Detection of microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus (DM) which is associated with high morbidity and mortality. There is high rate of bacteria colonization especially in those with tendencies for poor wound dressing. This is accompanied by high rate of inappropriate antibiotic usage. The aim of this study is to characterize microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria, and to determine the antibiotic susceptibility of these isolates. Methodology: This was a descriptive cross-sectional study of consecutively enrolled diabetic patients with foot ulcers in two tertiary healthcare facilities in Enugu, Nigeria, between May 2021 and February 2022. A structured questionnaire was used to obtain socio-demographic and clinical data of the patients. Pus samples and/or tissues were collected from the ulcer lesion of each patient for aerobic and anaerobic microbial cultures and biochemical identification using standard conventional techniques. Results: A total of 310 diabetic patients with foot ulcers were recruited into the study, with 62.3% (193/310) males and 37.7% (117/310) females, and mean age of 56.0±13.9 years. Bacteria and yeast were isolated from samples of 280 (90.3%) patients while samples of 30 (9.7%) patients had no microbial growth. Males had higher frequency of microbial isolates (90.7%, 175/193) than females (89.7%, 105/117), while the age group ≤ 40 years had higher frequency of microbial isolates (100%, 43/43) compared to other age groups, although the differences are not statistically significant (p>0.05). The distribution of the isolates showed that 15.7% (44/280) were monomicrobial while 84.3% (236/280) were polymicrobial. The highest single isolate was Bacteroides fragilis with 5.0% (14/280), followed by Staphylococcus aureus with 3.2% (9/280). Bacteroides fragilis and S. aureus occurred as the highest combined bacteria isolates with 5.7% (16/280). Most of the patients were colonized by combination of bacterial isolates. The susceptibility indicates that most of the anaerobic bacteria were sensitive to metronidazole while S. aureus isolates were resistant to ofloxacin at a rate of 65.0%. Conclusion: The findings in this study showed that there is high bacteria and fungi colonization of foot ulcers of diabetic patients in Enugu, Nigeria. Routine care of wounds especially frequent changes of dressing materials and the use of potent antiseptics, are recommended.

Aspects cliniques et paracliniques des amputations du pied diabétique au Mali

Introduction. La plaie du pied diabétique est une affection fréquente (10% des motifs d'hospitalisation) et grave, le risque d'amputation étant de 10 à 30 fois plus élevé chez les diabétiques par rapport à la population générale. Elle n'a que peu été étudiée au Mali. Objectif. Décrire les aspects cliniques, thérapeutiques et pronostiques des amputations du pied diabétique au Mali. Méthodologie. II s'agit d'une étude descriptive et transversale qui s'est déroulée à l'Hôpital du Mali du 1er Juillet 2016 au 30 Juin 2017. Elle a porté sur les patients diabétiques présentant une plaie du pied, hospitalisés dans le service de médecine et endocrinologie de l'Hôpital du Mali Les données recueillies et analysées étaient les données sociodémographiques, les données relatives au diabète, les données relatives au pied, les bilans biologiques récents, les radiographies standards, l'échographie doppler artériel des membres. Pour classer le pied atteint, nous avons utilisé la classification de l'Université de Texas. Résultats. Vingt-cinq (25) patients diabétiques ont été recrutés. Le sex ratio était de 0,66. Tous les patients avaient une artériopathie, 96% avaient une neuropathie, et 80% avaient un pied mixte. Un mauvais équilibre glycémique était noté chez 64% des patients ; une ostéite radiologique dans 52% des cas. En outre, 23 patients (92%) avaient un risque d'amputation à 100% selon la classification de l'Université du Texas. 12 patients (46%) avaient été amputés au niveau de la jambe. Nous avons enregistré un décès (4%). Conclusion. L'amputation du pied diabétique affecte surtout la diabétique de sexe féminin avec un mauvais équilibre glycémique. Dans la moitié des cas, elle a lieu au niveau de la jambe

Clinico­microbial profile of diabetic foot infections in Zaria, North­West Nigeria

Background: Diabetic foot infection (DFI) is a dreaded complication of diabetes mellitus, which usually occurs following foot ulceration. It may starts as a monomicrobial infection and end up as a polymicrobial infection. Antimicrobial regimens are usually selected empirically initially, based on local epidemiological and antimicrobial susceptibility pattern. Objective: The aim is to investigate the microbiological profile of patients admitted with DFIs in our institution and determine the antimicrobial susceptibility pattern of the isolates. Materials and Methods: A 2­year retrospective observational study of patients admitted with DFI into our institution. The microbiological culture and antimicrobial susceptibility results of swab specimens from the patients were retrieved and reviewed. These were correlated with the clinical stage of the disease. Results: Fifty­six patients' medical records were reviewed. There were 35 males and 21 females. The mean age of the patients was 56.2 years (range 48­75 years). Three patients had bilateral lesions. The Wagner grades of the lesions were Grades II­V, with Grade IV being predominant. Eight bacteria species and a fungus were isolated from the 59 swab specimens studied. Four specimens yielded no growth, whereas 7 specimens yielded contaminants. Monomicrobial cultures were predominant, with Gram­negative bacteria being preponderant.Staphylococcus aureus was the most common isolate, followed by Proteus species. The isolates showed greater susceptibility to levofloxacin and ciprofloxacin. Conclusion: The findings suggest that either levofloxacin or ciprofloxacin should be the anchor antimicrobial agent in empirical treatment of DFI in our locality

Indications et résultats de l'échographie doppler vasculaire à Cotonou : à propos de 73 cas

Objectif : Décrire les indications et les résultats de l'échographie Doppler vasculaire en pratique de ville à Cotonou au Bénin. Matériels et Méthodes : Une étude rétrospective et descriptive a été menée sur les archives des comptes rendus d'échographie Doppler vasculaire d'octobre 2015 à juin 2018, soit une période de 33 mois dans l'unité d'échographie du Centre d'Imagerie Médicale et de Diagnostic. Tous les patients ayant fait une échographie Doppler vasculaire dans la période ont été inclus dans l'étude. Les variables étudiées étaient l'âge et le sexe, les indications cliniques, la région anatomique examinée et les lésions retrouvées à l'échographie Doppler vasculaire. Résultats : 73 patients ont été inclus. L'âge moyen des patients était de 54,30 ans ± 11,58. Les patients étaient en majorité de sexe masculin (54,79%) avec une sex-ratio M/F égale à 1,21. L'indication de l'échographie Doppler vasculaire était pertinente dans 100% des cas. Les indications les plus fréquentes étaient le pied diabétique (32,88%), la suspicion de thrombose veineuse profonde (19,18%), les grosses jambes douloureuses (12,33%) et les œdèmes des membres pelviens (9,59%). L'échographie Doppler vasculaire des membres pelviens représentaient 93,11% des examens. 54 examens (73,97%) étaient revenus pathologiques. Les pathologies vasculaires les plus rencontrées étaient l'artériopathie calcifiante des membres pelviens (27,78%), l'insuffisance veineuse (18,51%) et la thrombose veineuse profonde (16,67%). Conclusion : L'échographie Doppler vasculaire réalisée par un spécialiste est performante dans le diagnostic des pathologies vasculaires périphériques. Elle constitue une alternative pertinente et peu onéreuse d'exploration vasculaire dans les pays à ressource limitée. Dans le contexte d'émergence des maladies cardio-vasculaires dans ces pays, elle mérite d'être vulgarisée dans les centres publiques et privées

Dépistage de l'artérite des membres inférieurs chez les patients ayant un pied diabétique en attente d'une chirurgie à cotonou

Objectifs : L'étude a été initiée afin de dépister l'artérite des membres inférieurs chez les patients ayant un pied diabétique. Méthodologie : L'étude est transversale, descriptive et analytique. La population d'étude est consti-tuée des diabétiques hospitalisés pour pied diabétique au CNHU-HKM de Cotonou. L'artérite des membres inférieurs est dépistée par l'échodoppler artériel.Résultats : l'artérite des membres inférieurs a été dépistée chez159 patients soit uneprévalence de 80,76%. Les facteurs associés à l'artérite sont la durée de dépistage du diabète d'au moins 10 ans, l'hypertension artérielle, les signes d'ischémie etl'absence du pouls pédieux.Conclusion : l'artérite des membres inférieurs chez les patients ayant un pied diabétique est fré-quente. Le dépistage systématique de l'artérite est fortement recommandé en cas de lésion du pied chez les diabétiques

Emergence de souches d'entérobactéries résistantes aux fluoroquinones dans les cultures des plaies diabétiques compliquées d'ostéites à Abidjan (Côte d'Ivoire)

Objectif. Décrire les caractéristiques épidémiologiques et microbiologiques des pieds diabétiques compliqués d'ostéite à Abidjan. Méthodes. Il s'agit d'une étude transversale, rétrospective ayant concerné 71 prélèvements bactériologiques (écouvillonnage) suivis d'une culture en présence d'un pied diabétique avec ostéite, colligés dans le service d'endocrinologie ­ Diabétologie du CHU de Yopougon (Abidjan) de 2002 à 2012. Résultats. La population d'étude était constituée de 71 patients dont 92,2% diabétiques de type 2, d'âge moyen 56,6± 12,6 ans, de durée moyenne d'évolution du diabète 10,4±8 avec une moyenne glycémique à 3,33±1,54 g/l et au stade de multiples complications du diabète. Le facteur déclenchant de la plaie était souvent un traumatisme (21,1%), une phlyctène spontanée (21,1%) ou un pied d'athlète (12,2%). Parmi les 71 patients avec pieds diabétiques compliqués d'ostéite ayant bénéficié d'un prélèvement, 51 cultures ont été positives soit 71,83 % des cas. Elles ont été le plus souvent monomicrobiennes 42 soit 82,3% des cas. A l'issue des examens microbiologiques 61 germes ont été isolés repartis selon les familles, les espèces et sous espèces. Parmi ces germes 60,65% étaient des bacilles Gram négatif, dont 86,5 % d'Entérobactéries, et 39,35% des Cocci Gram positif. La recherche de germes anaérobies n'a pas êté réalisée. En fonction des espèces, Escherichia coli a été isolé dans 35,13% des cas et les staphylocoques aureus ont été isolés dans 18% des cas. Au total 52,7% dessouches d'entérobactéries étaient résistantes aux quinolones et 22,7 des souches de Staphylocoque étaient méticillino-résistants. Conclusion. L'écologie bactérienne des pieds diabétiques compliqués d'ostéite est dominée par des souches d'entérobactéries résistantes aux antibiotiques usuels

Spectrum of disease and outcome of primary amputation for diabetic foot sepsis in rural KwaZulu-Natal

Background: Primary amputation (stump closure) for diabetic foot sepsis is perceived to have a higher re-amputation rate due to stump sepsis. A guillotine amputation with elective stump closure is widely practised due to the lower risk of stump sepsis and re-amputation.Aims: To provide an epidemiological analysis of the spectrum of disease and outcomes of primary amputation for diabetic foot sepsis in a regional rural hospital.Methods: A prospective cohort study of 100 patients who underwent surgery for diabetic foot sepsis over a 5-year period was undertaken at Madadeni Provincial Hospital, in northern KwaZulu- Natal. Demographic data, co-morbid profile, radiographic features, anatomical level of vascular occlusion and type of surgery performed were recorded. The Wagner classification (Wag) was used to classify disease severity. Outcome measures included length of hospital stay, in-hospital mortality and re-amputation rates.Results: Of the 100 patients, females (n = 50) accounted for 50% of admissions. The median age was 61 years (range: 29 to 80 years). Most patients presented with advanced disease: Wag 5, n = 71 (71%); Wag 4, n = 20 (20%); Wag 3, n = 7 (7%); Wag 2, n = 2 (2%). The anatomic levels of vascular occlusion comprised: aortoiliac disease n = 2 (2%), femoro-popliteal n=21(21%) and tibioperoneal disease n = 77 (77%). The following surgical procedures were undertaken: above knee amputation (AKA), n = 35 (35%); below knee amputation (BKA), n = 46 (46%); transmetatarsal amputation (TMA), n = 8 (8%); toe ectomy, n = 8 (8%) and debridement, n = 3 (3%). The re-amputation rate to above knee amputation was n = 2/46 (4.3%). All AKA stumps healed completely. The overall in-hospital mortality was n = 7 (7%) and median length of hospital stay was 7.8 ± 3.83 days.Conclusion: Most patients present with advanced disease requiring a major amputation. A definitive one stage primary amputation is a safe and effective procedure for diabetic foot sepsis with distinct advantages of a short hospital stay, low re-amputation rates and mortality. A guillotine amputation should be reserved for physiologically unstable patients

Pattern of Doppler Ultrasonographic Scan Requests and Findings: A 3-Year Study

Introduction: Doppler ultrasonography is a radiological investigative tool which is relatively new in developing countries, Nigeria inclusive.Objective: To describe the clinical indications, the pattern of requests and findings of Doppler ultrasonographic studies in a tertiary health facility in Sagamu, Nigeria. This is a preliminary report of a spanning June 2007 to July 2010 and highlighting the Methods: This initial report covered the period between June 2007 and July 2010. The subjects consisted of patients who were referred for Doppler Ultrasonography from public and private health facilities in Sagamu. The ultrasound scan was carried out using a Siemens's Sonoline G-40® Ultrasound Machine. The features recorded included the waveforms, peak velocities, pathologic features such as plaques, irregular pools of blood and the relative absence of flow as well as the lack of Doppler signals.Results: There were 42 patients comprising 29 (69%) males and 13 (31%) females, aged 16-78 years, with a mean age of 53 ± 15.5 years. The subjects were matched for age (p = 0.9). The clinical indications for Doppler ultrasound studies included Diabetes Foot Syndrome (DFS), Deep Venous Thrombosis (DVT), peripheral arterial disease, and leg swellings. Minor indications included oedema, gunshot wound, nephritic syndrome, supraclavicular tumour and varicose veins. The Doppler ultrasound findings were confirmatory of the clinical diagnosis of DVT in 5/8 (62.5%) and 5/23 (21.7%) in DFS patients.Conclusion: Doppler ultrasound confirmed a higher proportion of DVT compared to DFS

Lower limb amputation in diabetic foot disease: experience in a tertiary hospital in southern Nigeria

The diabetic foot is characterised by the triad of neuropathy, infection, and ischaemia, which may ultimately lead to limb amputation. It is important to understand the factors that place diabetic patients at increased risk of amputation in our society, hence the need for this study. The medical records of all patients admitted and treated for diabetic foot complications over a 3-year period (January 2007 to December 2009) were retrieved. Relevant information was obtained from the case notes. Thirty-six (36) patients entered the study, 25 males and 11 females (M:F ratio 2.3:1.0). Mean age was 54 years (range 24­74). Patients presented with foot gangrene (58%), ulceration (31%) and infection (11%) with trauma being the most common precipitating factor (53%). Nineteen patients (53%) had lower limb amputation, the commonest of which was below knee. Of the patients that had amputation, 18 (95%) had type 2 diabetics. Adequate diabetic foot disease preventive strategies need to be designed and implemented to reduce the incidence of lower limb amputations

The Pattern and Surgical Management of Diabetic Foot at Muhimbili National Hospital; Dar-es-Salaam; Tanzania

Background:Diabetic foot is one of the chronic consequences of diabetes mellitus and isresponsible for about 50of non-traumatic lower limb amputations.It is thus associated with social devastation to the patients and their families;both emotionally and economically.This study aimed at determining the pattern and the surgical management of patients with Diabetic Foot at Muhimbili National Hospital; from March to December 2008. Methods: All in-patients with diabetic foot who were admitted in the hospital during the study period were included into the study.Results: A total of 67 patients presented with diabetic foot during the study period of 10 months 4.5had Type 1 Diabetes Mellitus and 95.5had Type 2.The mean age of the patients was 52.4 years with a range of 21-75 years.The mean hospital stay was35.5 days.Most patients had a positive family history of Diabetes Mellitus (59.7).Majority of them lacked the known risk factors for foot ulceration such as hypertension;elevated cholesterol levels;trauma and duration of Diabetes Mellitus for longer than 10 years.Wagner Grade 4 and 5 were the most common ulcers encountered and major amputation was done in 44.8of the patients.The mortality rate was relatively high (25.4). Mortality was significantly higher in those with Wagner's Grade ulcers 3 (p-value = 0.0322). Conclusion:Diabetic foot ulceration was found to be a significant cause of morbidity and mortality in our setting.These patients stay in the surgical ward for a prolonged period of time.This causes a significant strain to the provision health services in the hospital.Designing a diabetic foot management protocol and initiating a diabetic foot unit for admission of these patients could reduce the associated morbidity and mortality and improve outcome

Antibiotherapie des infections du pied diabetique

L'infection du pied chez le diabetique entraine une morbidite importante avec un risque d'amputation. Elle necessite une prise en charge multidisciplinaire. Les cocci a Gram positif; notamment S. aureus; dominent la microbiologie des infections du pied diabetique. Cependant; les cocci a Gram negatif et les anaerobies sont plus frequents en cas d'ulcerations chroniques ou d'antibiotherapie prealable. Les infections du pied diabetique doivent etre cliniquement diagnostiquees devant la presence de signes generaux et locaux d'inflammation. Des prelevements microbiologiques correctement obtenus doivent etre adresses pour culture avant toute antibiotherapie. Les biopsies; les curetages d'ulcere et les aspirations seront privilegies. Les infections doivent etre classes pour juger le risque fonctionnel et le degre d'urgence de la prise en charge. L'antibiotherapie empirique sera debutee sur la base de la severite clinique et de la presomption microbiologique. Elle sera evaluee par la suite en fonction de la reponse clinique et des resultats de l'antibiogramme. Dans les formes moderees; une antibiotherapie couvrant les cocci a Gram positif peut s'averer suffisante. Dans les formes severes; la voie parenterale sera privilegiee surtout en presence d'osteite. Cependant; certains antibiotiques ayant une biodisponibilite orale elevee peuvent etre prescrits meme en cas d'osteite. L'antibiotherapie sera poursuivie jusqu'a la disparition des signes d'infection sans exiger une cicatrisation complete des ulcerations. Le recours a la chirurgie doit etre toujours discute surtout devant un abces profond; une extension aux structures osteo-articulaires; la presence d'une necrose ou d'une gangrene ou en ca de fasciite necrosante

Footcare practices among Nigerian diabetic patients presenting with foot gangrene

Diabetic foot ulceration and gangrene is a major cause of morbidity andmortality. This study has examined potential preventive footcare practices in a cohort of diabetic patients presenting with foot gangrene. One hundred and two (102) diabetic emergencies presented during the study period. Diabetic foot gangrene accounted for 27 (26%) of these cases. There were 18 males and 9 females (M:F = 2:1), with a mean age of 52+13 years. The mean duration of ulceration was 4±3 weeks and mean ulcer­gangrene interval was 1.2±0.5 weeks. Only 9 patients (33%) had been exposed to any form of footcare education, 15 patients (55%) treated their ulcers by unorthodox means, and 63% of the patients practiced no significant footcare. More widespread education and awareness is needed to prevent the continuing and serious problem of diabetic foot gangrene and consequent lower limb amputation

Diabetic foot disease in Ethiopian patients: a hospital based study

Background: Ulcers of the foot are one of the most feared and common complications of diabetes. It is a major cause of disability; morbidity and mortality among diabetic patients and about 15develop foot ulcers in their lifetime. So far; there are few published data in relation to the high-risk diabetic foot in Ethiopian subjects. Methods: A retrospective study was done to determine the various risks as well as antecedent factors; other long term complications; treatment profile and subsequent follow up of 196 patients with diabetic foot disease admitted to the Tikur Anbessa Specialized Referral Hospital from Jan 1999 to Dec 2003. Patients' medical records were reviewed using pre-prepared formats and relevant data were abstracted. The data were analyzed using Epi info version 3.4.3 statistical soft ware. Results: A total of 196 patients were included in this study. The male to female ratio was 3 to 1. The median age was 60 years (IQR; 47-65). Median duration of symptoms before presentation was 21 days (IQR; 14-30) and the median duration of diabetes mellitus was144 months (IQR; 60-216). More than two thirds had type 2 diabetes mellitus. Among 109 patients with identified antecedent risk factors for their foot problem; ill fitting or new shoes attributed in 48(44). Neuro-ischaemic ulcers were seen in 113 (58) of the cases and neuropathic ulcer in 63 (32). Ulcer with cellulitis or gangrene was the most common mode of presentation seen in 92 (47) of the patients. Ninety two (47) patients had amputations. Re-amputation was necessary in 24 (26) of these cases. Less than 40of the total cases had a regular follow up either at a clinic or hospital. Diabetes was diagnosed for the first time in 7 cases (4) on presentation with foot ulcer. The mean glycemic level was poorly controlled in over 80of the cases. The overall mortality rate was 21and sepsis was the most identified cause. Conclusion: Lack of regular patient follow up and diabetes education on foot care; poor glycemic control; delay in patient presentation and surgical intervention as well as patients' refusal to undergo surgical interventions were the reported contributing factors for the observed high mortality. Recommendation: Diabetic education on foot care; emphasis on metabolic control of diabetes; early presentation and surgical intervention when appropriate has to be highlighted in the management of diabetic patients. More studies have to be done in relation to the high-risk diabetic foot particularly in the Ethiopian setting emphasizing on preventive aspects. [Ethiop J Health Dev 2011;25(1):17-21]

Screening and identifying diabetic patients at risk of foot ulceration: use of the Semes­Weinstein monofilament

The diabetic foot can present with many different problems and the most important clinically are ulceration, amputation, and Charcot neuropathy. The majority of lower limb amputations in patients with diabetes are preceded by foot ulceration. Neuropathy results in loss of protective sensation and the use of 5.07/10 g Semmes­Weinstein monofilament is a simple device that detects patients with insensate feet. Clinical and demographic parameters of all consenting consecutive type 2 diabetes patients were documented. A history of the presence of peripheral neuropathy and sensory modalities of light touch, vibration sense, and joint position were assessed and the 5.07/10 g Semmes-Weinstein monofilament was used to detect patients with insensate feet. A total of 117 patients were examined (mean age 58 years, diabetes duration 6 years: there were 51% males and 49% females, and mean fasting plasma glucose was 8.1±2.9 mmol/L. Ninety-three (79%) presented with a history of peripheral neuropathy and 96% had one or more impaired sensory modality. The use of the monofilament showed impairment in 49%. Twenty-seven (23%) of these had severe peripheral neuropathy. The most frequent site of loss of sensation was the heel (31%). We concluded that the prevalence of peripheral neuropathy in our patients is high. Most patients walked sometimes barefoot, which may account for a high occurrence of foot ulceration. The Semmes-Weinstein monofilament should be routinely used in diabetes clinics

Bacteriological evaluation of diabetic ulcers in Nigeria

Diabetic foot ulcers are a common cause of morbidity and mortality in Nigeria. The lesions are usually infected, and this study was carried out in Enugu State, Nigeria to determine the common bacterial pathogens that infect ulcers and their antimicrobial susceptibly patterns. Deep wound swabs were collected from 71 consecutive diabetic patients admitted with foot ulcers into the medical wards of University of Nigeria Teaching Hospital, Enugu (26% of 274 total diabetes-related admissions). Polymicrobial isolates of Clostridium spp, Staphylococcus aureus, Escherichia coli, or Klebsiella aerogenes were found in 26 (53%) cases. Clostridium species showed susceptibility to fluoroquinolones, and high resistance to beta-lactams. Escherichia coli and Klebsiella aerogenes showed resistance to the aminoglycosides and beta-lactams. All the gram-negative organisms showed significant susceptibility to the fluoroquinolones used. Clostridium species, Staphylococcus aureus, Escherichia coli, and Klebsiella aerogenes were the most common causes of diabetic foot infections in the study and the rates of antibiotic resistance were observed to be relatively high. Antibiotic susceptibility testing remains of paramount importance in the management of diabetic foot ulceration

Diabetic Septic Foot in Omdurman Teaching Hospital

Objective: To audit the management of diabetic septic foot [DSF] lesions in Omdurman Teaching Hospital, using Wagner classification. Patients and methods: This is a retrospective study on 208 patients with DSF admitted to Omdurman Teaching Hospital, Sudan between June 2006 and May 2007. Data were analyzed manually Results: The male to female ratio was 2:1. The mean age± SD was 56 ± 12.35 year. 16.8% patients were grade 1. 33 (15.9%) patients were grade 2. grades 3, 4, 5 patients were 66 (37 %), 38 (18.3%) and 36 (17.3%) respectively. Major lower limb amputation and mortality were 19.2%, and 6.7% respectively. Conclusion: Preventive measures for patients at risk are highly needed as well early presentation is encouraged when ulcer develops in diabetic foot to avoid subsequent complications

Foot Ulceration in Nigerian Diabetic Patients: a Study of Risk Factors

Diabetic foot ulceration is an important cause of morbidity and mortality in Nigerian diabetic patients. Identification of the risk factors for ulceration is; therefore; of paramount significance. This study aimed to determine these risk factors. Forty-seven (47) diabetic patients with past or present foot ulceration were studied together with an equal number of controls which were diabetic subjects with no past/present history of ulceration. Risk factors strongly associated with foot ulceration included peripheral vascular disease; male sex; nephropathy; retinopathy; foot deformities; history of previous foot ulceration or amputation; cataract formation; poor glycaemic control; neuropathy; and tinea pedis. Weakly associated risk factors were walking unshod; being of low socio-educational status; and smoking. We concluded that many risk factors for foot ulceration are potentially preventable. As part of a comprehensive footcare programme; education on footcare should be directed at patients; family members; and healthcare providers

Bacteriology of Diabetic Foot Ulcers in Bacteriology; in Benin City; Nigeria

This study aimed to determine the bacteriological pattern and antimicrobial susceptibility of diabetic foot ulcer (DFU) infections seen in our practice; with a view to suggesting optimal therapy for these patients. Forty-seven persons with DFU were seen. The mean age was 56 years. Of these; 30 (64) had wound swabs sent for bacteriological assessment and antibiotic sensitivity patterns. There were 20 non-gangrenous ulcers and 10 gangrenous ulcers. Proteus spp and coliform organisms were the most predominantly isolated organisms in gangrenous ulcers; while Staphylococcus aureus; coliforms; and Pseudomonas aeruginosa were commonly isolated in non-gangrenous ulcers. Grampositive organisms were sensitive to ciprofloxacin (100); gentamicin (100); and perfloxacin (88). Gram-negative organisms were sensitive to ciprofloxacin (74); gentamicin (43); and perfloxacin (39). We conclude that ciprofloxacin and gentamicin are the most effective antibiotics against gram-positive and gram-negative organisms; and thus recommend the combination of ciprofloxacin and/or gentamicin and metronidazole as initial therapy for patients with infected DFU while awaiting culture results