الفهرس 
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Abstract
Foot infections are a common, complex and serious problem in diabetic patients. Infections usually begin in foot ulcers, which are associated with neuropathy, vasculopathy, and various metabolic disturbances. These infections are potentially limb and sometimes life threatening.
Foot complications in diabetics often lead to amputation. The leading cause of amputation in patients with diabetes is the non healing foot wound and its complication.
The most important characteristic of the microbiology of infection in the diabetic foot is that it is often polymicrobial. Aerobic Gram-positive cocci and to a lesser degree streptococci, are a major and often monomicrobial pathogens. Aerobic Gram-negative rods and obligate anaerobes may be isolated from skin lesions, usually as part of a mixed infections. Complicated infections and those recently treated with antibiotics are more frequently caused by Enterobacteriaceae and Pseudomonas species.
In the last decade, enhanced attention has paid to the photo-and sono-treatment of some bacterial infections and inflammatory processes, mainly due to the fast development of coherent optical light sources and laser technique. Laser and ultrasonic sources are used for the treatment of several bacterial infections, septic pathology as a result either of the sterilizing effect or biostimulating effect of light irradiation.
The use of laser radiation and US waves may prove to be beneficial in inhibiting bacterial growth in wounds.
The present study aimed at:
1- Isolating and identifying bacteria causing diabetic foot infection in the studied population.
2- Estimating the effect of laser and ultrasound waves on the total count of the isolated bacteria.
The study involved 100 bacterial isolates from 63 patients (27 males and 36 females) with diabetic foot infection from the Gangrene Unit of Alexandria Main University Hospital.
All full relevant information sheets were fulfilled for each patient.
A sterile swab samples were obtained form all the studied population. All swab samples were streaked on the surface of blood and MacConkey’s agar plates and incubated aerobically over night at 37C followed by full identification of isolates.
The identified isolates were exposed to laser or / and US waves CFU/ml was calculated for each isolate before and after exposure to laser or/and US waves.
Results of this study revealed that:
• The distribution of the Gram-positive and Gram-negative bacteria as etiologic agents in DFI was mostly different (22% and 78%, respectively).
• S.aureus was the most common Gram-positive isolate represented 15% of all isolates.
• P.mirabilis was the most common and frequently isolated Gram-negative bacteria represented 30% of all isolates.
• Enterobacter Sp. and K. oxytoca were the least ones isolated (1% and 1%, respectively).
• A significant reduction in the total bacterial species viable count was obtained by exposing to laser, US waves and laser +US waves after
20 min.
• A significant reduction in the viable count of Enterobacter Sp. was obtained by exposing to laser or/and US waves after 20 min. US waves alone was higher than laser in bacterial killing effect (63% and 55%, respectively). The combination of both laser and US waves were the highest effective 67%.
• A significant reduction in the viable count of S.pyogenes was obtained by exposing to laser, US waves and laser + US waves after
20 min. US waves alone was higher than laser in killing effect (53.75% and 50%, respectively). The combination of laser and US waves were the highest effective 56.25%.
• A significant reduction in the viable count of K.pneumoniae was obtained by exposing to laser, US waves and laser + US waves after
20 min. In this case the effect of laser and its waves alone were similar (67.12%) but the combination of them were the highest effect (70.1%).
• A significant reduction in the viable count of S.faecalis was obtained after exposure to laser, US waves and laser + US waves after 20 min. US waves was higher than laser in killing effect (50.34% and 47.37%, respectively). The combination of laser and US waves were the highest effect 56.9%.
• A significant reduction in the viable count of E.coli was obtained by exposing to laser, US waves and laser + US waves after 20 min. In this case the effect of laser was higher than US wave alone (41.6% and 39.5%, respectively). The combination of laser and US waves were the highest effective (47.8%).
• A significant reduction in the viable count of K.ozaena + K.oxytoca was obtained by exposing to laser, US waves and laser + US waves after
20 min. In this case the effect of laser was higher than US waves (43.9% and 24.7%, respectively). The combination of laser and US waves were the most effective (51.9%).
• A significant reduction in the viable count of P.aeruginosa was obtained by exposing to laser, US waves and laser+US waves after 20 min. The effect of US waves was higher than laser (42.7% and 41.63%, respectively). The combination of laser and the US waves was the most effective 44.7%.
• A significant reduction in the viable count of P.vulgaris was obtained by exposing to laser, US waves and laser + US waves after 20 min. The effect of laser was higher than US waves (32.25% and 31.6%, respectively). The combination of laser and US waves were the most effective 40.6%.
• A significant reduction in the viable count of C.freundii was obtained by exposing to laser, US waves and laser + US waves after 20 min. The effect of laser was higher than US waves (45.7% and 43.3%, respectively). The combination of laser and US waves were the most effective 48.9%.
• A significant reduction in the viable count of S.aureus was obtained by exposing to laser, US waves and laser + US waves after 20 min. The effect of US waves was higher than laser (25% and 24.4%, respectively). The combination of laser and US waves were the most effective 30.63%.
• A significant reduction in the viable count of P.mirabilis was obtained by exposing to laser, US waves and laser + US waves after 20 min. The effect of laser was higher than US waves (45.24% and 40%, respectively). The combination of laser and US waves were the most effective 46.4%.