A clinico-microbiological study of diabetic foot ulcer patients to identify risk factors and their correlation with prognosis in tertiary care hospital in India

Abstract

Background: The number of diabetics in India is rising very fast and foot ulcer patients are consuming lot of hospital resources and manpower. Foot infection, leading to ulcer formation eventually leading to amputation, is totally preventable. Few studies have been done in India to predict risk factors. We studied the clinico-microbiological profile of diabetic foot ulcer patients to correlate prognosis and to identify patients who are at increased risk of amputation.

Methods: 50 diabetic foot patients were assessed for age, sex, clinical presentation and routine haematological investigations. Ulcer characteristics were determined based on Wagner’s classification. Tissue samples from these patients were also cultured for infection. We studied various factors affecting healing of ulcers. We also tried to find factors predicting the need of amputation in these patients.

Results: The mean age of the patients was 52.42 years. The male: female ratio is 3.5:1. The WAGNER grade of III was seen in 48% of the patients, grade I in 16%, grade II in 14%, grade IV in 14% and grade V in 8%.100% of the patients with grade IV and V underwent amputation, while 8.3% with grade III and 4.16% with grade II had to undergo amputation and none with grade I had to receive amputation. Sixty-eight percent of these patients had been diagnosed with Diabetes for less than 10 years while the rest have been diagnosed for more than 10 years. 60% of patients were found to have peripheral neuropathy out of which 40% were sensory type and the rest were motor type. Proteus mirabilis was isolated in 80% of the patients who underwent amputation, Streptococcus pyogenes in 57%, Pseudomonas aeruginosa (50%), Klebsiella pneumonia (33%), and Staphylococcus aureus (12%).

Conclusions: This study showed that male sex, smoking, above 50 years age, neuropathy and infection with Gram negative organisms are important predicting factors for developing severe foot infection in diabetics, often leading to amputation. There is a need for developing a risk assessment model in a larger prospective cohort study.