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[9000451.] رقم البحث : 9000451 - |
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Infection in diabetic foot / |
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قطاع الدراسات الطبية / جراحه العامه |
| تخصص البحث : جراحه العامه |
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Menoufia Medical Journal / / Vol. 25, No. 2 - July 2012 |
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أ/ سعيد ابراهيم الملاح ( smallah1@yahoo.com - 0122130947 ) |
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diabetic foot infection, multidrug-resistant organisms, polymicrobial, risk factors |
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Objectives
The present study was carried out to determine the prevalence of aerobic and
anaerobic pathogens in diabetic foot infections (DFIs), detect their susceptibility
to different antimicrobial agents, investigate the microbiological profiles of DFIs in
relation to different grades of Wagner classification, and assess the risk factors
for DFIs.
Background
DFI is the most frequent reason for diabetes-related hospitalization. It develops
because of several diabetes-related factors including arterial insufficiency, neuropathy,
foot deformities, previous ulcers, previous amputation, and local trauma.
Materials and methods
The study was carried out on clinical specimens taken from 100 diabetic patients
(50 patients had type I insulin-dependent diabetes mellitus (IDDM) and 50 patients
had type II noninsulin-dependent diabetes mellitus (NIDDM) and 50 nondiabetic patients
with foot infection during the period from May 2011 to July 2012. The specimens
were cultured using aerobic and anaerobic microbiological techniques, and antibiotic
susceptibility testing was performed according to the methods recommended by the
Clinical and Laboratory Standards Institute (CLSI). Multidrug-resistant organisms were
detected including oxacillin-resistant and vancomycin-resistant staphylococci and
gram-negative bacilli extended-spectrum beta-lactamase producers.
Results
DFIs were polymicrobial in 76% of cases. Staphylococcus aureus was the most
common aerobic isolate (17.6%) (including 74.4% methicillin resistant and 23.1%
vancomycin resistant). Peptostreptococcus spp. were the most common anaerobic
isolate (39.4%). Extended-spectrum b-lactamase production was detected in 53.4%
of Gram-negative bacilli. About 62% of diabetic patients were infected with multidrugresistant
organisms. The risk factors for DFIs were duration of diabetes more than
1 year, random blood sugar of at least 200 mg/dl, trauma, previous ulcer and
amputation, and comorbidities related to diabetes.
Conclusion
Imipenem was the most effective drug against all isolates. Effective glycemic control
and educating patients on the prophylactic foot care are of key importance for
decreasing DFIs. |
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