Bacteriology Profile of Diabetic Foot Infection and In Vitro activity of Antimicrobial Agents

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Bacteriology Profile of Diabetic Foot Infection and In Vitro activity of Antimicrobial Agents

Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 1

Abstract

The study was carried out in the Department of Microbiology Index Medical College, Hospital and research centre (IMCHRC) Indore. In 100 diabetic foot patients studied, 73% were male and 27% were female. The age ranged from 31-80 yrs and majority of patients were in the age group o 51- 60 yrs. Out of 100 patients, 53 patients were diagnosed to have diabetes mellitus for> 10 yrs, 35 for 5 - 10 yrs and 12 for < 5 yrs. Out of 100 patients majority of the patients (90.29%) had ulcer for > 1 month duration. Out of 100 patients, 17 patients with ulcer belonged to the Wagner's grade 1, while 31 belonged to Grade 2, 40 belonged to grade 3 and 12 belonged to Grade 4. No growth was seen in 6 specimens out of 100 specimens. From 94 patients with culture positive specimens 170 organisms were isolated. Out of 94 culture positive cases, 22 patients had only 1 isolate, 72 patients had polymicrobial isolates Among the bacterial isolates, Gram negative comprised of 97 (57.1%) and Gram positive accounted for 73 (42.9%). Pseudomonas spp. was the most common isolates, accounting for 23.5% of all isolates followed by Staph. Aureus, Esch. Coli and Enterococci spp. comprising of 19.4%,10.5% and 10% respectively. All strains of S. aureus were sensitive to Vancomycin, 63.6% were sensitive to gentamicin and 60.60% were sensitive to cotrimoxazole. Erythromycin and penicillin showed least sensitivity 36.36% and 36.3% respectively. Enterococci spp. showed 100% sensitivity to vancomycin, 70.59% were sensitive to amikacin and gentamicin. Coagulase Negative Staphylococci showed relatively high sensitivity to all antibiotics, gentamicin 56.5% ciprofloxacin 82.6% penicillin 56.5% erythromycin 52% and cotrimoxazole 52% Among Pseudomonas spp. 90% strains showed sensitivity to Imipenem, 90% were sensitive to Amikacin, 70% were sensitive to Gentamicin. Pipercillin - Tazobactam combination showed sensitivity of 62.5 % Ceftazidime and Piperacillin had least acivity 45% and 30 % respectively. All other Gram negative bacteria were sensitive to Imipenem (100%), followed by Amikacin 71.93%, Ceftazidime 64.92%, Gentamicin 66.66 %, Cotrimoxazole 57.9 % and Amoxicillin-clavulanic acid. They were least sensitive to Ciprofloxacin, Piperacillin and Cefuroxime. 100 out of 170 isolates 58.8%were found multidrug resistant showing resistance to 3 groups of antibiotics which can be attributed due to previous antibiotic treatment and previous history of hospitalization. Penicillins, Quinolons and Cephalosporin’s especially second generation showed least activity against the bacterial isolates from diabetic wound, so it should not be included in the empirical treatment regimen. A combination regimen consisting of amikacin, imipenem and vancomycin seems to be the most prudent empirical treatment of diabetic foot infection. Co-Trim oxazole can be considered in the regimen. This empirical therapy can be later modified appropriately based on the antiprogram of the isolates from the individual patients.

Authors and Affiliations

Dr. Niral Garg, Dr. Kogekar SP

Keywords

EP ID EP474709
DOI -
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