Clinical and microbiological profile of diabetic foot in patients admitted at a tertiary care center in Mangalore

Background: Worldwide diabetes affects more than 194 million people and the figure is expected to reach 333 million by 2025. India is considered as the diabetic capital of the world. Diabetic foot is the most common complication of diabetes. Amputation which is the end result of diabetic foot disease is associated with significant morbidity and mortality. Since it is crucial to identity those at an increased risk of diabetic foot complications, a detailed study of the natural history of diabetic foot, various clinical characteristics, the role of micro-organisms and their contribution toward worsening of ulcerations was undertaken in our hospital. Materials and Methods: A prospective study was carried out on 100 diabetic patients with foot ulcers for a period of one and half years at Father Muller Medical college Hospital, Mangalore. Results: The data analysis of 100 patients yielded the following results. Diabetic foot was very common in the elderly age group (>55 years) 54% and male dominant (87%). Majority of them had diabetes for more than 5 years (41%) and complications of diabetes were present on admission in 15% of them. Presentation of diabetic foot in the form of single/multiple toe disarticulation/above knee/below knee amputation accounted for a quarter (23%) of surgical interventions in our hospital. The glycemic control in most of the patients was very poor with random blood sugar >200 mg/dl (70%) and glycosylated hemoglobin >7 g% (74%) of them. One-fourth of the patients stayed for at least a month in the hospital (25%). In culture, Gram-negative organisms were predominant (11%). The most common bacteria isolated were Staphylococcus aureus (20.6%), Pseudomonas (16.2%), Escherichia coli (14.7%), and Klebsiella (11.8%). Conclusion: Based on the results of our study, it can be concluded that diabetic foot in various forms accounts for significant morbidity in the surgical wards. The factors contributing mainly are poor glycemic control at the time of admission, presence of gangrene, complications of diabetes (nephropathy, neuropathy), and associated comorbidities (peripheral vascular disease, hypertension, ischemic disease). There is a lot of scope for improvement in the approach to treatment of diabetic foot in our set-up which needs urgent attention. This article is presented to highlight the colossal neglect in the management of diabetic foot in most of the tertiary care centers in and around this part of the world