Bacteria Patterns in Infected Diabetic Foot : Is There a Surgical Implication ?

Abstract

Background: The number of patients suffering from diabetes and its complications in the world is doubling every 10-15 years. Apart from development of retinopathy, nephropathy, and diabetic-induced atherosclerotic changes in high caliber arteries. Critical ischemia with gangrenous changes of the lower limb has occurred quite often as a result of micro-angiopathy. Objective: This study aimed to investigate the bacterial spreading and related outcomes of treatment in 81 patients with diabetic foot complicated by infection. Materials and methods: A retrospective study based on the analysis of the patients medical records from the hospital database. The bacteriological analysis of the tissues from infected wounds, obtained during surgical debridement or amputation, were conducted in all patients. Microbiological investigations of the the contents of an aerobic and anaerobic bacterial flora in the wounds were compared and analyzed in all cases considered suitable for this study. Results: Analysis of microbial spreading revealed growth of bacteria in all diabetic foot wounds. Associations of aerobes with anaerobes were found in 89.9 % of the cases. Escherichia coli was the dominating agent among anaerobes (22%), leading to development of infectious process and distributed in a proximal direction along synovial-tendon sheets of the foot. Conclusion: Aggressive debridement of necrotized tissues, including proximal and distal parts of tendons up to 5 cm within the limits of healthy looking tissues may disrupt further spreading of purulent infection and lead to favorable outcome.