A neglected causative agent in diabetic foot infection: a retrospective evaluation of 13 patients with fungal etiology

Anıl Murat Öztürk,Ilgın Yildirim Şimşir,Bilgin Arda,Dilek Yeşim Metin,Hüsnü Pullukçu,Meltem Işıkgöz Taşbakan,Can Yener,İlgen Ertam,Serhat Uysal

doi:10.3906/sag-1809-74

Abstract

Background/aimClinicians often neglect fungal infections and do not routinely investigate deep tissue from the wound for fungal culture and sensitivity due to insufficient information in the literature. In this study, we aimed to evaluate fungal etiology of invasive fungal diabetic foot which is rarely reported in the literature.Materials and methodsThe patients who were unresponsive to antibiotic therapy and those with positive fungal in bone or deep tissue culture were enrolled in the study. Detailed hospital records were retrieved for demographics and clinical features. Results A total of 13 patients who were diagnosed with invasive fungal diabetic foot (ten females, three males, mean age 59.8 ± 9 years) were included. All of the patients had type-2 diabetes mellitus. Eleven (84.6%) patients had mixed infection. The most common cause of fungal infections of diabetic foot ulcers was the Candida species. Ten (76.9%) patients underwent amputation, two (15.4%) patients refused amputation, and one patient died before surgery. ConclusionInvasive fungal infections may also be a causative pathogen in deep tissue infections. Therefore, fungal pathogens should be considered in patients unresponsive to long-term antibiotic therapy. Early detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation.

Highlights

Diabetes mellitus (DM) is the most common endocrine metabolic disease, and its prevalence has been increasing steadily all over the world with recently diagnosed cases [1,2]
Invasive fungal infections may be a causative pathogen in deep tissue infections
Detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation

Summary

Introduction

Diabetes mellitus (DM) is the most common endocrine metabolic disease, and its prevalence has been increasing steadily all over the world with recently diagnosed cases [1,2]. Diabetes mellitus generally affects the lower extremities more than the upper extremities, leading to death in some cases. Diabetic foot complications are the most common causes of nontraumatic lower extremity amputations and are associated with a five-year mortality rate of 43% to 55%, which is even higher than some common types. Several pathogenic abnormalities, such as intrinsic flaws in the blood supply, angiogenesis, and other extrinsic factors, such as infections and continued trauma, contribute to failure of recovery from diabetic foot ulcers [11,12]. Despite current treatment modalities for nonhealing diabetic foot ulcers, following systemic antifungal therapy will lead to improvement [13,14,15,16,17,18,19,20,21]

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