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Study for microbiological pattern and in vitro antibiotic susceptibility in patients having diabetic foot infections at tertiary care hospital in Abbottabad
... Worldwide, the prevalence of DM has been estimated to be 2.8% in 2000, and projected to be 4.4% in the year of 2030. Foot ulcers are a serious complication of diabetes with recent studies suggesting that life time risk of developing a foot ulcer in diabetic patients may be as high as 25% (Hayat et al., 2011). They are now the most common proximate and nontraumatic causes of leg amputation (Hayat et al., 2011).Various microorganisms colonize the wound and in some patients one or more species of organisms proliferate in the wound, which may lead to tissue damage, host response accompanied by inflammation, that is, clinical infection (Lipsky et al., 2012). ...
... Foot ulcers are a serious complication of diabetes with recent studies suggesting that life time risk of developing a foot ulcer in diabetic patients may be as high as 25% (Hayat et al., 2011). They are now the most common proximate and nontraumatic causes of leg amputation (Hayat et al., 2011).Various microorganisms colonize the wound and in some patients one or more species of organisms proliferate in the wound, which may lead to tissue damage, host response accompanied by inflammation, that is, clinical infection (Lipsky et al., 2012). Mostly the diabetic foot infections are mixed bacterial infection (Zubair et al., Diabetes Mellitus is a serious health problem worldwide and India has the highest number of people with diabetics. ...
... In the present study Staphylococci are the most common pathogen isolated (49/95). This results is in agreement with Goldstein et al., (1996), Hayat et al., (2011) andOates et al., (2012) who also reported a high frequency of S. aureus being isolated from diabetic foot infection. ...
Diabetes Mellitus is a serious health problem worldwide and India has the highest
number of people with diabetics. In the present study, out of 105 samples collected
from wounds of diabetic patients 95 showed bacterial infections. Among males
93.82% and among females 79.16% showed positive results. In the age wise
distribution of positive cases there is not much difference among the age groups. In
the same way there is not much variation in the positive cases of inpatient and
outpatient categories. Staphylococcus sp was the primary pathogen in most of the
wound infections in the study. The frequently reported bacterial pathogens of
wound infections such as Klebsiella sp. and Pseudomonas sp. were not so common
in the present study. Almost all isolates showed resistance against most of the
broad spectrum and narrow spectrum antibiotics tested. Thus, multidrug resistance
among the pathogens is a problem in the present study. Proper management of
diabetic wound infection with appropriate antibiotic must be implemented, keeping
in mind the high incidence of drug resistance among the bacteria isolated from
diabetic cases.
... Infections have been identified as one of the major contributing factors to delayed wound healing in diabetic and normoglycemic wounds. These wound infections may include bacterial, viral and fungal infections [14,15]. Diabetic wounds develop a sustained and co-invasive infections that delay wound healing [16]. ...
... It has been reported that Staphylococcus aureus is the most frequently isolated organism from diabetic foot infection [14,15]. Samples from the wound of diabetic patients collected from the hospital yielded only Staphylococcus spp. ...
The wounds of diabetic patients are associated with delayed healing and microbial invasion. This study evaluated the healing and microbial responses to surgical wounds in diabetic rabbits. Sixteen (16) New Zealand White rabbits were used in this study. They were divided into 4 groups of 4 rabbits each, namely; A, B, C and D. A is the control (non-diabetic and non-wounded), B (diabetic and non-wounded), C (wounded and non-diabetic) and D (wounded and diabetic). Three (3) cm2 skin wounds were created in a standard aseptic condition while diabetes was induced by intravenous administration of 200 mg/kg of alloxan monohydrate. Blood samples were collected from ear vein of each rabbit on days 0, 3, 7, 14, 21 and 28 post-surgery for analysis of blood glucose level. Wound samples were collected on days 3, 7, 14 and 21 to evaluate microbial contaminants. The wounds were examined for exudation and recorded as none (0), scant (1), moderate (2) and large (3) and diameter of wound epithelialization and contraction were determined. The blood glucose concentration of groups B and D from days 3 to 28 ranged between 288.00 ± 40.22 mg/dl to 358.65 ± 25.89 mg/dl), and were significantly higher (P < 0.05) than the corresponding values of groups A and C which ranged from 120.60 mg/dl ± 14.29 to 129.60 ± 8.18 mg/dl. The rate of wound contraction in the C group on day 7 (11.02 ± 2.17%) was significantly higher (P < 0.05) than the D group (2.23 ± 4.60%). Staphylococcus and Pseudomonas subspecies were identified in the wounds of rabbits in groups C and D. It was concluded that alloxan-induced diabetes caused delayed wound healing. At the same time Staphyloccocus and Pseudomonas species were the predominant microorganism detected in the acute wounds of diabetic and non-diabetic rabbits.
... Sterile swabs were used for sample collection from foot ulcers of t2d patients. The DFU was classified according to Wagner's classification (Hefni et al., 2013;Hayat et al., 2011) ...
... The aerobic bacterial pathogens invaded the diabetic foot isolated in this study were S. aureus (83%), E. coli (66%), K. pneumoniae (40%) and P. aeruginosa (16%). The aerobic bacterial isolates such as S. aureus, Streptococcus agalactiae and P. aeruginosa were commonly found in diabetic foot wounds and antibiotic resistance was reported (Hayat et al., 2011;Perim et al., 2015). Esmat and Islam in 2012 conducted a study to determine the common aerobic bacterial causes of diabetic foot infections and there in vitro antibiotic susceptibility pattern (Esmat and Islam, 2012). ...
The present study aimed to decipher the bacterial infections in diabetic foot human patients in Pakistan and the anti-microbial susceptibility for clinical relevance. A total of 30 samples were collected from hospitalized type 2 diabetic patients (men and women) having foot ulcers. The collected samples were cultured on mannitol salt agar, Blood agar and MacConkey's agar and cetrimide agar. Gram staining and specific biochemical tests were performed to identify the invading bacteria. Antibiotic sensitivity and resistance pattern was performed for isolated bacteria by Kirby-Bauer disc diffusion method. In diabetic foot ulcers, most prevalent bacteria were S. aureus with percent positivity of 83% followed by E. coli (66%), K. pneumoniae (40%) and P. aeruginosa (16%). The infected ulcer with poly-microorganisms was 83.4% and the infected ulcer with single isolates was 16.6%. Imipenem was found to be most sensitive antibiotic against Gram positive as well as Gram negative bacterial isolates from diabetic foot ulcer human patients. Gram negative isolates from diabetic foot showed resistance to ampicillin, sulfamethoxazole/trimethoprim, cefotaxime/clavulanate, metronidazole. The diabetic foot ulcers of human patients revealed high prevalence of S. aureus followed by E. coli, K. pneumoniae and P. aeruginosa respectively. Imipenem was found to be the most sensitive antibiotic for all the bacterial isolates from foot ulcers of type 2 diabetic patients. This study suggests imipenem as effective antibiotic for treatment of diabetic foot ulcers against bacteria.
... In our study, a total of 1356 pathogen were isolated from 885 patients, with a rate of 1.53 isolates per culture (IPC). This concurs with results of recent literature; with an IPC of 1.16 (Turhan et al., 2013) and 1.24 (Hayat et al., 2011), indicating that DFI usually involves more than one microbe due to underlying immunosuppression caused by diabetes mellitus alone. ...
... (11.1%). The apparent predominance of P. aeruginosa is not surprising as it tallies with many previous studies by Abdulrazak et al. (2005) that reported a 17.5% of P. aeruginosa among all isolates while studies in India (Ramakant et al., 2011) and Pakistan (Hayat et al., 2011) also reported high rates of 27.05% and 20.1%, respectively. This observation may be attributed in part to the opportunistic nature of P. aeruginosa infesting chronic and non-healing ulcers as proposed by Turhan et al. (2013). ...
Abstract
Background
In developing countries like Malaysia, the prevalence of diabetes mellitus is increasing at an alarming rate. Various complications develop in patients diagnosed with diabetes. Diabetic foot is one such complication that is a threat to morbidity and mortality rate owing to its risk of amputation. Understanding the microbiology of diabetic foot infection becomes an essential part of management as it can help to channel the exact treatment rather than empirical treatment.
Aim
To determine the distribution and prevalence of microorganism causing diabetic foot infection in Hospital Serdang and Hospital Ampang for the year 2010 till 2014.
Methodology
This was a cross-sectional study using retrospective data from January 2010 to December 2014 of 885 patients with diabetic foot infection in Hospital Serdang and Hospital Ampang, tertiary hospitals in Klang Valley. Data were analyzed using IBM SPSS Statistics version 22.0 for Windows.
Results
A total of 1356 pathogens were isolated from 885 patients, with a rate of 1.53 isolates per culture (IPC). The prevalence of gram-negative bacteria was predominant in DFI accounting for 71.27% whereas gram-positive was only 28.73%. Among the gram-negative isolates, the most common pathogen was Pseudomonas aeroginosa accounting for 24.49% followed by Proteus mirabilis (14.34%) and Klebsiella spp. (11.12%). Gram-positive isolates consist of Staphylococcus aureus with a percentage of 66.77% and Streptococcus spp. 33.23%. The Methicillin-Resistant Staphylococcus aureus (MRSA) accounts for 26.24% of the isolates. There were more monomicrobial cultures than polymicrobial culture (465 vs. 420). The most common antibiotic prescribed is ampicillin/sulbactam (55.57%) followed by cloxacillin (13.29%) and penicillin (10.77%)
Conclusion
The prevalence of gram-negative bacteria in DFI is higher than gram-positive bacteria. The most common gram-negative bacteria is Pseudomonas aeroginosa followed by Proteus mirabilis and Klebsiella spp. whereas the most common gram-positive bacteria is Staphylococcus aureus. The rate of monomicrobial infection is slightly higher than polymicrobial infection. Ampicillin/sulbactam is the most commonly prescribed antibiotic for a patient with DFI.
Keywords
prevalencediabetic foot infection
... Out 120 patients, 84(100%) and 36(100%) males and females were found to be infected by many pathogens respectively as all of them were found to be diabetic and their age ranged from 40 to 80 years. The supportive data was seen in (Ahmed and El-Tahawy, 2000; Sharma et al., 2006;Hena and Growther, 2010;Hayat et al., 2011) as they indicate males dominate in having diabetes with foot infections when compared to females. During the study, the history of diabetic patients were analyzed and found out type I diabetic was accounted for 38.1% among males and nil in females. ...
... Similar organisms were isolated by Sharma et al. (2006) and Zubair et al. (2010) on foot ulcers. Among all Staphylococcus was found to be most common isolate among the patients tested, wereas Pseudomonas was the next common pathogen that was found in the diabetic foot ulcer (Ahmed and El-Tahawy, 2000;Hayat et al., 2011), E. coli was found in the third position common in foot ulcers (Rouhipour et al., 2012). Enterobacter was seen the next among the pathogens of foot ulcer (Ahmed and El-Tahawy, 2000). ...
The relative frequencies of bacterial isolates cultured from diabetic foot infections were studied. Samples were collected from 120 patients with diabetic foot infections from K. R. Hospital, Mysore, Karnataka, India, from June to November 2010. Out of 120 patients, 88 were of non-insulin dependent (NIDDM) and 32 male were insulin dependent (IDDM) among NIDDM 52 were male and 36 female. The specimens were collected from the site of the wound and cultured and identified by standards methods.From the results it is found that Staphylococcus sp.(76.66%), Pseudomonas sp.(63.33%),E. coli(56.6%),Enterobacter sp.(53.33%),Proteus sp.(50.00%),Klebsiella sp.(43.33%) and Bacillus sp. (16.66%) were the most common bacterial isolates. Whereas, Candida sp.(66.66%) was the only fungal isolate that was foun
(9) (PDF) Isolation and identification of pathogens from diabetic foot infections from K. R. Hospital, Mysore. Available from: https://www.researchgate.net/publication/316317470_Isolation_and_identification_of_pathogens_from_diabetic_foot_infections_from_K_R_Hospital_Mysore [accessed Dec 22 2018].
... The prevalence of diabetic foot ulcers among was found to be 54.23% in males against 45.76 and their age ranged from 14 to 75 years, this higher level of outdoor activity among males females. This is in support with study findings co-workers [7], Sharma and co-workers co-workers [9]; Hayat and co-workers [10] males dominate in having diabetes with foot compared to females. Majority of patients falling in between 51 to 60 (32,2%), followed (16,9%) and 41 to 50 (16,9%) and it clearly that age factor plays an important role sensitivity, resistance and negative bacilli with a respectively (Fig 9). ...
... 100% sensitive to Ampicillin (AMC) shown in Figure 10. among male subjects 45.76% in females this may be due to males compared to findings of Ahmed and workers [8]; Hena and [10] as they indicate foot infections when patients are in age group followed by 61 to 70 clearly explains the fact in occurrence to infections, while this may be including non-compliance due economic issues. More over the with diabetes mellitus for a longer patients thereby making them more that predispose to foot ulceration. ...
Foot infections are a major complication of diabetes mellitus and eventually lead to development of gangrene and lower extremity amputation. Many studies reported the bacteriology of Diabetic Foot Infections (DFIs) over the past 25 years, but the results have been varied and often contradictory. Aims and Objectives. This study was carried out to determine the bacterial profiles of infected ulcers and the antibiotic resistance pattern of the isolates at the endocrinology and metabolic diseases unit of the Yaoundé Central Hospital. Materials and Methods. Samples were collected from 59 patients with diabetic foot ulcers by using sterile swabs and they were processed. Results. A total of 148 bacterial isolates were obtained from 56 positive cultures, with an average of 2.5 organisms per case. The age group of these patients ranged from 14 to 75 years and the maximum number of patients was in the age group of 51 to 60 years. Gram negative bacilli were more prevalent (65.5%) than gram positive cocci (36.4%). Polymicrobial growth was observed in 84.48% of the specimen, Monomicrobial growth in 18.59% and sterile growth in 6.25% of the isolates. The commonest isolates among the gram negative bacteria’s were Proteus spp. (21.6%), Escherichia coli (18.9%), Klebsiella. spp (16.9%) and Pseudomonas aeruginosa (8.1%) while among the gram positive bacteria’s Staphylococcus aureus was predominant (17.6%), followed by Staphylococcus epidermidis (10.1%) then by Streptococcus pyogenes (6.8%). Antimicrobial susceptibility results showed that Gram negative bacterial isolates were 100% sensitive to Imipenem and 86.5% resistance to Ampicillin, while for the Gram positive bacterial, they were 44.5% sensitive to Ciprofloxacin and 46.8% resistance to Oxacillin. Conclusion. This study showed a preponderance of gram negative bacilli among the isolates from the diabetic foot ulcers. Knowledge on the antibiotic sensitivity pattern of the isolates will be helpful in determining adequate drugs for the empirical treatment of diabetic ulcers.
... The prevalence of diabetic foot ulcers among was found to be 54.23% in males against 45.76 and their age ranged from 14 to 75 years, this higher level of outdoor activity among males females. This is in support with study findings co-workers [7], Sharma and co-workers co-workers [9]; Hayat and co-workers [10] males dominate in having diabetes with foot compared to females. Majority of patients falling in between 51 to 60 (32,2%), followed (16,9%) and 41 to 50 (16,9%) and it clearly that age factor plays an important role sensitivity, resistance and negative bacilli with a respectively (Fig 9). ...
... 100% sensitive to Ampicillin (AMC) shown in Figure 10. among male subjects 45.76% in females this may be due to males compared to findings of Ahmed and workers [8]; Hena and [10] as they indicate foot infections when patients are in age group followed by 61 to 70 clearly explains the fact in occurrence to infections, while this may be including non-compliance due economic issues. More over the with diabetes mellitus for a longer patients thereby making them more that predispose to foot ulceration. ...
Introduction. Foot infections are a major complication of diabetes mellitus and eventually lead to development of gangrene and lower extremity amputation. Many studies reported the bacteriology of Diabetic Foot Infections (DFIs) over the past 25 years, but the results have been varied and often contradictory. Aims and Objectives. This study was carried out to determine the bacterial profiles of infected ulcers and the antibiotic resistance pattern of the isolates at the endocrinology and metabolic diseases unit of the Yaoundé Central Hospital. Materials and Methods. Samples were collected from 59 patients with diabetic foot ulcers by using sterile swabs and they were processed. Results. A total of 148 bacterial isolates were obtained from 56 positive cultures, with an average of 2.5 organisms per case. The age group of these patients ranged from 14 to 75 years and the maximum number of patients was in the age group of 51 to 60 years. Gram negative bacilli were more prevalent (65.5%) than gram positive cocci (36.4%). Polymicrobial growth was observed in 84.48% of the specimen, Monomicrobial growth in 18.59% and sterile growth in 6.25% of the isolates. The commonest isolates among the gram negative bacteria's were Proteus spp. (21.6%), Escherichia coli (18.9%), Klebsiella. spp (16.9%) and Pseudomonas aeruginosa (8.1%) while among the gram positive bacteria's Staphylococcus aureus was predominant (17.6%), followed by Staphylococcus epidermidis (10.1%) then by Streptococcus pyogenes (6.8%). Antimicrobial susceptibility results showed that Gram negative bacterial isolates were 100% sensitive to Imipenem and 86.5% resistance to Ampicillin, while for the Gram positive bacterial, they were 44.5% sensitive to Ciprofloxacin and 46.8% resistance to Oxacillin. Conclusion. This study showed a preponderance of gram negative bacilli among the isolates from the diabetic foot ulcers. Knowledge on the antibiotic sensitivity pattern of the isolates will be helpful in determining adequate drugs for the empirical treatment of diabetic ulcers.
... This result is in agreement with the observation of Hayyat et al, having found a sensitivity close to 100% to Amikacin and Imipenem for all GNB. 31 For the other more classic antibiotics and more accessible in our country such as Amoxicillin-Clavulanic Acid, Gentamicin, Ciprofloxacin and Ceftriaxone, their efficacy seems to be mixed with respect to these main GNB. However, it is difficult to extrapolate this result given the limited number of GNB isolated in our study. ...
Background: Diabetic foot infection is a serious risk of amputation and death. Our study aims to describe the epidemiological, clinical, biological, therapeutic and evolutionary profiles of patients hospitalized for infected diabetic foot. Methods: This is a descriptive cross-sectional study conducted in the Endocrinology department of the Joseph Raseta Befelatanana University Hospital, Antananarivo over a period of 4 years. The diagnosis of infected diabetic foot was made according to the criteria of the French-Speaking Society of Infectious Pathology. We included all patients who had undergone bacteriological examination with antibiogram of their diabetic foot lesion. Results: Fifty patients were retained, giving a hospital prevalence of 2.84%. Their mean age was 55.50±9.63 years, the sex ratio was 0.72 and mean duration of their diabetes was 6.87±6.13 years. The majority of the lesions were post-traumatic (28%). The mean hospital length stay was 42.82±35.26 days. Infections were classified as stage 4 for 72% of the patients. The main isolated bacteria were Staphylococcus aureus (54.69%), of which 83% were sensitive to Amoxicillin-Clavulanic Acid. Seventy percent of the patients were infected with multidrug-resistant bacteria. The amputation rate was 30% and the mortality rate was 2%. Conclusions: Therapeutic education on podiatric care must be optimized. Multi-disciplinarity is essential for management. Amoxicillin-clavulanic acid should be preferred as probabilistic antibiotic therapy for diabetic foot infection in our country where bacteriological examination is often lacking.
... [4][5][6]26 Similarly, it is also noted that P aeruginosa infection was most common in the wound of diabetic patients; however, the extent of its distribution varies from 27.05% to 20.1%. 20,[27][28][29] Recently, it has been suggested that infections caused by Pseudomonas spp, Staphylococcus spp, and Acinetobacter spp, can develop into chronic wounds with complex infections in both diabetic and nondiabetic individuals. 25 Interestingly, the present study observed infections of Acinetobacter spp, Enterobacter spp, Morgonella spp, K oxytoca, and Stenotrophomonas spp in Wagner's grade 2 ulcer. ...
This study collected wound swab samples from 50 diabetic patients, especially in Wagner’s grade 2 (28) and grade 3 (22)
foot ulcers. The samples were processed and subjected to bacterial isolation and characterization. The obtained diabetic
foot ulcer (DFU) bacterial isolates were also subjected to antibiotic susceptibility assay. All the collected samples were
culture positive and produced a total of 85 isolates. Monomicrobial and polymicrobial infections were observed from
the collected grade 2 and 3 samples, respectively. Gram’s staining and morphological analyses of the obtained bacterial
colony demonstrated the presence of both Gram-positive and Gram-negative bacilli, Gram-positive cocci, and Gram-
negative cocco-bacilli in the wounds of diabetic patients. The bacterial profiling of 85 isolates revealed the presence of
Gram-negative bacteria such as Pseudomonas aeruginosa, Escherichia coli, Proteus spp, Acinetobacter spp, Enterobacter spp,
Klebsiella pneumoniae, Citrobacter spp, K oxytoca, and Stenotrophomonas spp Gram-positive bacteria such as Staphylococcus
aureus, Bacillus subtilis, Enterococcus faecalis, Corynebacterium spp, and Streptococcus dysgalactiae were also identified. The
predominant microbial flora found in the collected samples were Staphylococcus aureus (38%) and P aeruginosa (23.2%),
followed by B subtilis (21%) and Escherichia coli (18%) and other bacteria. Furthermore, the obtained antibiotic susceptibility
assay data of DFU isolates have also confirmed the distribution of multiantibiotic-resistant bacteria in the wound site of
diabetic patients. The findings of the present study suggest that there is a need for the discovery of novel drug(s) to alleviate
antibiotic-resistant bacterial infections in DFU patients.
... The number of the percentage of P. aeruginosa isolates were isolated in a high percentage of infection 13(65%) from male, 7(35%) female Respectively. as shown in TABLE, 4 results were consistent with the study [14,15] as confirmed by the dominance of infection in males. ...
Pseudomonas aeruginosa from specimens of Diabetic Foot patients carries a high risk of misidentification. That leads to a non-specific treatment by antibiotic, so that present study was target virulence gene as specific gene Cup A gene, for the accurate and rapid identification of P. aeruginosa from Diabetic Foot Patients using sequencing for specific virulence genes Cup A gene, that gene facilitate the infection as adhesion gene. This technique was evaluated against 20 clinical isolates that were suspected as P. aeruginosa. The results were compared with those obtained using as a control of P. aeruginosa isolates from clinical samples. This reliable technique may offer a rapid tool that would help clinicians to initiate an appropriate treatment earlier. Further investigations are needed to assess the clinical benefit of this novel strategy as compared to antibiotic using. Nanoparticles (NPs) are increasingly used to target bacteria as an alternative to antibiotics. Nanotechnology may be particularly advantageous in treating bacterial infections. The antibacterial mechanisms of NPs against bacteria and the factors that are involved for comparison. Evaluation the result of nanoparticles on Bacteria by studying the genetic variation in bacterial genome before and after treatment was the aim of present study. Present results showed genetic variation for bacterial adhesion gene Cup A, the deletion mutation was repeated 5 times at the cytosine base, resulting in a breakthrough from Frame shift. Deletion Cytosine more than any other nitrogen base needs more investigation.
... In this study, majority of patients with diabetic foot ulcers were males (78.6%). This finding is in agreement with the studies conducted by Varsha et al (2017), Hayat et al (2011), Hena and Growther (2010), Sharma et al (2006) and Ahmed and EI-Tahawy (2000). In the present study, majority of patients were type-2 diabetic (75.7%). ...
... among Gram-negatives and 29.8% among all isolates, compared to 18.6% in our study [4]. Similar results have been reported in other parts of the world such as India, where a study showed that the most commonly isolated pathogen was Pseudomonas aeruginosa, constituting 20.1% of all isolated pathogens [8]. In a similar study from Kuwait on the microbiology of diabetic foot infections, Pseudomonas aeruginosa constituted 17.4% of all isolates [9]. ...
Introduction:
Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Global studies on the epidemiology of diabetic foot ulcer (DFU) infections and guidelines detailing the most common pathogens and their respective antimicrobial susceptibilities are available. While Gram-positive cocci, mainly Staphylococcus species (spp.), were the most common organisms cultured from DFU in the United States, the Gram-negative Pseudomonas spp. were found to be the most common in some Middle Eastern countries. In Lebanon, however, such studies remain scarce. This study, conducted in Lebanon, investigated the most common organisms in DFU infections and their antimicrobial profiles.
Methodology:
We collected data from all documented diabetic foot infections between January 2015 and March 2016, 128 participants total, from 5 different hospitals in various regions of Lebanon.
Results:
Among all isolates, Enterobacteriaceae (42%), Pseudomonas spp. (18.6%) and methicillin-sensitive Staphylococcus aureus (MSSA) (15.3%) were the most frequent bacteria. In addition, 72% of Pseudomonas spp. were susceptible to ciprofloxacin and 63.6% of Enterobacteriaceae were susceptible to either amoxicillin/clavulanate or ciprofloxacin, 91% were susceptible to piperacillin/tazobactam. Methicillin-resistant Staphylococcus aureus (MRSA) was only found in hospitalized patients or those who received prior antibiotics. Polymicrobial infections were documented in only 38% of patients.
Conclusion:
In Lebanon, the most appropriate empirical oral outpatient treatment would be a combination of amoxicillin/clavulanate and ciprofloxacin. As for admitted patients who have failed the oral regimen, piperacillin/tazobactam would then be the treatment of choice.
... Diabetic foot ulcer were found to be more common in males compared to females. The supportive data was seen in other similar as they indicate males dominate in having diabetes with foot infections when compared to females (12)(13)(14). This could be due to gender related factors that affect the skin and differences in professional activity predispose the male patients to foot ulcer (1). ...
Background: Diabetic foot syndrome is one of the most common and devastating preventable complications of diabetes resulting in major economic consequences for the patients, their families, and the society. Aims & Objectives: The present study was carried out to assess knowledge, attitude and practices of Diabetic Foot Wound Care among the patients suffering from Diabetic Foot and to correlate them with the socio-demographic parameters. Material & Methods: It was a Hospital based cross-sectional study involving clinically diagnosed adult (>18 years) patients of Diabetic Foot visiting the Surgery and Medicine OPDs at Teerthankar Mahaveer Medical College & Research Centre, Moradabad, India. Results: Significant association KAP (Knowledge, Attitude and Practices) score was seen with age of the patient, education, addiction, family history of Diabetes Mellitus, prior receipt of information regarding Diabetic foot-care practices, compliance towards the treatment and the type of foot wear used. Conclusions: The results highlight areas especially Health education, use of safe footwear and life style adjustments, where efforts to improve knowledge and practice may contribute to the prevention of development of Foot ulcers and amputation. © 2016, Indian Association of Preventive and Social Medicine. All rights reserved.
... In our study, majority of patients with diabetic foot ulcers were male, similar results were seen in. (5)(6)(7)(8) The total fungal positive cultures seen in our study were 17.5%, similar findings were seen in. (9,10) In our study, Candida species were most frequently isolated, the predominant was the Candida albicans 42.85% similar results were seen in. ...
Abstract
Introduction: Diabetes is an important predisposing factor for fungal infections and causes significant morbidity and mortality. The study was carried out for detection of fungal infections in diabetic foot ulcers.
Material and Methods: One year study was carried out on 80 patients. Samples were collected with the help of sterile swab. Direct microscopy by 10% KOH and for cultures samples were inoculated on two sets of SDA, one set incubated at room temperature and the other at 37oC. Yeasts were identified by germ-tube tests, urease test, and sugar fermentation.
Result: Out of 80 patients studied, 68.75% were male and 31.25% were female. Fungal culture positivity was seen in 17.5%.The predominant fungus isolated was C. albicans 42.85%, C. tropicalis 21.42%, C. glabrata 14.28%, T. mentagrophytes 7.14% T. rubrum 7.14% and A. fumigatus 7.14%.
Conclusion: Fungal infections in diabetic patients if not detected and treated in time leads to the fatal complications such as foot amputation.
Keywords: Diabetic foot ulcer, fungal infections, S.D.A., Candida albicans.
... Mostly the diabetic foot infections are mixed bacterial infections [6,7] and the proper management of these infections requires appropriate antibiotic selection based on culture and antimicrobial susceptibility testing. Infection with multidrug resistant organisms may increase the duration of hospital stay, cost of management and may cause additional morbidity and mortality [8]. Early diagnosis of microbial infections is aimed to institute the appropriate antibacterial therapy to avoid further complications. ...
Abstract
The study was conducted from January to March 2012. In this study colorimetric VITEK-2 Compact system used for its accuracy and rapidity to identify isolates and to detect several antimicrobial resistances.The study also investigate the antibacterial effect of Kombucha tea on isolated bacteria from diabetic foot ulcer. The bacteria isolated were eight gram negative bacteria, namely, Acinetobacter baumannii 3 (2%), Enterobacter cloacae 5 (4%), Escherichia coli 13 (10%), Klebsiella pneumoniae 7 (6%), Citrobacter spp. 4 (3%), Proteus mirabilis 3 (2%), Proteus vulgaris 3 (2%) and Pseudomonas aeruginosa 44 (35%). Four gram positive bacterium, Enterococcus faecalis 6 (5%), Staphylococcus aureus 17 (13%), Staphylococcus epidermidis 13 (10%) and Streptococcus spp. 9 (8%). The antimicrobial activities of antibiotics showed that, all isolates are sensitive to Ciprofloxacin, Levofloxacin and Ofloxacin. The resistance to other types of antimicrobial differ with different isolate. The effect of Kombucha tea on all isolates wasclear at 7days of incubation; the diameter of inhibition was 6mm for Acinetobacter baumannii, Proteus vulgaris and Enterococcus faecalis. 7mm for Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Citrobacter spp., Staphylococcus epidermidis and Streptococcus spp. 8mm for Proteus mirabilis, Pseudomonas aeruginosa and Staphylococcus aureus. The maximum activity of fermented tea was recorded at 14days incubation of Kombucha organism against all isolates, the diameter of inhibition was 21mm for Acinetobacter baumannii, 24mm for Enterobacter cloacae, 23mm for Escherichia coli, Staphylococcus epidermidis and Streptococcus spp., 16mm for Klebsiella pneumoniae, 22mm for Citrobacter spp. and Enterococcus faecalis, 25mm for Proteus mirabilis and Staphylococcus aureus, 20mm for Proteus vulgaris, 26mm for Pseudomonas aeruginosa. The antibacterial activity of Kombucha tea decrease with increase incubation periods28 days.
Key Words: Diabetic foot ulcer, Vitek 2 compact, Antimicrobials, Kombucha tea.
... Several studies with large patient cohorts, especially those from Pakistan and India, have reported similar rates of Pseudomonas in diabetic patients with foot infections [7,8]. While Abdulrazak et al. [18] reported a 17.5% rate of P. aeruginosa among all isolates, Ramakant et al. [9] and Hayat et al. [14] reported rates of 27.05% and 20.1%, respectively. The majority of these studies have also reported a proportional increase in the prevalence of multi-drug resistance among pathogens identified from DFIs during the same period. ...
In the present study, we sought to identify the bacterial organisms associated with diabetic foot infections (DFIs) and their antibiotic sensitivity profiles.
We retrospectively reviewed the records of wound cultures collected from diabetic patients with foot infections between May 2005 and July 2010.
We identified a total of 298 culture specimens (165 [55%] wound swab, 108 [36%] tissue samples, and 25 [9%] bone samples) from 107 patients (74 [69%] males and 33 [31%] females, mean age 62 ± 13 yr) with a DFI. Among all cultures 83.5% (223/267) were monomicrobial and 16.4% (44/267) were polymicrobial. Gram-negative bacterial isolates (n = 191; 61.3%) significantly outnumbered Gram-positive isolates (n = 121; 38.7%). The most frequently isolated bacteria were Pseudomonas species (29.8%), Staphylococcus aureus (16.7%), Enterococcus species (11.5%), Escherichia coli (7.1%), and Enterobacter species (7.1%), respectively. While 13.2% of the Gram-negative isolates were inducible beta-lactamase positive, 44.2% of Staphylococcus aureus isolates were methicillin resistant. Conclusions: Our results support the recent view that Gram-negative organisms, depending on the geographical location, may predominate in DFIs.
... This is consistent with reports from other studies [2,2324252627. Ati et al [28] reported a high frequency of monomicrobial bacterial infections. All the microorganisms isolated in this study showed high resistance to commonly used antibiotics except for Meropenem and imipenem which were all 100% sensitive respectively. ...
Diabetic foot ulcers (DFUs) pose a therapeutic challenge to surgeons, especially in developing countries where health care resources are limited and the vast majority of patients present to health facilities late with advanced foot ulcers. A prospective descriptive study was done at Bugando Medical Centre from February 2008 to January 2010 to describe our experience in the surgical management of DFUs in our local environment and compare with what is known in the literature.
Of the total 4238 diabetic patients seen at BMC during the period under study, 136 (3.2%) patients had DFUs. Males outnumbered females by the ratio of 1.2:1. Their mean age was 54.32 years (ranged 21-72years). Thirty-eight (27.9%) patients were newly diagnosed diabetic patients. The majority of patients (95.5%) had type 2 diabetes mellitus. The mean duration of diabetes was 8.2 years while the duration of DFUs was 18.34 weeks. Fourteen (10.3%) patients had previous history of foot ulcers and six (4.4%) patients had previous amputations. The forefoot was commonly affected in 60.3% of cases. Neuropathic ulcers were the most common type of DFUs in 57.4% of cases. Wagner's stage 4 and 5 ulcers were the most prevalent at 29.4% and 23.5% respectively. The majority of patients (72.1%) were treated surgically. Lower limb amputation was the most common surgical procedure performed in 56.7% of cases. The complication rate was (33.5%) and surgical site infection was the most common complication (18.8%). Bacterial profile revealed polymicrobial pattern and Staphylococcus aureus was the most frequent microorganism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. The mean hospital stay was 36.24 ± 12.62 days (ranged 18-128 days). Mortality rate was 13.2%.
Diabetic foot ulceration constitutes a major source of morbidity and mortality among patients with diabetes mellitus at Bugando Medical Centre and is the leading cause of non-traumatic lower limb amputation. A multidisciplinary team approach targeting at good glycaemic control, education on foot care and appropriate footware, control of infection and early surgical intervention is required in order to reduce the morbidity and mortality associated with DFUs. Due to polymicrobial infection and antibiotic resistance, surgical intervention must be concerned.
Background: Wound infections are the major factor for development of diabetic foot ulcer.Objectives: To identify the prevalence of aerobic bacterial isolates and its antimicrobial susceptibility pattern in diabetic foot ulcer patients.Methods: The Prospective observational study was undertaken from July 16th to September 16th 2017 in tertiary care teaching Hospital, Tiruchirappalli, Tamilnadu.Result: Seventy-three (73) organisms were isolated from 63 diabetic foot ulcer patients. Staphylococcus aureus (26%), E. coli (19.2%) and Pseudomonas aeruginosa (19.2%) were isolated. MRSA with 53% were showed 100% sensitivity to vancomycin, linizolid and teicoplanin. By phenotypic Confirmatory Disc Diffusion Test, 57.1% of E. coli were ESBL producers whereas 50% of Klebsiella species were ESBL producers. All ESBL producers showed 100% sensitivity to imipenem.Interpretation and Conclusion: The microbiological report helps for initiating the narrow spectrum antibiotic therapy and reduce the emergence of multidrug resistant organisms.
Tuberculosis is a common Childhood illness. Every eighth TB
patient has extra-pulmonary disease; of which, abdominal
involvement accounts for a significant proportion. Abdominal
TB presents a diagnostic challenge owing to its variable
presentation.
Objectives
Determine the frequency of different clinical presentations and
utility of various investigations for diagnosis of abdominal
tuberculosis in children.
Study Design
Prospective descriptive study.
Place and Duration of Study
The Department of Pediatric Gastroenterology & Hepatology
at The Children’s Hospital and The Institute of Child Health,
Lahore, Pakistan. January 2014 till April 2015.
Material and Methods
Total number of 60 children of ages 1-15 years having abdominal
tuberculosis were included. A detailed history was taken.
Presence of BCG scar, abdominal guarding, rigidity and
abdominal tenderness, Ascites, Hepatosplenomegaly were also
noted. CBC, ESR, Montoux, CXR, Abdominal USG, Abdominal
CT and Barium meal and follow through were done in all
patients. T spot TB test, laparoscopy and colonoscopy were
done in selected patients.
Results
A total of 60 children between 1-15 years of age were diagnosed
with abdominal tuberculosis during study period. Male to female
ratio was 1:2.16. Abdominal pain was observed in 88% of
children, fever, diarrhea and weight loss in 70% each, abdominal
tenderness and guarding in 80%, failure to thrive in 70%.
Abdominal lymphadenopathy in 35% subjects and thickening of bowel loops was present in 95%, mesenteric lymphadenitis
in 85% and ascites in 50% of patients. IGRA T spot TB test
was performed in 20% subjects and was positive in all. Barium
study, CT scan abdomen, ultrsonography were positive in 90%,
90% and 70% cases. Montoux test was positive in 50% subjects.
Conclusion
Common presentation of ATB is with abdominal pain &
tenderness, fever and weight loss. Common findings on imaging
studies are thickening of bowel, mesenteric lympadenopathy
and ascites. Most useful diagnostic investigations are Ultrasound
scan, CT scan, Barium meal and follow through and T Spot
TB test.
Key Words
Abdominal Tuberculosis, Pediatrics, Diagnosis
Skin ulcer infections and Diabetic foot ulcer (DFU) are wide clinical spectrum common causes of hospitalization and require acute antibiotic treatment that associated with wide range of pathogens which characterized with resistance against wide range of antibiotics that lead to failure therapy. The aim of the study was investigation bacterial profile, antibiotic resistance of isolated bacteria in skin and Diabetic foot ulcer patient and the effect of degree the ulcer patients. This study included 90 pus samples were collected from patients having skin ulcer and diabetic foot ulcer attended to AL-sader hospital during period 1-9 /2019. This study has shown that higher frequency of DFU and skin ulcer patients was male and the median of age in the patients were older than 40 years. Culture investigation shows that 82 specimens give positive growth of bacteria with total bacterial growth 94 isolates, 70 (74.5%) of cases had mono-microbial infection whereas 24 (25.5%) of cases give poly-microbial infection. Out of 94 bacterial isolates, 53 (56.4 %) isolates were gram negative bacteria (G-ve), which includes P.aerogenosa was 18 (33.96%) isolates, followed by K.pneumonia 11 (20.75%) isolates, Proteus spp 9 (16.98%) isolates, then E.coli 8 (15%) isolates, Citrobacter freundii 3 (7.5%) isolates and Acinetobacter baumanni 4 (5.6%) isolates, whereas G+ve bacteria recorded 41 (43.6%), which include S. aureus as predominant isolated bacteria in this study that record 14 (34.14 %) isolates followed by S. pyogenes was 9 (21.95%) isolates, then S. epidermedes, S. haemolyticus and E. fecalis 8 (19.51%), 6 (14.63%) and 4 (9.75%) isolates respectively. In this study the predominance bacteria isolated of superficial in Diabetic foot and skin ulcer were S. aureus while most bacteria presented of Deep ulcer in both ulcers were P. aerogenosa. The results of antibiotic resistance show most isolates in G+ve were sensitive to Vancomycin and high resistance to Gentamycin, Penicillin and Erythromycin whereas most G−ve isolates were resistant to Ampicilline, gentamicin, Pipercillin/tazobactam and sensitive to imipenem.
The study was conducted from January to March 2012. In this study colorimetric VITEK-2 Compact system used for its accuracy and rapidity to identify isolates and to detect several antimicrobial resistances.The study also investigate the antibacterial effect of Kombucha tea on isolated bacteria from diabetic foot ulcer. The bacteria isolated were eight gram negative bacteria, namely, Acinetobacter baumannii 3 (2%), Enterobacter cloacae 5 (4%), Escherichia coli 13 (10%), Klebsiella pneumoniae 7 (6%), Citrobacter spp. 4 (3%), Proteus mirabilis 3 (2%), Proteus vulgaris 3 (2%) and Pseudomonas aeruginosa 44 (35%). Four gram positive bacterium, Enterococcus faecalis 6 (5%), Staphylococcus aureus 17 (13%), Staphylococcus epidermidis 13 (10%) and Streptococcus spp. 9 (8%). The antimicrobial activities of antibiotics showed that, all isolates are sensitive to Ciprofloxacin, Levofloxacin and Ofloxacin. The resistance to other types of antimicrobial differ with different isolate. The effect of Kombucha tea on all isolates wasclear at 7days of incubation; the diameter of inhibition was 6mm for Acinetobacter baumannii, Proteus vulgaris and Enterococcus faecalis. 7mm for Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Citrobacter spp., Staphylococcus epidermidis and Streptococcus spp. 8mm for Proteus mirabilis, Pseudomonas aeruginosa and Staphylococcus aureus. The maximum activity of fermented tea was recorded at 14days incubation of Kombucha organism against all isolates, the diameter of inhibition was 21mm for Acinetobacter baumannii, 24mm for Enterobacter cloacae, 23mm for Escherichia coli, Staphylococcus epidermidis and Streptococcus spp., 16mm for Klebsiella pneumoniae, 22mm for Citrobacter spp. and Enterococcus faecalis, 25mm for Proteus mirabilis and Staphylococcus aureus, 20mm for Proteus vulgaris, 26mm for Pseudomonas aeruginosa. The antibacterial activity of Kombucha tea decrease with increase incubation periods28 days.
This study collected wound swab samples from 50 diabetic patients, especially in Wagner’s grade 2 (28) and grade 3 (22) foot ulcers. The samples were processed and subjected to bacterial isolation and characterization. The obtained diabetic foot ulcer (DFU) bacterial isolates were also subjected to antibiotic susceptibility assay. All the collected samples were culture positive and produced a total of 85 isolates. Monomicrobial and polymicrobial infections were observed from the collected grade 2 and 3 samples, respectively. Gram’s staining and morphological analyses of the obtained bacterial colony demonstrated the presence of both Gram-positive and Gram-negative bacilli, Gram-positive cocci, and Gram-negative cocco-bacilli in the wounds of diabetic patients. The bacterial profiling of 85 isolates revealed the presence of Gram-negative bacteria such as Pseudomonas aeruginosa, Escherichia coli, Proteus spp, Acinetobacter spp, Enterobacter spp, Klebsiella pneumoniae, Citrobacter spp, K oxytoca, and Stenotrophomonas spp Gram-positive bacteria such as Staphylococcus aureus, Bacillus subtilis, Enterococcus faecalis, Corynebacterium spp, and Streptococcus dysgalactiae were also identified. The predominant microbial flora found in the collected samples were Staphylococcus aureus (38%) and P aeruginosa (23.2%), followed by B subtilis (21%) and Escherichia coli (18%) and other bacteria. Furthermore, the obtained antibiotic susceptibility assay data of DFU isolates have also confirmed the distribution of multiantibiotic-resistant bacteria in the wound site of diabetic patients. The findings of the present study suggest that there is a need for the discovery of novel drug(s) to alleviate antibiotic-resistant bacterial infections in DFU patients.
Background
There is limited literature available on the clinical features and postoperative outcomes of patients with pulmonary aspergilloma. This study presents the outcome of patients managed surgically over nine years at a tertiary care hospital of a developing country.
Methods
This is a retrospective review of patients who underwent surgery for pulmonary aspergilloma over a period of nine years (from July 2001 to July 2010). Cases of aspergilloma were diagnosed on the basis of CT scan chest. Outcomes were morbidity, mortality and recurrence of aspergilloma.
Results
A total of 56 patients who underwent surgery for pulmonary aspergilloma were included. All patients presented with massive hemoptysis. Unilateral aspergilloma was found in 52 (92.8%). 49 patients (87.5%) had past history of pulmonary tuberculosis. Most common surgical procedure performed was lobectomy (53 patients) with median intraoperative blood loss of 400 ml (IQR: 300 ml to 587 ml). Postoperative morbidity was recorded in 10 patients (17.8%). Complications included prolonged air leak [8, 14.2%)], atelectasis requiring bronchoscopy [2, 3.6%)], renal dysfunction [1, 1.7%)] and prolonged ventilation [1, 1.7%)]. One patient expired within 30 days due to hospital acquired Acinetobacter pneumonia. With minimum follow up of one year, none of the patients had recurrent hemoptysis or aspergilloma.
Conclusion
Surgery, being safe and effective, should be treatment of choice in patients with pulmonary aspergilloma especially in the life- threatening situation of massive hemoptysis.
There is controversy as to whether or not diabetic foot infections (DFIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with worse outcomes than DFIs caused by other pathogens. To address this issue we performed a nonsystematic literature search of published articles in English language journals seeking studies reporting on the outcomes of DFIs related to their microbiology. We retrieved 48 articles published from 1999 to 2013 that described a total of 7771 cases of DFI. The overall proportion of DFIs with an isolate of S aureus was about 30%; just over one third of these (11% of all cases) were MRSA strains. Among the DFI cases caused by MRSA 1543 were episodes of soft tissue infections and 113 of osteomyelitis, while non-MRSA organisms caused 5761 soft tissue infections and 354 cases of osteomyelitis. Only 5 of the included articles attempted a comparison between DFI caused by MRSA and those caused by other pathogens, with no clear differences noted. The median total duration of antibiotic therapy for DFI caused by MRSA was 26 days, of which a median of 10 days was given intravenously. Only a few articles reported the proportion of patients with a recurrence, but they often did not differentiate between MRSA and non-MRSA cases. Four publications reported a worse functional or microbiological outcome in MRSA, compared to non-MRSA, cases, but the findings were variable and differences did not seem to be significant. Many trials failed to adjust for case-mix or to definitively demonstrate a relationship between microbiology and outcomes. Few of the articles specifically commented on whether the MRSA isolates were health care- or community-acquired strains. Notwithstanding the substantial limitations of the available literature, there does not appear to be a need for any special treatment for DFI caused by MRSA. The current guidelines for treating according to established international recommendations seem appropriate.
Foot infections are frequent and potentially devastating complications of diabetes. Unchecked, infection can progress contiguously to involve the deeper soft tissues and ultimately the bone. Foot ulcers in persons with diabetes are most often the consequence of one or more of the following: peripheral sensory neuropathy, motor neuropathy and gait disorders, peripheral arterial insufficiency, or immunological impairments. Infection develops in over half of foot ulcers and is the factor that most often leads to lower extremity amputation. These amputations are associated with substantial morbidity, reduced quality of life and major financial costs. Most infections can be successfully treated with optimal wound care, antibiotic therapy and surgical procedures. Employing evidence-based guidelines, multidisciplinary teams, and institution-specific clinical pathways provides the best approach to guide clinicians through this multifaceted problem. All clinicians regularly seeing persons with diabetes should have an understanding of how to prevent, diagnose and treat foot infections, which requires familiarity with the pathophysiology of the problem and the literature supporting currently recommended care.
Wagner's classification is the most widely utilized grading system for lesions of the diabetic foot. The aim of the study was to evaluate and manage the different lesions of diabetic foot according to Wagner classification. This will help to describe the lesions we treat study and compare outcomes and also identify measures to decrease morbidity and mortality due to diabetic foot disease.
The study was conducted in surgical "c" unit of Khyber Teaching Hospital, Peshawar from July 2002 to June 2003. 100 patients with diabetic foot disease were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to wagner classification and appropriate medical and surgical treatment carried out.
Diabetic foot disease formed 1.04% of total admissions and 0.23% of OPD patients. 62 (62%) were males and 38 were females. Common age group was 40-60 years, 6 patients had grade 0, 14 grade 1, 25 with grade 2, 30 with grade 4 and 4 with grade 5 lesions. 17 patients were managed conservatively with antibiotics alone, 33 had incision drainage and debridement while 48 needed amputation of different types. Staphylococcus aureus was the commonest organism isolated.
Majority of the diabetic foot lesions were in grade 2 to 5. Lesser grade lesions responded well to conservative treatment with antibiotics and surgical debridement while those with higher grades needed amputations. Effective glycemic control, timely hospital admissions, approximate surgical/medical treatment along with patient education in foot care can decrease morbidity and mortality due to diabetic foot disease.