Clinico-bacteriological study of diabetic foot ulcer and its management based on Wagner’s classification and HbA1c as an indicator for duration of antibiotic therapy in a tertiary hospital in Sullia


  • Abhirup H. R. Department of General Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India
  • Chidananda K. V. Department of General Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India
  • Jagadish B. Department of General Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India
  • Ranjith K. B. Department of General Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India
  • Gopinath Pai Department of General Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India
  • Balakrishna M. A. Department of General Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India



Diabetic foot, HbA1C, Wagner’s


Background: Diabetic foot ulcer is a serious and common complication of diabetes mellitus. 12%–25% have a risk of developing a foot ulcer during their lifetime. Diabetic neuropathy and micro- or macro-ischemia are the two main risk factors that cause diabetic foot ulcer.

Methods: A cross sectional study was conducted in dept of general surgery, KVGMCH between 1st November 2019 and 30th August 2020 among 90 pts with diabetic foot ulcers, selected by systematic random sampling methods. Considering prevalence of DFU, among the diabetic pts as 8.8%, the sample size was estimated to be 90 using the formula 4pq/L2, with absolute error as 6%. Patients will be managed conservatively with antibiotics like aminoglycosides, cephalosporins, penicillin derivatives and dressings and if needed surgical interventions will be performed.

Results: Maximum number of pts had HbA1c levels of >8% and they accounted for 35.55%. Almost 98% of the patients had neuropathy, 50% of them had signs of ischemia and 80% had infection. Maximum number of patients (58.88%) presented with diabetic ulcers belonging to Class 2 of Wagners classification. The most commonly isolated P. aeruginosa was sensitive to colistin, imipenem and amikacin. Most diabetics with HbA1C levels >8, had mean antibiotic duration of 19.04±4.65 days.

Conclusions: Prevention is the best treatment. Wagner’s classification helps in correlating appropriate treatment to proper grade of lesion with better outcome. Effective glycemic control and education are of key importance for decreasing diabetic foot disease.

Author Biography

Abhirup H. R., Department of General Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India

Department of General Surgery , Post graduate


Frier M, Fischer M. Diabetes Mellitus. Davidsons principles practice of medicine. Churchill Livingstone, Elsevier; 20th Ed. 2009:810.

International Diabetes Available at: what-is-diabetes/facts-figures.html. Accessed 15 Oct. 2019.

Jain SK, Barman R. Bacteriological profile of diabetic foot ulcer with special reference to drug-resistant strains in a tertiary care center in North-East India. Indian J Endocr Metab. 2017;21:688-94.

Andrew JM, Bpoulton, Vileikyte L. Diabetic foot problems and their management around the world. Levin o neal “the diabetic foot”. 6th ed. mosby, inc; 2001:266.

Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361:1545-51.

Shahi S, Kumar A, Kumar S, Singh S, Gupta S, Singh T B. Prevalence of Diabetic Foot Ulcer and Associated Risk Factors in Diabetic Patients From North India. J Diab Foot Complic 2012;4(3):83-91.

Dalem Pemayun T, Naibaho RM. Diabetic Foot Ulcer Registry at a Tertiary Care Hospital in Semarang, Indonesia: an Overview of its Clinical Profile and Management Outcome. Diab Manag. 2016;6(4):82-9.

Pemayun TG, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Indonesia. Diab Foot Ankle. 2017;8(1):1312974.

Nyamu PN, Otieno CF, Amayo EO, McLigeyo SO. Risk factors and prevalence of diabetic foot ulcers at Kenyatta National Hospital, Nairobi. East African Med J. 2003;80(1):36-43.

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-16.

Abdulrazak A, Bitar ZI, Al Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diab Complic. 2005;19:138 41.

El Tahawy AT. Bacteriology of diabetic foot. Saudi Med J. 2000;21:344 7.

Amini M, Davati A, Piri M. Determination of the resistance pattern of prevalent aerobic bacterial infections of diabetic foot ulcer. Iran J Pathol. 2013;8:21 6.

Ako Nai A, Ikem I, Akinloye O, Aboderin A, Ikem R, Kassim O. Characterization of bacterial isolates from diabetic foot infections in Ile Ife, Southwestern Nigeria. Foot (Edinb). 2006;16:158.

Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR.Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med. 2005;16:567.

Konar J, Das S. Bacteriological profile of diabetic foot ulcers, with special reference to antibiogram in a tertiary care hospital in Eastern India. J Evol Med Dent Sci. 2013;2(48):9323-8.

Spichler A, Hurwitz BL, Armstrong DG, Lipsky BA. Microbiology of diabetic foot infections: from Louis Pasteur to “crime scene investigation”. BMC Med. 2015;13:2.

Banu A, Noorul Hassan MM, Rajkumar J, Srinivasa S. Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: a prospective study. Aust Med J. 2015;8(9):280–5.

Uckay I, Gariani I, Pataky Z, Lipsky BA. Diabetic foot infections: state-of-the-art. Diabetes Obes Metab. 2014;16(4):305–16.

Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med. 1992;117:97–105.

Karugu L. Mainstreaming diabetic foot education in Kenya: prevalence of diabetes in Kenya. In: World, I. D. F., & Congress D, editor. 2011.

Achieng L, Menge TOE. The KNH guide to empiric antibiotic therapy. 2nd ed. Nairobi: Kenyatta National Hospital; 2018.

Unnikrishnan AG: Approach to a patient with a diabetic foot. Natl Med J India. 2008;21:134-7.

Murray HJ, Young MJ, Hollis S, Boulton AJ: The association between callus formation, high pressures and neuropathy in diabetic foot ulceration. Diabet Med. 1996;13:979-82.

Tantisiriwat N, Janchai S. Common foot problems in diabetic foot clinic. J Med Assoc Thai. 2008;91:1097-101.

Lepore G, Maglio ML, Cuni C, Dodesini AR, Nosari I, Minetti B, et al. Poor glucose control in the year before admission as a powerful predictor of amputation in hospitalized patients with diabetic foot ulceration. Diabetes Care. 2006;29:1985.

Slovenkai MP. Foot problems in diabetes. Med Clin North Am. 1998;82:949–71.

Bennett PJ, Stocks AE, Whittam DJ. Analysis of risk factors for neuropathic foot ulceration in diabetes mellitus. J Am Podiatr Med Assoc. 1996;86:112–6.

Ertugrul BM, Lipsky BA, Guvenc U. Turkish Intralesional Epidermal Growth Factor Study Group for Diabetic Foot Wounds. An assessment of intralesional epidermal growth factor for treating diabetic foot wounds the first experiences in Turkey. J Am Podiatr Med Assoc. 2017;107:17–29.

Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. IDSA Guideline CID; 2012:54.

Eren Z. Davutoğlu M, Ulay M, Özsoy Z, Olcay E. Bayca 1. Diabetik ayak infeksiyonları. Türk Diyabet Yıllığı. 1998-99;323–7.






Original Research Articles