Abstract

CLINICO-BACTERIOLOGICAL PROFILE AND MANAGEMENT OF DIABETIC FOOT ULCER INFECTIONS IN A TERTIARY CARE HOSPITAL

Achsah S. Johns*, Fathima Nazar, Emily James, Julie Mariam Joshua and Dr. Santhosh M. Mathews

ABSTRACT

Diabetic foot infections (DFIs) are a significant health issue and a common complication among patients with diabetes. This study aims to determine the clinical and microbiological profile of diabetic foot ulcers and to determine their susceptibility pattern. A retrospective observational study was conducted in 118 Diabetic foot ulcer (DFU) patients who were admitted in the surgical ward of a teaching hospital in Kerala, India. Grade of ulcer was assessed using the Wagner classification. Microbial infection was found in 86.4% of cases and majority of the organisms were found to be gram negative. Severity of DFUIs was classified using IWGDF-IDSA DFUIs classification into mild, moderate, and severe diabetic foot infections (DFI). Pseudomonas aeruginosa (25.2%) was found to be the most common among gram negative organisms and Staphylococcus aureus (40.3%) among gram positive organisms. The maximum bacterial isolates were seen in ulcer Grade III and IV. There was a positive correlation between the ulcer grade and number of bacterial isolates (p=0.037). Gram positive organisms showed more susceptibility to Linezolid and Vancomycin. Gram negative organisms showed more susceptibility to Colistin, Linezolid, Ertapenem, Netilmicin. 97.5% of patients were treated with antibiotics, 79.7% with Insulin, 60.2 % with Oral Hypoglycemic Agents (OHA), 60.2% with combination of Insulin and OHA and 43.2% with topical preparations. The prevalence of foot ulcer infections among diabetic patients in our study population was found to be high. Optimal glycemic control, patients’ education about the importance of foot care, and increasing the awareness of health care providers is important to reduce the burden of DFUs. Implementation of Antibiotic stewardship is required for the adequate management of diabetic foot ulcers and to reduce rise of resistant organisms.

Keywords: DFU; DFIs; Wagner’s classification; IWGDF; Antibiotic resistance; OHA; Debridement; Amputation; Offloading.