ABSTRACT
Background: Foot complications are found to be a significant frequent, complication of Diabetes mellitus. Carbapenem-resistant Acinetobacter baumannii is gradually becoming dominant among Diabetes patients in urban population. The purpose of this study was to evaluate the clinical relationship of these gram negative bacteria and their resistance mechanisms in patients with diabetic foot and infected ulcer in India. Methods: An observational study of 532 patients with infected ulcers in diabetic feet was conducted in Hycare for Wounds a tertiary care centre exclusively dedicated for Wound care and Management between May, 2017 and April, 2018. Processing and identification was done as per standard guidelines. The bacteriological assessment was performed in deep tissue cultures and amputation was considered major when performed above the foot’s middle tarsus. Results: Out of 532 patients studied 350 were positive for bacterial growth. Commonest isolate was Pseudomonas aeruginosa followed by Staphylococcus aureus (MSSA) species, Klebsiella and E. coli. We observed that 14 patients were infected with Acinetobacter baumannii and 50 % were carbapenamase producers. Clinical Outcomes: Out of 14 patients 6 were major amputees and 5 were minor amputees and the rest 3 patients are under medical management. Conclusion: Carbapenem-resistant Acinetobacter baumannii is a serious threat to Diabetic patients and can be considered as a risk factor for major amputation.
ABSTRACT
Background & objectives: Diabetic foot ulcers are the most common cause of non-traumatic lower extremity amputations in developing countries. The aim of this pilot study was to evaluate the safety of using a polyherbal formulation in healing diabetic foot ulcers in comparison with standard silver sulphadiazine cream among patients with type 2 diabetes. Methods: A total of 40 (M:F=29:14) consecutive type 2 diabetes patients with foot ulcers were enrolled in this study. They were randomly assigned to two groups of 20 each; Group 1 was treated with polyherbal formulation and group 2 with silver sulphadiazine cream. All the patients were followed up for a period of 5 months. The baseline ulcer size was noted and photograph of the wound was taken at the baseline and at each follow up visit. Number of days taken for healing of the wound was recorded. Results: The mean age of patients, duration of diabetes and HbA1c% were similar in both the study groups. The mean length and width of the ulcers was also similar in both the groups at baseline visit. There was a significant decrease in the size of the wound (length and width) in both the study groups (P<0.001). The mean time taken for the healing of the ulcer was around 43 days in both groups. Interpretation & conclusions: Diabetic wound cream prepared by using polyherbal formulation was found to be effective as well as safe in healing diabetic foot ulcers like the standard silver sulphadiazine cream.