Clinico-microbiological profile and outcome of diabetic foot ulcers

Authors

  • Pratha Anantha Ramani Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, India
  • Murali Manohar Deevi Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, India
  • Simhadri Uday Kiran Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, India
  • Ginni Vijay Sainath Reddy Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, India
  • Ginjupalli Saichand Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, India
  • Sivaram Shashank Yeeli Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, India
  • Potireddy Yaswanth Reddy Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, India

DOI:

https://doi.org/10.18203/2349-2902.isj20203245

Keywords:

Amputations, Diabetes, Foot ulcers, Microbiological profile, Organisms, Outcomes

Abstract

Background: Diabetic foot ulcers (DFU) are debilitating to the patients and significantly impair their quality of life. DFU associated with infection have the worst outcomes and may lead to amputations if timely intervention is not done. In the present study, aim was to identify the association between the type of organism isolated and the rates of amputations in diabetic foot ulcers.

Methods: We retrospectively studied 50 diabetic foot ulcers from January 2017 to June 2017, who were in-patients in a single unit of surgery department in King George Hospital, Visakhapatnam. Baseline clinical examination was done. Parameters such as age, sex, duration, diabetic status and its treatment, organisms isolated, various treatment options for ulcers and the outcomes were studies.

Results: Males were the predominant study subjects (M: F=32:18). The age of presentation was 18-65 years with an average of 46 years. Gram negative organisms were the frequent microbial isolates, all being mono-microbial infections. It was dominated by E. coli (17), Pseudomonas (12) and Klebsiella (11). Above-knee amputation was done in one patient and below-knee amputations in three patients. Total mortality in our study was 5. After applying the chi-square test, it was found that there is no significant association between the type of organism and the rate of amputations in our study.

Conclusions: Diabetes is a significant risk factor for ulceration in the extremities, which possesses considerable mortality and morbidity. Early intervention, control of diabetes and compliance of the patient treatment are all necessary to reduce the rates of amputations and mortality in patients with diabetic foot ulcers.

References

Bakker K, Apelqvist J, Lipsky BA, Van Netten JJ. International Working Group on the Diabetic Foot. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes Metab Res Rev. 2016;32(11):2-6.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28.

Rastogi A, Bhansali A. Diabetic foot infection: an Indian scenario. J Foot Ankle Surg. 2016;3:71-9.

Armstrong DG, Wrobel J, Robbins JM. Guest editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4:286-7.

Shanker EM, Mohan V, Premlatha G, Srinivasan RS, Usha AR. Bacterial aetiology of diabetic foot infections in South India. Eur J Intern Med. 2005;16:567-70.

Chammas NK, Hill RLR, Edmonds ME. Increased mortality in diabetic foot ulcer patients: the significance of ulcer type. Diabetes Res. 2016;2016:2879809.

Bowler PG, Davies BJ. The microbiology of infected and noninfected leg ulcers. Int J Dermatol. 1999;38(8):573-8.

Seth A, Attri AK, Kataria H, Kochhar S, Seth SA, Gautam N. Clinical profile and outcome in patients of diabetic foot infection. Int J Appl Basic Med Res. 2019;9(1):14-9.

Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diab Care. 2006;29(8):1727-32.

Rastogi A, Sukumar S, Hajela A, Mukherjee S, Dutta P, Bhadada SK, et al. The microbiology of diabetic foot infections in patients recently treated with antibiotic therapy: a prospective study from India. J Diab Compl. 2017;31(2):407-12.

Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diab Care. 2003;26(2):491-4.

Eskelinen E, Eskelinen A, Albäck A, Lepäntalo M. Major amputation incidence decreases both in non-diabetic and in diabetic patients in Helsinki. Scandinavian J Surg. 2006;95(3):185-9.

Wahab WFA, Bakhiet MA, Mahadi D, Mahmoud SM, Widataal AH, Ahmed MEIM. Diabetic foot infections with Pseudomonas: Jabir Abueliz Diabetic Center Khartoum Experience. Clin Res Foot Ankle. 2013;3:001.

Fosse S, Heurtier HA, Jacqueminet S, Van G, Grimaldi A, Campagna FA. Incidence and characteristics of lower limb amputations in people with diabetes diabetic medicine. J British Diab Asso. 2009;26(4):391-6.

Renzi R, Unwin N, Jubelirer R, Haag L. An international comparison of lower extremity amputation rates. Annals Vascular Surg. 2006;20(3):346-50.

Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality after nontraumatic major amputation among patients with diabetes and peripheral vascular disease: a systematic review. J Foot Ankle Surg. 2016;55(3):591-9.

Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clin Diab. 2006;24(2):91-3.

Dean S. Leg ulcers and management. Australian Family Phys. 2006;35(7):480-5.

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Published

2020-07-23

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Original Research Articles