CLINICOMICROBIOLOGICAL STUDY OF DIABETIC FOOT ULCERS

BACKGROUND Type 2 diabetes mellitus is a chronic disease caused by a combination of lifestyle and genetic factors affecting all organs in the body. Foot ulcers are one of the common and serious long-term complications of diabetes leads to recurrent and chronic infections, which results in limb loss when treatment is delayed. The aim of this study is to find out the clinical outcome and microbiological profile in patients admitted with diabetic foot ulcers. MATERIALS AND METHODS The study conducted between November 2008 to November 2009 over 50 patients with history of foot ulceration and diabetes. 50 patients were admitted with diabetic foot ulcer over a period of one year between November 2008-2009. They were studied after getting written consent. A predesigned pro forma was used to get the parameters comprising age, gender, duration, type of diabetes mellitus, presence of neuropathy, nephropathy (serum creatinine, urine albumin), retinopathy (screening funduscopy by ophthalmologist). RESULTS Among 50 patients admitted and treated for diabetic foot ulcers with mean stay of 18 days, 29 (58%) had complete healing on conservative management, 18 (36%) underwent minor amputation (toes), 3 (6%) had major amputation (below knee/above knee). No mortality among the study groups encountered. Gram-negative aerobes E. coli (36%), Pseudomonas (52%), Klebsiella (28%), Proteus vulgaris (20%) and Acinetobacter (16%) were most frequently isolated followed by gram-positive aerobes MRSA (14%), Enterococcus (6%), Strep pyogenes (4%) and no anaerobic growth. CONCLUSION Diabetic foot infections are frequently polymicrobial and predominantly gram-negative aerobic bacteria at presentation. Multidrug resistance pseudomonas aeruginosa and MRSA in diabetic foot ulcer is at its emergence and life threatening. Initial aggressive multimodal approach with surgical intervention, culture specific and sensitive targeted combined broad-spectrum antibiotics decreases the morbidity and mortality. Early screening for diabetes, tight glycaemic control decreases the prevalence of risk factors for diabetic foot ulcer related amputations and enhances the quality of life