CLINICOPATHOLOGICAL AND MICROBIOLOGICAL CORRELATION OF DIABETIC FOOT INFECTIONS IN PATIENTS UNDERGOING SURGICAL MANAGEMENT
Main Article Content
Keywords
Diabetes mellitus, diabetic foot infection, diabetic foot ulcer, microbiological profile, antimicrobial resistance, osteomyelitis, amputation, surgical management
Abstract
Methods
This prospective observational study included 100 patients with diabetic foot infections undergoing surgical management. Clinical characteristics, Wagner grade, glycaemic status, peripheral neuropathy, peripheral arterial disease, and surgical procedures were recorded. Deep-tissue specimens obtained during surgery were subjected to microbiological culture, antimicrobial susceptibility testing, and histopathological examination. Clinical, microbiological, and pathological findings were correlated with disease severity and surgical outcomes.
Results
The mean age was 56.8 ± 10.9 years, and 72.0% were males. Wagner Grade ≥3 disease was present in 67.0% of patients. Microbiological cultures were positive in 91.0%, with 38.5% being polymicrobial. Gram-negative organisms constituted 63.6% of isolates. Staphylococcus aureus was the most frequent individual isolate (25.0%), followed by Escherichia coli (18.2%) and Pseudomonas aeruginosa (15.9%). Multidrug resistance was detected in 36.4% of isolates. Histopathological examination demonstrated tissue necrosis in 52.0% and osteomyelitis in 27.0%. Overall, 43.0% underwent amputation. Amputation was significantly associated with Wagner Grade ≥3, multidrug-resistant infection, peripheral arterial disease, tissue necrosis, and osteomyelitis.
Conclusion
Advanced clinical severity, antimicrobial resistance, vascular compromise, tissue necrosis, and osteomyelitis were important correlates of adverse surgical outcomes in DFI. Integrated clinicopathological and microbiological assessment may facilitate targeted antimicrobial therapy, timely surgical intervention, and limb preservation.
References
2. Teku RF, Karri R. Bacteriological profile and antibiotic sensitivity patterns in diabetic foot ulcer: a retrospective study. Int Surg J. 2003;10(5):1665-9.
3. Rai S, Thomas R, Giri PA. Prevalence of diabetic foot ulcers and associated risk factors in patients with type 2 diabetes mellitus. Int J Res Med Sci. 2001;9(1):241-6.
4. Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA, et al, Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-93.
5. Boulton AJM, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31(8):1679-85.
6. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJG, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2002;54(12):e132-73.
7. Roy PG, Srinivasan S, Prabhu V, Rajagopal T, Udayabhaskar M, Vignesh K, et al. Clinical profile and outcomes of patients with diabetic foot infections. J Assoc Physicians India. 2007;65(3):17-21.
8. Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R, et al. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care. 2006;29(8):1727-32.
9. Shanmugam P, Jeya M, Linda S, Selvam M, Rajendran P. Bacteriological profile and antibiotic resistance pattern in diabetic foot ulcer patients. Asian J Pharm Clin Res. 2007;10(12):148-50.
10. Rai S, Thomas R, Giri PA. Prevalence of diabetic foot ulcers and associated risk factors in patients with type 2 diabetes mellitus. Int J Res Med Sci. 2001;9(1):241-6.
11. Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R, et al. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care. 2006;29(8):1727-32.
12. Roy PG, Srinivasan S, Prabhu V, Rajagopal T, Udayabhaskar M, Vignesh K, et al. Clinical profile and outcomes of patients with diabetic foot infections. J Assoc Physicians India. 2007;65(3):17-21.
13. Saseedharan S, Sahu M, Chaddha R, Pathrose E, Bal A, Bhalekar P, et al. Epidemiology of diabetic foot infections in a reference tertiary hospital in India. Braz J Microbiol. 2008;49(2):401-6.
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