Fungal Infection in Egyptian Patients with Diabetic Foot Ulcer ( Prevalence , Spectrum , and Antifungal Susceptibility )

Abstract

Background: Foot ulcers are a very common complication of Type 1 and Type 2 diabetes. Patients having diabetic foot ulcer infection face serious problems including gangrene and amputations. Objective: The aim of this study was to determine the prevalence, spectrum of fungal infections in diabetic foot ulcer and to assess in vitro the antifungal susceptibility. Methodology: This study was conducted on 108 diabetic patients with foot ulcer attending the out-patient clinic of the National Institute of Diabetes and Endocrinology, from May to July 2014. Wound swabs were inoculated to slants of Sabouraud dextrose agar (SDA). Yeast like growth on SDA was identified by Gram stain, germ tube formation, culture on Chrom agar Candida. Results: The susceptibility of the isolated fungi was evaluated by disk diffusion method on Mueller- Hinton agar, using Amphotericin B, ketoconazole, fluconazole and itraconazole, posaconazole and caspofungin disks. Among the 108 patients 51% were females. Fungal foot infection were highest among the age group 51-60 years. 3'.5% of patients were having fungal infection, Candida spp. was the most predominant isolated fungus (94.2%); C. albicans (6'.8%), C. glabrata (''.8%), other Candia spp. (8.8%), C. tropicalis and C. krusei each (5.9%). In vitro susceptibility was highest to ketoconazole (78.'%), the highest resistance was for amphotericin B (87.5%). Candida spp. is a predominant pathogen causing fungal infection in diabetic foot ulcer. Conclusion: High resistance to antifungal drugs is an emerging major problem