Abstract
Background: Approximately 85% of all diabetes-related lower-extremity amputations are preceded by foot ulcers. Diabetic foot ulcers are at high risk of infection secondary to high glucose levels and poor tissue perfusion. Aims of the Study: To identify the microbial pathogens and the antimicrobial sensitivity pattern of the bacterial isolates involved in the different grades of diabetic foot ulcers. Materials and Methods: Pus samples from 104 diabetic foot ulcers were processed for aerobic, anaerobic, and fungal culture. Antimicrobial sensitivity was performed as per clinical and laboratory Standards Institute guidelines. Results: Aerobic (81.66%), anaerobic (14.79%), and fungal (3.55%) isolates were obtained on culture with Gram-negative bacilli (78.98%) being isolated more than the Gram-positive cocci (21.01%). Proteus mirabilis was the most common isolate (26.08%) while Bacteroides fragilis and Peptococcus sp. were the common anaerobes obtained. 56.73% of patients had polymicrobial infection, and 23.08% of staphylococci were methicillin resistant Staphylococcus aureus . In hospitalized patients and amputees, infections were often polymicrobial (74.32%) involving anaerobic and fungal pathogens. Multi-drug resistance was seen in 28.26% of isolates. Conclusion: Our study showed polymicrobial diabetic foot infections. The isolation pattern varied according to the grade of ulcer with S. aureus being predominant in Wagner I diabetic foot and Gram-negative organisms and anaerobes being isolated as the foot grade advanced to gangrene. Management of early stages includes treatment with oral quinolones/cloxacillin/cephalosporins. Imipenem monotherapy or third-generation cephalosporins with beta lactamase inhibitors plus an anti-anaerobe drug are regimens that can be used for the advanced stage of the disease.
Highlights
Diabetes mellitus with its multisystem affliction has emerged as the scourge of the 21st century
The isolation pattern varied according to the grade of ulcer with S. aureus being predominant in Wagner I diabetic foot and Gram-negative organisms and anaerobes being isolated as the foot grade advanced to gangrene
Our study showed polymicrobial diabetic foot infections with Gramnegative aerobes being the most common pathogens
Summary
Diabetes mellitus with its multisystem affliction has emerged as the scourge of the 21st century. About 370 million people are affected with diabetes mellitus globally, and the numbers are estimated to reach 552 million by 2030.[1] About 15% of diabetics develop foot ulcers during their lifetime, and this constitutes the most common cause of disability and hospitalization.[2] Limb-threatening diabetic infections are usually polymicrobial involving multiple aerobic and anaerobic organisms. Staphylococcus aureus, Streptococcus spp., Enterobacteriaceae spp., Bacteroides fragilis, Peptococcus spp. and Peptostreptococcus spp. are the common organisms cultured from diabetic ulcers.[3] Proper choice of antimicrobials in the treatment of a limb-threatening diabetic foot ulcer infection is imperative in preventing amputation
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