IS BACTERIOLOGY A CONTRIBUTING FACTOR IN UNSALVAGEABLE NATURE OF DIABETIC FOOT INFECTIONS?â€“A STUDY IN A DISTRICT HOSPITAL IN MALAYSIA
Keywords:Diabetic foot infections, Diabetic foot microbiology, Salvageable diabetic foot infection, Bacterial profile, Antimicrobial susceptibility
Objective: The objective is to study bacterial pathogens isolated in diabetic foot infection (DFI) and their sensitivity pattern to antibiotics commonly used in the management of DFI in the salvageable and unsalvageable groups of patients in a district hospital.
Methods: 122 patients with diabetic limb infections treated at the Orthopedic Department of Hospital Sultan Abdul Halim, Sungai Petani, Kedah State in Malaysia. Clinically, limb infections were classified as salvageable and unsalvageable infections. Salvageable-mild, superficial/deep, localized ulcer with no systemic derangements necessitating conservative treatment or surgical procedures with minor amputations of limb (toe/ray amputation). Unsalvageable-deep seated extensive or spreading ulcers threatening the integrity of limb with or without toxic symptoms or metabolic derangement and could result in major limb amputation. A standard questionnaire was used to collect demographic, clinical and microbiological details of patients in both groups. Co-morbid illnesses, type/severity of limb infection during presentation and results of routine blood investigations were recorded. Details of nature of each specimen, species of isolate pathogen and sensitivity pattern to antibiotic of each clinical isolates were recorded.
Results: 62 and 60 patients respectively belonged to the salvageable and unsalvageable groups. Only 11.66% presented with evidence of toxemia in the unsalvageable group. ESBL was the commonest nosocomial organisms. Percentage of organism sensitivity was most to vancomycin, ceftazidime, and gentamicin.
Conclusion: All severe infections do not present with toxemia in diabetic patients. Gram-negative organisms were predominant in both groups although Staphylococcal organisms were the single largest group in the unsalvageable group. 3rd generation antibiotics are more useful in its control.
Wan Nazaimoon WM, Md Isa SH, Wan Mohamad WB, Khir AS, Kamaruddin NA, Kamarul IM, et al. Research: epidemiology prevalence of diabetes in malaysia and usefulness of Hba1c As A diagnostic criterion. Diabet Med 2013;30 Suppl7:825-8.
Frykberg RG. An evidence-based approach to a diabetic foot infection. Am J Surg 2003;186 Suppl 5A:44S-54S.
Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJG, David G, et al. Infectious diseases society of America. Clinical practice guideline for the diagnosis and treatment of diabetic foot infectionsa; 2012, Available from: http://Cid.Oxfordjournals.Org/ATIdsaon. [Last accessed on 22 May 2012].
Hobizal KB, Wukich DK. Diabetic foot infections: a current concept review. Diabetic Foot Ankle 2012;3. doi: 10.3402/dfa.v3i0.18409.[Epub 2012 May 8]
Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. Clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care 2006;29: Suppl 8:1727-32.
Lipsky BA. Editorial: diabetic foot infections: microbiology made modern? Array Diabetes Care 2007;30:8.
Nadeem Sajjad Raja. Microbiology of diabetic foot infections in a teaching hospital in Malaysia: a retrospective study of 194 cases. J Microbiol Immunol Infect 2007;40:39-44.