Diabetic Foot Ulcer and Multidrug - Resistant Organisms: Prevalence and Risk Factors a Hospital Based Cross-Sectional Study

Manikandan, K (2013) Diabetic Foot Ulcer and Multidrug - Resistant Organisms: Prevalence and Risk Factors a Hospital Based Cross-Sectional Study. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Diabetes mellitus is a chronic disease with chronic microvascular and macrovascular complications. India is considered by many, as the diabetic capital of the world. Like in other developing countries, complications of diabetic foot such as ulceration and infections, apart from causing high morbidity and mortality, also have social, and economic ramifications (Ako et al., 200610; Shankar et al., 200511; Gadepalle et al., 200612). It has been reported that as high as 15 % of all diabetics are prone to develop ulcers in their feet during their life time. These can result in severe tissue destruction and can lead to some form of amputation (Lipsky et al., 200413). The major concern at present is the increasing incidence of multi-drug resistant organisms. The problem of multi-drug resistant organisms were poorly studied because of lack of uniform definitions and specific criteria to name an organism as multi-drug resistant. The European center for disease control and prevention has defined criteriae, which are applicable universally. Very few studies have been done in India to analyse the prevalence and risk factors of multi-drug resistant organisms in relation to diabetic foot ulcers. The impact caused by multi-drug resistant organism were least analysed in Indian litearature. Hence this study was done to analyse the prevalene, risk factors and impact of multi-drug resistant organisms in diabetic foot ulcers at a tertiary care hospital. AIM OF THE STUDY: To study the prevalence, risk factors and impact of multi-drug resistant organism (MDRO) infection in diabetic foot ulcers. METHODOLOGY: 150 diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. Patients were screened for neuropathy, nephropathy, retinopathy, peripheral arterial disease and underlying osteomyelitis using appropriate methods. The microbiological profile was analyzed in detail for each patient. Using internationally accepted criteria, the multidrug resistant organisms were identified. Infected ulcers were grouped into those with MDRO and those without MDRO and were then compared using univariate analysis. In order to identify the risk factor, for the presence of MDRO, analysis by logistic regression was done. Each patient was followed for a period of ten weeks to assess the status of wound healing. The impact of MDRO was assessed by analyzing the associations of amputations, duration of hospital stay, status of wound at ten weeks with MDRO infected ulcers using appropriate statistical tools. The influence of other factors on wound healing were analyzed by the same statistical tools. RESULTS: MDRO were isolated from 99 patients of 150 (66 %). 54.8 % (153 out of 279) of isolated organisms were multidrug resistant organisms. The commonest organism isolated in our study was Escherechia coli followed by Staphylococcus aureus and Pseudomonas aeruginosa. By univariate analysis poor glycaemic control, previous hospitalisation, previous history of amputation, previous antibiotic usage, size of ulcer, necrotic ulcer, recurrent ulcers, higher grade of ulcer, presence of osteomyelitis, presence of retinopathy, peripheral vascular disease, neuropathy and polymicrobial culture, were associated with significance in those with MDRO infected foot ulcers. Analysis by Logistic regression indicated that, only two factors significantly increased the risk of acquiring MDRO infection; 1) recurrent ulcer (OR = 3.39, p < 0.05, 95 % CI = [1.081 – 10.664]), 2) Higher grade of ulcer ( OR = 13.44, p < 0.001, 95 % CI = [3.595 – 50.278]). It was found that the mean duration of hospital stay of patients with MDRO infections was 15.36 days (p < 0.001). MDRO in the foot ulcers significantly increased the frequency of amputations (p < 0.01). MDRO infected ulcers had no impact on wound healing although they were significant by univariate analysis. By Logistic regression, age (OR = 0.942, p <0.1, 95 % CI = [0.882 – 1.005 ]), presence of PVD (OR = 7.872, p < 0.01, 95 % CI = [2.009 – 30.849 ]), osteomyelitis (OR = 8.280, p<0.01, 95 % CI = [1.768 – 38.766 ]), nephropathy (OR = 4.36, p < 0.05, 95 % CI = [ 1.226 – 15.564 ]), inter-digital / digital ulcer (OR = 0.073, p < 0.05 , 95 % CI = [0.006 – 0.869 ]), elevated HbA1c (OR = 6.020, p < 0.05, 95 % CI = [1.240 – 29.226 ]), and higher Grade of ulcer (OR = 4.10, p <0.1, 95 % CI = [0.863 – 19.549]) significantly delayed wound healing. CONCLUSION: The prevalence of MDRO is alarmingly high in infected diabetic foot ulcers. Recurrent ulcers and higher grade of ulcers are more prone to acquire MDROs. MDROs in diabetic foot ulcers are associated with longer duration of hospital stay and higher rates of amputations. MDROs have no significant impact on wound healing. Presence peripheral arterial disease, osteomyelitis, nephropathy, inter-digital / digital ulcers, higher grade of ulcer and poor glycaemic control delays the healing of foot ulcer.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diabetic Foot Ulcer and Multidrug ; Resistant Organisms: Prevalence and Risk Factors ; Hospital Based Cross-Sectional Study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 04 May 2018 01:34
Last Modified: 04 May 2018 01:38
URI: http://repository-tnmgrmu.ac.in/id/eprint/7414

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