BATTLING BENEATH THE SURFACE: DECODING THE MICROBIAL LANDSCAPE OF DIABETIC FOOT ULCERS IN AN INDIAN TERTIARY CARE HOSPITAL – A PIONEERING STUDY ON PREVALENCE AND ANTIBIOTIC SENSITIVITY
Main Article Content
Keywords
Diabetic foot ulcer, Microorganisms, Antibiotic sensitivity, Resistance, Klebsiella pneumoniae, MRSA
Abstract
Background: Diabetic foot ulcers (DFUs) are the leading cause of lower limb amputations in medicine and may lead to days of expensive hospital stays. Identification of the bacteria causing DFUs is crucial for selecting the right antibiotic therapy. Antibiotic resistance has significantly increased, especially in the wound infections of Diabetic patients according to various studies.
Objectives: In order to determine the prevalence of bacteria and the profiles of their antibiotic sensitivity, the current study looked at a variety of patient cultures with DFUs.
Methods: This is a prospective observational study. 194 DFU patients who were admitted to tertiary care hospital at Chengalpattu district, Tamil Nadu, India was included in this study. The Wagner Classification was employed to evaluate the DFUs' location and degree of severity. Sterile swabs were used to collect the samples needed for testing. Routine microbiological laboratory Conventional tests were done and results were recorded.
Results: A total of 181 microorganisms were isolated. Klebsiella pneumoniae (20.5%), Escherichia coli (14.9%) and Pseudomonas aeruginosa (12.7%) were the major three organisms isolated. The most often isolated gram-positive and gram-negative bacteria were Staphylococcus species and Klebsiella pneumoniae, respectively. Vancomycin shown 100% sensitivity to all Gram-positive bacteria, although meropenem and Cefoperazone/Sulbactam were found to be effective against Gram negative bacteria.
Conclusion: In conclusion, clinicians are advised to consider cultures before starting empirical medication because several microbes may be involved and multidrug-resistant strains may emerge
References
2. Ahmad S, Khan MS, Shah MH, Khan A, Bano R, Qazi M, Khan MS. Microbial Profile and Antimicrobial Susceptibility Pattern in Diabetic Foot Ulcer Patients Attending a Tertiary Care Hospital. Cureus. 2022 Sep 30; 14 (9).
3. Fosse S, Hartemann‐Heurtier A, Jacqueminet SH, Ha Van G, Grimaldi A, Fagot‐Campagna A. Incidence and characteristics of lower limb amputations in people with diabetes. Diabetic Medicine. 2009 Apr; 26(4):391-6.
4. Rahim F, Ullah F, Ishfaq M, Afridi AK, ur Rahman S, Rahman H. Frequency of common bacteria and their antibiotic sensitivity pattern in diabetics presenting with foot ulcer. Journal of Ayub Medical College Abbottabad. 2016 Aug 28; 28(3):528-33.
5. Sadeghpour Heravi F, Zakrzewski M, Vickery K, G. Armstrong D, Hu H. Bacterial diversity of diabetic foot ulcers: current status and future prospectives. Journal of clinical medicine. 2019 Nov 10; 8 (11):1935.
6. Abbas G, Khan Ha, Iqbal S, Nabi A. Bacterial Isolates And Their Sensitivity Patterns In Patients With Diabetic Foot Ulcers Journal Of Medical Sciences. 2023 Mar 27; 31 (01):4-9.
7. Barwell ND, Devers MC, Kennon B, Hopkinson HE, McDougall C, Young MJ, Robertson HM, Stang D, Dancer SJ, Seaton A, Leese GP. Diabetic foot infection: Antibiotic therapy and good practice recommendations. International journal of clinical practice. 2017 Oct; 71(10):e13006.
8. Li X, Qi X, Yuan G, Ju S, Yu Z, Deng W, Liu Y, Li Y, Bu X, Ding M, Li Q. Microbiological profile and clinical characteristics of diabetic foot infection in northern China: a retrospective multicentre survey in the Beijing area. Journal of Medical Microbiology. 2018 Feb; 67(2):160-8.
9. Andrianaki AM, Koutserimpas C, Kafetzakis A, Tavlas E, Maraki S, Papadakis JA, Ioannou P, Samonis G, Kofteridis DP. Diabetic foot infection and osteomyelitis. Are deep-tissue cultures necessary? Germs. 2020 Dec10 (4):346.
10. Forbes BA, Sahm DF, Weissfeld AS. Skin, soft tissue and wound infections. Diagnostic Microbiology 10th. St Louis, MO: Mosby. 1998:972.
11. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS. Diagnosis and treatment of diabetic foot infections. Plastic and reconstructive surgery. 2006 Jun 1; 117(7S):212S-38S.
12. Hadi P, Rampal S, Neela VK, Cheema MS, Sarawan Singh SS, Kee Tan E, Sinniah A. Distribution of Causative Microorganisms in Diabetic Foot Infections: A Ten-Year Retrospective Study in a Tertiary Care Hospital in Central Malaysia. Antibiotics. 2023 Mar 31; 12(4):687.
13. Dhanasekaran G, Sastry G, Viswanathan M. Microbial pattern of soft tissue infections in diabetic patients in South India. Asian J Diabet. 2003; 5:8- 10.
14. Murali TS, Kavitha S, Spoorthi J, Bhat DV, Prasad AS, Upton Z, Ramachandra L, Acharya RV, Satyamoorthy K. Characteristics of microbial drug resistance and its correlates in chronic diabetic foot ulcer infections. Journal of medical microbiology. 2014 Oct; 63(10):1377-85.
15. Shashanka R, Rajanna B. Bacteriological Profile of Diabetic Foot Ulcers: A Clinical Study.
16. Saseedharan S, Sahu M, Chaddha R, Pathrose E, Bal A, Bhalekar P, Sekar P, Krishnan P. Epidemiology of diabetic foot infections in a reference tertiary hospital in India. brazilian journal of microbiology. 2018 Apr; 49:401-6.
17. Prasant HA, Lalithambigai J, Prabhusaran N. Bacteriological Profile of Diabetic Ulcer Foot and Their Antimicrobial Susceptibility Pattern in a Tertiary Care Hospital, Trichy. Journal of Pharmaceutical Negative Results. 2022 Nov 7:86-97.
18. Zubair M, Malik A, Ahmad J. Clinico-bacteriology and risk factors for the diabetic foot infection with multidrug resistant microorganisms in north India. Biol Med. 2010; 2(4):22-34.