounds, such as antibiofilm approaches that could prevent the establishment of microbial biofilms and wound chronicity. These innovative therapeutic strategies could replace or complement the classical strategy for the management of DFU to improve the healing process.

scholarly journals Some influential factors on severity of diabetic foot ulcers and Predisposing of limb amputation: A 7-year study on diabetic patients

2019 ◽  
Vol 10 (1) ◽  
pp. 75-81
Author(s):  
Mostafa Madmoli ◽  
Yaghoob Madmoli ◽  
Hosein Taqvaeinasab ◽  
Mahboobeh Khodadadi ◽  
Pouriya Darabiyan ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Statistical Tests ◽  
Laboratory Data ◽  
Influential Factors ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
History Of ◽  
The Relationship

Introduction: Diabetes is the most common metabolic disease and a major global challenge that is the leading cause of death in the industrialized and developing world. Therefore, this study was performed on some influential factors on severity of diabetic foot ulcers and predisposing of limb amputation. Materials and Methods: In this cross-sectional descriptive-analytic study, 4436 cases of diabetic patients admitted to Khatam-ol-Anbia hospital of Shoushtar from 2010 to 2016 were studied. The data in this study included three sections: demographic information, ulcer severity based on Wagner’s criterion, and clinical and laboratory data. Then data were analyzed using descriptive and analytical statistical tests. Results: This study included 4436 patients with diabetes with a mean age of 54.36 ± 42.68 years. 421 patients (9.4 percent) had a history of diabetic foot ulcers. Also, 385 patients (8.6%) had a history of limb amputation. In this study, 596 patients (13.4%) had a history of smoking and the relationship between smoking and drug use with the severity of ulcer was significant (p = 0.006). In this study, in the majority of patients with diabetic foot ulcers (60.3%) had severity of ulcer based on Wagner’s criterion was second grade. In terms of bacteriology, 57.7% of the patients during the admission period had cultures of the ulcer site discharge, that the most commonly of mass in 26.7% of cases was Staphylococcus aureus. In this study, the relationship between type of bacteria and severity of ulcer and limb amputation was significant (P <0.05), This means that the ulcers that had negative coagulase-staphylococcus bacteria, were higher the severe ulcer and amputations.  Conclusion: In this study, the relationship between type of bacteria and severity of ulcer and limb amputation was significant, this means that the ulcers that had negative coagulase-staphylococcus bacteria, were higher the severe ulcer and amputations.  

scholarly journals Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Apoorva Jnana ◽  
Vigneshwaran Muthuraman ◽  
Vinay Koshy Varghese ◽  
Sanjiban Chakrabarty ◽  
Thokur Sreepathy Murali ◽  
...  
Keyword(s):  
Community Structure ◽  
Microbial Community ◽  
Diabetic Foot ◽  
Antibiotic Susceptibility ◽  
Morbidity And Mortality ◽  
Wound Management ◽  
Foot Ulcers ◽  
High Morbidity ◽  
Diabetic Foot Ulcers ◽  
Core Microbiome

ABSTRACT Diabetic foot ulcer (DFU) is a major complication of diabetes with high morbidity and mortality rates. The pathogenesis of DFUs is governed by a complex milieu of environmental and host factors. The empirical treatment is initially based on wound severity since culturing and profiling the antibiotic sensitivity of wound-associated microbes is time-consuming. Hence, a thorough and rapid analysis of the microbial landscape is a major requirement toward devising evidence-based interventions. Toward this, 122 wound (100 diabetic and 22 nondiabetic) samples were sampled for their bacterial community structure using both culture-based and next-generation 16S rRNA-based metagenomics approach. Both the approaches showed that the Gram-negative microbes were more abundant in the wound microbiome. The core microbiome consisted of bacterial genera, including Alcaligenes, Pseudomonas, Burkholderia, and Corynebacterium in decreasing order of average relative abundance. Despite the heterogenous nature and extensive sharing of microbes, an inherent community structure was apparent, as revealed by a cluster analysis based on Euclidean distances. Facultative anaerobes (26.5%) were predominant in Wagner grade 5, while strict anaerobes were abundant in Wagner grade 1 (26%). A nonmetric dimensional scaling analysis could not clearly discriminate samples based on HbA1c levels. Sequencing approach revealed the presence of major culturable species even in samples with no bacterial growth in culture-based approach. Our study indicates that (i) the composition of core microbial community varies with wound severity, (ii) polymicrobial species distribution is individual specific, and (iii) antibiotic susceptibility varies with individuals. Our study suggests the need to evolve better-personalized care for better wound management therapies. IMPORTANCE Chronic nonhealing diabetic foot ulcers (DFUs) are a serious complication of diabetes and are further exacerbated by bacterial colonization. The microbial burden in the wound of each individual displays diverse morphological and physiological characteristics with unique patterns of host-pathogen interactions, antibiotic resistance, and virulence. Treatment involves empirical decisions until definitive results on the causative wound pathogens and their antibiotic susceptibility profiles are available. Hence, there is a need for rapid and accurate detection of these polymicrobial communities for effective wound management. Deciphering microbial communities will aid clinicians to tailor their treatment specifically to the microbes prevalent in the DFU at the time of assessment. This may reduce DFUs associated morbidity and mortality while impeding the rise of multidrug-resistant microbes.

Potential Biomolecules and Current Treatment Technologies for Diabetic Foot Ulcer: An Overview

2018 ◽  
Vol 15 (1) ◽  
pp. 2-14 ◽  
Author(s):  
Zenith Khashim ◽  
Shila Samuel ◽  
Nallusamy Duraisamy ◽  
Kathiravan Krishnan
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Impaired Wound Healing ◽  
Advanced Therapies ◽  
Dressing Materials

Background:Diabetic foot ulceration remains a major challenge and is one of the most expensive and leading causes of major and minor amputations among patients with diabetic foot ulcer. Hence the purpose of this review is to emphasize on potential molecular markers involved in diabetic foot ulcer physiology, the efficacy of different types of dressing materials, adjunct therapy and newer therapeutic approach like nanoparticles for the treatment of diabetic foot ulcer.Methods:We conducted a systematic literature review search by using Pubmed and other web searches. The quality evidence of diabetic foot ulcer biomolecules and treatments was collected, summarized and compared with other studies.Results:The present investigation suggested that impaired wound healing in diabetic patients is an influence of several factors. All the advanced therapies and foot ulcer dressing materials are not suitable for all types of diabetic foot ulcers, however more prospective follow ups and in vivo and in vitro studies are needed to draw certain conclusion. Several critical wound biomolecules have been identified and are in need to be investigated in diabetic foot ulcers. The application of biocompatible nanoparticles holds a promising approach for designing dressing materials for the treatment of diabetic foot ulcer.Conclusion:Understanding the cellular and molecular events and identifying the appropriate treatment strategies for different foot ulcer grades will reduce recurrence of foot ulcer and lower limb amputation.

Inflammatory Biomarkers as Predictors of Infected Diabetic Foot Ulcer

2021 ◽  
Vol 17 ◽  
Author(s):  
Mariya Dmitriyeva ◽  
Zhanar Kozhakhmetova ◽  
Saltanat Urazova ◽  
Saken Kozhakhmetov ◽  
Dulat Turebayev ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Inflammatory Biomarkers ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers

: Diabetic foot ulcer infection is a crucial complication associated with lower-limb amputation and postoperative mortality in individuals with diabetes mellitus. Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Early detection of infected diabetic foot ulcers can reduce the frequency of hospitalizations, the occurrence of disability, and chances of mortality. Inflammatory biomarkers are predictors of infected diabetic foot ulcers and lower-limb amputation. Procalcitonin, CRP, pentraxin-3, interleukin-6, and calprotectin may help to distinguish uninfected from mildly infected diabetic foot ulcers and diagnose soft tissue infections, bone lesions, and sepsis in diabetic patients. Moreover, these biomarkers may be predictors of lower-limb amputation and postoperative mortality. The current management of infected diabetic foot ulcers is disappointing and unsatisfactory, both in preventing its development and in halting and modifying its progression. The use of new (molecular) techniques for the identification of the IDFU have not yet proven superior to classic cultural techniques for the management of such patients. For clinicians, if the risk stratification of DFU can be obtained earlier in diabetic patients the hospitalization, disability, and mortality rate will be reduced. For practical application of these biomarkers, it is important to correlate these quantitative parameters with clinical symptoms. Based on clinical observations and inflammatory biomarker evaluation, it can be used to guide clinical treatment methods. This review details clinical information published during the past several decades and discusses inflammatory biomarkers that may determine the risk and level of infection of diabetic foot ulcers.

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

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