Clinical study of coexistence of fungal infections in diabetic foot ulcers and its management

Abstract

Background: Presently 62 million Indians are diabetics and these numbers are on the rise. Amongst chronic complications of uncontrolled diabetes, foot ulcer is one. Diabetes is the leading cause of non-traumatic lower extremity amputation in developing countries with risk being 15 to 46 times higher. Infections are predominantly polymicrobial, predominantly Aerobic Gram-Positive cocci with higher incidence of anaerobic species and fungal infections. Treatment of fungal infections in diabetic foot ulcers might reduce the disability, morbidity and mortality in diabetic patients.Methods: A total of 100 diabetic foot ulcer patients admitted or who visited to JSS Hospital over a period of 2 years, meeting the inclusion/exclusion criteria of the study, formed the study population. Detailed history, clinical evaluation & necessary investigations were done. Fungal isolation from the ulcer done by 10% KOH study, Gram stain, SDA culture and slide culture methods. Positive patients were treated with antifungal agents. Outcome of the disease studied based on ulcer progression, wound healing and tissue amputations.Results: Polymicrobial flora in diabetic foot ulcers was seen (137 organisms in 100 subjects), predominantly Enterobacteriaceae and Pseudomonas. Prevalence of fungal infections in present study was 19%, of which Candida species was the commonest.Conclusions: Present study signifies the need of mycological evaluation of nonhealing diabetic ulcer, with poor progression despite antibacterial therapy & foot care, introduction of antifungal treatment for proved fungal infections in diabetic foot ulcers, considering fungal infection as significant risk factor.