Bacteriology of diabetic foot infections and their antibacterial susceptibility
Keywords:Antimicrobial susceptibility, Bacterial profile, Diabetic foot infections
Background: Diabetic foot infections are the most common bacterial infections encountered in patients with diabetes mellitus and remain the leading complication requiring frequent hospitalization. Hence, this study was carried out to determine the prevalence of bacteria in diabetic foot infections and their antibiogram which can help to inform therapeutic choices.
Methods: A prospective study conducted on clinical specimens taken from patients with diabetic foot infections, over 3 years duration. The clinical specimens were processed by using the standard microbiological techniques. The antimicrobial susceptibility pattern was studied by the Kirby-Bauer disc diffusion method.
Results: Among 103 cases studied, 97 were culture positive. Out of these specimens, 25 (25.77%) had monomicrobial flora and 72 (74.23%) had polymicrobial flora. A total of 176 bacteria were obtained which include 62 gram positive cocci and 114 gram negative bacilli. All gram negative bacilli showed good sensitivity to imipenem (97.30%), followed by cefaperazone sulbactam (81.98%), piperacillin-tazobactam (75.68%) and amikacin (72.97%). All gram positive cocci remained 100% sensitive to Vancomycin and Linezolid followed by clindamycin (not tested for Enterococci Spp.) and gentamicin in a range of 91.43 % to 72.88%. The prevalence of multidrug resistant organisms among aerobic isolates were 59.66%.Conclusions: Diabetic foot infections are polymicrobial. Pseudomonas aeruginosa and Staphylococus aureus were the most common isolates. The most sensitive antibiotics are imipenem for gram negative bacilli while vancomycin and linezolid were effective for gram positive cocci. The antibiogram of isolates will be helpful in determining the drugs for the empirical treatment of diabetic foot infection.
Dinh TL, Veves A. The diabetic foot. In: Defronzo RA, Ferrannini E, Keen H. Eds. 3rd ed. International text book of Diabetes mellitus. England, Wiley;2004:1315-32.
Boulton AJM, Armstrong DG. The diabetic foot. In:Vivian Fonseca ed. Text book of Clinical diabetes; Translating research into practice. 1st ed Philadelphia, Saunders Elsevier;2006:179-195.
Richard JL, Sotto A, Lavigne JP. New insights in diabetic foot infection. World J Diabetes. 2011;2:24-32.
Umadevi S, Kumar S, Joseph NM, Easow JM, Kandhakumari G, Srirangaraj S, et al. Microbiological study of diabetic foot infections. Indian J medical specialities. 2011 Jan 1;2(1).
Wagner FW. The dysvascular foot: a system of diagnosis and treatment. Foot Ankle. 1981;2:64-122.
Winn JW, Allen S, Janda W, Koneman E. Charts. In: Koneman’s colour atlas and text book of diagnostic microbiology. 6th ed. Lippincott, Williams and Wilkins publication, 2006:1443-71.
Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clinical Infectious Diseases. 2004 Oct 1:885-910.
Gadepalli R, Dhawan B, Sreenivas A. Clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. J Diabet Care. 2006;29:1727-32.
Bansal E, Garg A, Bhatia S, Attri Ak, Chander J. Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol. 2008;51:204-8.
Viswanathan V, Jasmine JJ, Snehalatha C, Ramachandran A. Prevalence of pathogens in diabetic foot infections in south Indian type 2 diabetes patients. J Assoc Physician India. 2002;50:1013-16.
Alvin C P. Diabetes mellitus. In: Braunwald, Fauci, Kasper, Hauser editors. Harrison’s principles of internal medicine. 15th ed. US, Mc Graw Hill, 2001:2125-26.
Sharma VK, Khadka PB, Joshi A, Sharma R. Common pathogens isolated in diabetic foot infection in Bir hospital. Kathmandu University Med J. 2006;4:295-301.
Anandi C, Alaguraja, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, Sumithra S. Bacteriology of diabetic foot lesions. Indian J of Med Microbiol. 2004;22:175-8.
Citron DM, Goldstein EJ, Lipsky BA. Bacteriology of moderate to severe diabetic foot infection and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007;2819-28.
Tahway AT. Bacteriology of diabetic foot infections. Saudi Med J. 2000;21:344-7.
Abdulrazak A, Ibrahim Z, Ayesh A, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabet Comp. 2005;3:138-41.
Chincholikar DA, Pal RB. Study of fungal and bacterial infections of diabetic foot. Indian J Pathol Microbiol. 2002;45:15-22.
Sasikala R, Latha R, Muruganandam N. Surveillance of multi drug resistant organism associated with diabetic foot ulcers in Pondicherry. Internet J Microbiol. 2008;5:1937-89.