Surveillance of infection in diabetic foot from an Indian tertiary care teaching hospital

Shobhitendu Kabi; Baikuntha Nath Panda; Mahesh Chandra Sahu

Volume : VII, Issue : XI, November - 2017

Surveillance of infection in diabetic foot from an Indian tertiary care teaching hospital

Shobhitendu Kabi, Baikuntha Nath Panda, Mahesh Chandra Sahu

Abstract :

Background: Foot infection is a frequent complication of patients with diabetes mellitus, accounting for up to 20% of diabetes–related hospital admissions. Some infectious agents are associated with the worst outcomes, which may ultimately lead to amputation of the infected foot

unless prompt treatment strategies are ensured. The present study sought to reveal the bacterial profile of diabetic foot ulcers in Eastern India where socio–economic status of the population is low.

Methods: A 10–month–long descriptive study was carried out to analyse the aerobic and anaerobic bacterial isolates of all patients admitted with diabetic foot infections presenting with Wagner grade 2–5 ulcers. Bacteriological diagnosis and antibiotic sensitivity profiles were carried out and analysed using standard procedures.

Results: Diabetic poly–neuropathy was found to be common (56.8%). Gram–negative bacteria (57.6%) were isolated more often than gram–positive ones (42.4%) in the patients screened. The most frequent bacterial isolates were Staphylococcus aureus, coagulase–negative staphylococci (CONS), Pseudomonas aeruginosa, and Enterobacteriaceae. Forty–nine cultures (68%) showed polymicrobial involvement. About 44% of P. aeruginosa were multi–drug–resistant, and MRSA was recovered on eight occasions (10.3%). Bacteroides spp. and Peptostreptococcus spp. were the major anaerobic isolates.

Conclusions: Our study supports the viewpoint put forth by previous Eastern Indian authors that the distribution of gram–negative bacteria (57.6%) is more common than gram–positive ones (42.3%). Also it is contrary to the viewpoint that diabetic foot infections are frequently monomicrobial. Furthermore, recovery of multi–drug–resistant P. aeruginosa isolates is of serious concern, as almost no one has reported the same from the Eastern Indian milieu.