Clinical and Microbiological Profile of Diabetic Ulcer Foot in Government Rajaji Hospital, Madurai

Jaideep, P (2017) Clinical and Microbiological Profile of Diabetic Ulcer Foot in Government Rajaji Hospital, Madurai. Masters thesis, Madurai Medical College, Madurai.


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BACKGROUND AND OBJECTIVE: Diabetic foot ulcers are one of the major medical, social and economic problems and one of the leading causes of hospitalization for patients with diabetes all over the world. Infection may lead to amputation of the infected foot if it is not promptly treated. My study was undertaken with the aim of determining the clinical and microbiological profile of diabetic ulcer foot in Government Rajaji Hospital, Madurai. In this study various clinical parameters, prevalence of Methicillin Resistant Staphylococcus aureus and the antibiotic resistance pattern of the bacterial isolates obtained were studied to reduce the risk of complications. METHODS: A prospective study of 6 months, from March 2016 to August 2016, where patients presenting with diabetic ulcer foot in GRH Madurai will be recruited for this study. A total of 200 patients with diabetic foot will be included in the study and classified according to Wagner's grade. Following consent, a questionnaire will be filled to record the patient's demographic data, duration of diabetes, method of diabetic control, history of smoking, wound duration, and previous history of treatment. Peripheral neuropathy was assessed by touch sensation with pin prick, cotton, and peripheral vascular disease by palpation of dorsalis pedis artery and posterior tibial artery. Pus and tissue biopsy specimens will be obtained for bacteriological study. Culture, isolation, antibiotic sensitivity and identification of the microorganisms will be done according to standard microbiological procedures. Antimicrobial susceptibility testing will be performed by Kirby Bauer disc diffusion method as recommended by the Clinical and Laboratory standards Institute. RESULTS: Out of the 200 patients included in the study 73% were males with 72% of patients being above the age of 50 years. Average duration of ulcer was 24.94 ±4.9 days and mean duration of DM was 5.64±3.2 years. 65.5% of population was on treatment for DM with OHA alone. 37.5% of the patients had no form of formal education and a further 55% had no knowledge about diabetic foot care, with only 39.5% having a regular foot wear wearing habit. While 71.5% had history of previuos foot ulcer, 60.5% gave a history of pre-disposing trauma to foot. Ulcers were more common 61.5% on the right foot, with sole, 53% being the most common site. Maximum number of ulcers,30% were Wagner’s grade III with, peripheral neuropathy, 57% being the most common complication associated. A large majority of the patients 69% had poor glycemic control as characterised by high HbA1C levels. Amongst the 200 samples cultured, 250 aerobic organisms were isolated showing a high prevalence of multibacterial infection. 55.6% of them were were Gram negative and 44.4% were Gram positive. Most common organism was Staphyloccal spp (38%), while 16.8% of the Staphylococcal isolates being MRS spp followed by Klebsiella spp (30.8%), Escherichia coli (7.2%), Streptococcus spp (6.4%), Proteus spp (6%), Psuedomonas spp (4.8%), Enterococci (4%), and Actinomycetes spp (2.8%). Most of the Gram negative isolates were sensitive to Imipenem and piperacillin/ tazobactam. Out of the 95 Staphylococcal spp, 16 were MRSA. INTERPRETATION AND CONCLUSION: A majority of the diabetic patients had little knowledge about diabetic foot care, with no proper foot wear usage with poor glycemic control and peripheral neuropathy. Moreover late presentation to the hospital was noted with a higher grade of foot ulcer. Staphylococcal aureus was the most common organism isolated, a small fraction of them showing methicillin resistance, followed by Klebsiella spp. Many of the isolates showed multi drug resistance. A combination of levofloxacin (flouroquinolones) with gentamycin is a better choice for diabetic foot ulcer infections caused by Gram negative and positive organisms. In more severe life threatening infections linezolid/ vancomycin for MRSA coverage and imipenem for Gram negative coverage can be considered.

Item Type: Thesis (Masters)
Additional Information: Reg.No.221411106
Uncontrolled Keywords: Diabetic ulcer foot, clinical profile, microbiological profile, antibiotic sensitivity, MRSA.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 18 Jul 2020 17:20
Last Modified: 19 Jul 2020 03:11

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