A PROSPECTIVE OBSERVATIONAL STUDY OF ANTIBIOTIC USAGE PATTERNS AND MICROBIOLOGICAL ANALYSIS IN DIABETIC FOOT ULCER PATIENTS

Abstract Background Diabetes foot ulcer is a devastating and much-feared complication of diabetes. Diabetes foot ulcerations which developed gangrene can take weeks or months to heal and can sometimes not heal at all so that amputation for non-traumatic causes is a frequent outcome in the diabetic foot. Despite this, there is no finding on predictors of the amputation rate of diabetes foot ulcers in Ethiopia. Hence this study was aimed to identify factors associated with the amputation rate of diabetes foot ulcer patients in Nekemte referral hospital. Patients and methods A prospective observational study was conducted among adult diabetes foot ulcer patients admitted to Nekemte referral hospital from March 15 to June 15, 2018. A pus swab was obtained from the ulcers before any ulcer cleaning to conduct gram staining. The primary outcome was the amputation rate. Cox regression analysis was used to estimate the hazard ratios and time from study entry to healing was evaluated as censored event times by Kaplan-Meier curves. Result Over the study period, 115 diabetes foot ulcer patients were admitted to the NRH; of these patients, 64(55.65%) were males while the mean age of participants was 44.4 ± 14.7. A total of 34(29.57%) of the diabetes foot ulcer were overweight and 16(13.91%) were obese while the mean ± standard deviation of body mass index (BMI) was 24.94 ± 3.69 kg/m2 and a total of 56(48.69%) diabetic foot ulcer had a diabetic complication. Of patients with diabetic foot ulcer, 35(30.43%) were undergone lower extremity amputations (LEA). Patients who were prescribed with inappropriate antibiotics were unlikely to heal. A total of 18(46.15%) of the patients who were taken inappropriate antibiotics were healed whereas 21(53.85%) were not healed (P = 0.017). Besides, the higher the Wagner grade, the worse the outcome of healing. A total of 19(21.84%) and 16(57.14%) of patients with grade < 4 and grade ≥ 4, respectively, did not heal (P = 0.005). Conclusion The amputation rate of diabetes foot ulcers was rapid for patients prescribed inappropriate antibiotics and higher grades of the foot ulcer. Therefore, the presence of clinical pharmacists plays a pivotal role to promote the appropriate use of antibiotics and besides the daily care, special attention should be given for patients having an advanced grade of diabetes foot ulcer.

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A prospective observational study of drug prescription pattern of antibiotics in diabetic foot ulcer in tertiary care teaching hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20202934 ◽

2020 ◽

Vol 9 (7) ◽

pp. 1020

Author(s):

Kamalavarshini Paramasivamsasanger ◽

Prema Mariappan ◽

Dhivya Govindasamy ◽

Padmavathi Karunakaran ◽

Rajalakshmi Ramesh

Keyword(s):

Observational Study ◽

Diabetic Foot ◽

Prospective Observational Study ◽

Drug Prescription ◽

Tertiary Care ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Prescribing Pattern ◽

College Hospital ◽

First Choice

Background: Our aim was to study a prescribing pattern of antibiotics used in diabetic foot ulcer (DFU).Methods: 50 patients were selected by inclusion and exclusion criteria basis. It was a prospective observational study conducted in Department of Surgery, Rajah Muthiah Medical College Hospital (RMMCH), Annamalai University.Results: This study reveals that male patients 60% are more prone to develop diabetic foot ulcer than the female patients 40%. Patients of 50 to 60 age group 32% has higher prevalence of DFU. The most commonly prescribed antibiotics are metronidazole 48% and cefotaxime 48% followed by piperacillin and tazobactam combination 30%, ciprofloxacin 20%, linezolid 18%, amoxicillin and clavulanic acid combination 12%, cefixime 6%, clindamycin 4%, amikacin 4%, faropenam 4%, ceftriaxone 2%, amoxicillin 2%, gentamicin 2%, cefoperazone sodium and sulbactam combination 2%.Conclusions: Lack of antibiotic sensitivity test leads to growth of organism, wrong antibiotic selection and irrational use of antibiotics. And also observed patient developed resistance to linezolid antibiotic when used as a first choice of drug to treat diabetic foot infection including methicillin-resistant Staphylococcus aureus (MRSA) infected patients.

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Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study

Journal of Foot and Ankle Research ◽

10.1186/s13047-019-0345-y ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 11

Author(s):

Ejiofor Ugwu ◽

Olufunmilayo Adeleye ◽

Ibrahim Gezawa ◽

Innocent Okpe ◽

Marcelina Enamino ◽

...

Keyword(s):

Observational Study ◽

Lower Extremity ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Lower Extremity Amputation ◽

Extremity Amputation

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Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study

Diabetes/Metabolism Research and Reviews ◽

10.1002/dmrr.2867 ◽

2016 ◽

Vol 33 (3) ◽

pp. e2867 ◽

Cited By ~ 13

Author(s):

K. Pickwell ◽

V. Siersma ◽

M. Kars ◽

J. Apelqvist ◽

K. Bakker ◽

...

Keyword(s):

Quality Of Life ◽

Conservative Treatment ◽

Observational Study ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Prevalence and Association of Diabetic Retinopathy with Diabetic Foot Ulcer: A Cross-Sectional Observational Study

Frontiers in Ophthalmology and Ocular Imaging ◽

10.5772/intechopen.82667 ◽

2019 ◽

Author(s):

Shaista Zafar ◽

Kashif Rahim ◽

Inayat Ullah Khan ◽

Muhammad Yasin ◽

Muhammad Dawood ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Observational Study ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Cross Sectional

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Clinical and Antimicrobial Efficacy of a Silver Foam Dressing With Silicone Adhesive in Diabetic Foot Ulcers With Mild Infection

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619866610 ◽

2019 ◽

Vol 18 (3) ◽

pp. 269-278 ◽

Cited By ~ 2

Author(s):

José Luis Lázaro-Martínez ◽

Francisco Javier Álvaro-Afonso ◽

David Sevillano-Fernández ◽

Raúl Juan Molines-Barroso ◽

Yolanda García-Álvarez ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Treatment Period ◽

Diabetic Foot ◽

Bacterial Load ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Foot Ulcers ◽

Microbiological Analysis ◽

Diabetic Foot Ulcers ◽

Silicone Adhesive

The use of an antimicrobial dressing instead of a non-antimicrobial dressing may increase the number of diabetic foot ulcers healed over a medium-term follow-up period. The study aim was to evaluate the clinical and microbiological efficacy of a silver foam dressing in the management of diabetic foot ulcers. We conducted a single-center, prospective, open, noncontrolled study involving 21 outpatients with diabetic foot ulcers with mild infection. All patients received standard of care for their wounds and a silver foam dressing with silicone adhesive was applied twice per week for wound management during a 6-week treatment period. Soft tissue punch biopsies were taken every second week for qualitative and quantitative microbiological analysis. Wounds were assessed at patient admission, and wound bed tissue was evaluated for presence, quality, and consistency of granulation tissue. Clinical evaluation revealed improvements in wound conditions as a result of treatment with the silver dressing. Wollina wound scores improved significantly, from a mean score of 3.9 ± 1.6 points at inclusion to 6.1 ± 1.3 points at the end of the study (n = 19, P < .001). Treatment with the silver dressing resulted in significant decreases in the bioburden of classically considered diabetic foot ulcer pathogenic organisms such as Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, Enterobacteriaceae species, Pseudomonas aeruginosa, and other nonfermenting gram-negative bacilli. Findings revealed that the use of silver foam dressing significantly reduced the pathogenic bacterial load and markedly improved the clinical outcome in patients with diabetic foot ulcer with mild infection over a 6-week treatment period.

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