Abstract
Diabetic foot ulcer (DFU) is becoming one of the major complications around the world with associated consequences such as lower-extremity amputation, high morbidity, mortality and hospitalization. It has the possibility to become the next global epidemic. Major part of the concern comes from the diverse bacterial and fungal population that is found at the infection site and their growing antimicrobial resistance. If the threat of antimicrobial resistance is not dealt with than it will rise to become the main cause of mortality and below knee amputation in case DFU. Also, most of the time main focus is given on detecting bacterial population which causes the fungal population to go unnoticed and act as the silent enemy. Bacterial and fungal prevalence scenario from different countries have been discussed in this study along with the alarming antibiotic resistance scenario around the globe. Furthermore, choosing the correct technique to identify them also plays a vital role. With proven lacking’s of the culture-based methods maybe it is time to move on to the faster and more specific molecular methods. As, many of the molecular techniques have already proven to be more efficient. This review discussed the bacterial and fungal prevalence along with their growing antimicrobial resistance and evaluated different biochemical and molecular techniques in identification process.
Highlights
Diabetic foot is a serious diabetic complication that consists ulceration of the soft tissue or bone below the malleoli irrespective of duration due to diabetes mellitus [1,2]
85% of amputations are associated by a prior foot ulceration that progresses to extreme gangrene or infection [6]
Diabetic patients with ulceration have two-fold chances to increase the mortality than nonulcerated diabetic patients [7]
Summary
Diabetic foot is a serious diabetic complication that consists ulceration of the soft tissue or bone below the malleoli irrespective of duration due to diabetes mellitus [1,2]. S. aureus (44%), Group B Streptococci (25%) and Enterococcus spp (9%) were the most frequently detected gram-positive organism. Detected aerobic bacteria included, Nonfermenting gram-negative rods (7.7%), Pseudomonas spp. Fungal species detected from a study on patients admitted to Emam Reza Hospital, Iran was comprised of, C. albicans (9.1%), C. tropicalis (4.1%), C. parapsilosis (0.83%), C. galbrata (0.83%), C. krusei (0.83%), Candida spp. Corrnebacterium striatum, Propionibacterium spp., Pophyromonas somerae, Brevibacterium massiliense, Klebsiella oxytoca and Coagulase-negative species such as, Staphylococcus pettenkoferi, Staphylococcus simulans and Staphylococcus lugdunensis were detected using this technique [37]. An investigation conducted on patients admitted to two Bangladeshi hospitals detected that, Staphylococcus spp. was 100% resistant towards monobactam and 67% resistant to penicillin-G group. Aerobic gram-negative organisms showed higher resistance to Amoxycillin (92%), amoxycillinclavulanic acid (60%) and cephalosporins (72%). Fugal species were found to be 100% resistant to clindamycin + amikacin and cloxacillin + pipracillin + tazobactum and cephalosporins [30]
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