A Study on multiple drug resistant bacterial isolates in foot ulcers in diabetes with special reference to blaKPC and nlaNDM

Vandna Vijayeta Kiro, (2017) A Study on multiple drug resistant bacterial isolates in foot ulcers in diabetes with special reference to blaKPC and nlaNDM. Masters thesis, Stanley Medical College, Chennai.


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BACKGROUND AND OBJECTIVE: India is currently experiencing an epidemic of Diabetes. As life expectancy is increasing so are the complications of Diabetes. Diabetic foot ulcer is one of the most studied complications by various groups around the World. Ulcers caused by infections and infections due to ulcer have attracted lots of researches as to help the diabetics to prevent this complication and if infected; to visit clinicians for rationale antibiotic according to the sensitivity pattern of the causative pathogen in that area, apart from surgical interventions. Variations have been seen in the etiological agents of foot ulcers in studies from different parts of the world and have also highlighted on increasing incidence of drug resistance. MDROs has lead to inadequate or delayed antimicrobial therapy and are also associated with poorer patient outcomes. It increases the duration of hospital stay, cost of management as well as morbidity and mortality. There is a dearth of data on MDROs and especially evolving Carbapenemase resistance; if any from this part of the world. This study was done in our tertiary care centre to acquire knowledge of the aerobic bacterial profile and their sensitivity pattern focussing on Multidrug resistant organisms and Carbapenemase producers. MATERIAL AND METHODS: Patients having infected ulcers were chosen for this study and those having Diabetes were considered. Sample was collected from infected wound and processed for isolating aerobic pathogen. Susceptibility test was done by Kirby-Bauer method and Imipenem or Meropenem resistant isolate was subjected to E- Test for confirmation. The resistant pathogen were further tested to find incidence of blaKPC and blaNDM which have been reported to be spreading. Modified Hodge test was performed to detect Carbapenemase production. RESULTS: 50 Patients sample with infected ulcers, suffering or newly diagnosed diabetes were taken into study. 45 pathogenic aerobic bacteria were isolated. In 10(20%) patients there was no aerobic bacterial growth. Gram positives isolated were 10(22.2%) among which Enterococcus was the only one isolated 10(100%). Among the Gram negatives 35 (77.7%); Klebsiella spps.-most common isolate -14 (31.1%) followed by Proteus spps- 13(28.8%), Pseudomonas aeruginosa -5(11.1%), Escherichia coli -2 (4.44%) and Citrobacter freundii -1(2.22%). Greater than 1 organism was isolated from 5 patients. MDRO rate was 62.2%, ESBL-88.8%, AmpC -8.5 and MBL- 5.7%. The two Carbapenem resistance organisms confirmed by E-Test were Modified Hodge test positive. PCR done for these isolate showed negative test for both the genes tested. CONCLUSION: Being a tertiary care centre we receive patients moving from one hospital to another with chronic infections that has reduced the incidence of Gram positive cocci (especially notorious Staphylococcus) in our study. This study done on these patients for bacterial profile and their antibiotic profile unearths Gram negatives to be the most important etiological agents – Klebsiella spps, followed by Proteus, Enterococcus (Gram positive), Pseudomonas, Escherichia coli and Citrobacter. MDR rate has increased with most cephalosporins also becoming resistant leading to elevation in ESBL rate. Apart from other higher antibiotics; Piperacilin /Tazobactam showed least resistance favouring its use for high grade diabetic ulcers as it covers aerobic, anaerobic and is a good β-lactamase inhibitor. However it does not rule out the necessity of culture and sensitivity tests with rationale surgical procedures to prevent further spread of infection. The genotypic test done on those two isolates for blaKPC and blaNDM by conventional PCR proved absence of these genes in those two resistant isolates. Further other molecular studies need to be done to detect the resistance mechanisms. This evidence –based study will definitely lead to a well guided approach to the management of foot ulcers in diabetics in our centre. Using evolving technologies in detection of resistance will also help in infection control in health care.

Item Type: Thesis (Masters)
Additional Information: Reg.No.201414053
Uncontrolled Keywords: Diabetic foot ulcer, Multiple drug resistance organisms (MDROs), blaKPC, blaNDM.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 18 Jul 2020 16:52
Last Modified: 19 Jul 2020 13:05
URI: http://repository-tnmgrmu.ac.in/id/eprint/12534

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