Bacteriology and Antibiotics Usage in Patients with Diabetic Foot Infection

Abstract Bacteriology and Antibiotics Usage in Patients with Diabetic Foot Infection Waigoon               Stapanavatr         MD Burapa                  Karnjanabatr       MD Department of Surgery, BMA Medical College and Vajira Hospital Infection in diabetic foot is usually severe and is the most common cause of admission in diabetic patients. If surgical management is delayed, improper or missed diagnosis, risk of amputation will be high since nearly half of diabetic foot infection patients have peripheral arterial occlusive diseases. Patients with diabetic foot infection who need surgical intervention are usually infected with multiple organisms. Staphylococcus aureus is the common cause of infection in the United States of America, which is different from Asia. In Asia, bacteria in diabetic foot infection are usually response to simple antibiotics e.g. Proteus Mirabilis, Escherichia Coli, Klebsiella Pneumoniae, etc. Proper management for patients with diabetic foot infection consists of appropriate correction of arterial occlusion and combination antibiotics to cover gram positive, gram negative and anaerobic organisms. Erythromycin, Ciprofloxacin and Gentamicin have sensitivity to organisms in diabetic foot infection in South East Asia. Keywords: diabetic foot, organisms, antibiotics Vajira Med J 2010 ; 54 : 199-208  

Results of Arteriovenous Fistula without Prosthetic Usage for Hemodialysis in BMA Medical College and Vajira Hospital

Abstract Results of Arteriovenous Fistula without Prosthetic Usage for Hemodialysis in BMA Medical College and Vajira Hospital Waigoon     Stapanavatr         MD, FICS, M.Ed (Educational Measurement) Yuthapong  Sangpayup           MD, FICS Burapa        Karnjanabatr       MD, FICS Department of Surgery, BMA Medical College and Vajira Hospital Objectivs: To determine the result of vascular access by autogenous arteriovenous fistula (AVF) for hemodialysis and to evaluate factors that may associate with the success of autogenous AVF. Study design: Descriptive study. Subjects: Chronic renal failure patients who needed hemodialysis and had permanent vascular access creation in our institution during April 2004 and March 2007. Methods: The data were retrospectively collected from medical records, operative records and computer database. Main outcome measures: The success rate of permanent vascular access using autogenous AVF. Results: During the study period; 225 patients were consulted for permanent vascular access for hemodialysis. Twelve cases had tunnel cuffed catheter (TCC) while 22 cases had inadequate medical records and were excluded. 191 cases who were operated for permanent vascular access using autogenous AVF were recruited. Mean age was 57.5 ± 13.9 years (15-91 years). 84 cases were men and 107 cases were women. 114 cases had hypertension and 119 cases had diabetes. Men had successful AVF in 90.5% which was significantly higher than 86.0% in women. Hypertensive patients had success rate of 89.5% which was not significantly different from non-hypertensive patients (94.8%). Diabetic patients had success rate of 90.8% which was not significantly different from non-diabetic patients (93.1%). Conclusion: Most of the chronic renal failure patients had successful autogenous AVF for hemodialysis, a few patients needed TCC and none needed graft. Vajira Med J 2009 ; 53 : 51 - 57