Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections / Perfil microbiológico e de resistência bacteriana no pé diabético infectado

ABSTRACT Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.

RESUMO Objetivo: identificar o perfil sociodemográfico, microbiológico e de resistência bacteriana em pacientes com pé diabético infectado. Métodos: tratou-se de estudo observacional, transversal que avaliou os perfis sóciodemográfico e microbiológico de pacientes portadores de pé diabético infectado internados em Pronto Socorro de referência. Os dados sociodemográficos foram coletados por meio de entrevista. Foram colhidos, durante os procedimentos cirúrgicos, fragmentos de tecidos das lesões podais infectadas para realização de cultura/antibiograma. Resultados: a amostra foi composta por 105 pacientes. O perfil sociodemográfico mais prevalente foi o de pacientes do sexo masculino, acima dos 50 anos, casados e com baixa escolaridade. Das 105 amostras de fragmentos de tecidos colhidos para realização de cultura e antibiograma, 95 foram positivas, com crescimento de um único germe em cada um dos exames. Houve predomínio de germes da família Enterobacteriaceae (51,5%). Germes Gram-negativos foram isolados em 60,0% das culturas e os espécimes mais isolados individualmente foram os cocos Gram-positivos, Staphylococcus aureus (20,0%) e Enterococcus faecalis (17,9%). Considerando-se os perfis de resistência bacteriana, verificou-se alta taxa de Staphylococcus aureus resistente à meticilina (63,0%) e à ciprofloxacino (55,5%); verificou-se, também, que 43,5% dos germes Gram-negativos eram resistentes à ciprofloxacino. Conclusões: o perfil sociodemográfico majoritário, foi o de homens, com mais de 50 anos e com baixa escolaridade. Concluímos que os germes mais prevalentes nas lesões podais dos pacientes diabéticos foram os Gram-negativos, resistentes ao ciprofloxacino e que o germe mais isolado individualmente foi o Staphylococcus aureus resistente à meticilina.

Caracterización clínica y microbiológica de pacientes con pie diabético que requieren hospitalización en alta complejidad. Serie de casos / Clinical and microbiological profile of patients with diabetic foot requiring admission to a high complexity hospital. Case Series

Introducción El pie diabético infectado es una complicación frecuente de la diabetes y un marcador de deterioro del paciente. Existe escasa información en Colombia sobre características de los pacientes que ingresan a los servicios de urgencias de alta complejidad con esta patología y desenlaces como amputación y perfil microbiológico. Materiales y Métodos Serie de casos de pacientes que ingresaron al servicio de urgencias del Hospital Pablo Tobón Uribe con motivo de consulta principal pie diabético infectado. Se analizaron las historias clínicas de manera retrospectiva y se utilizaron herramientas de estadística descriptiva para la caracterización de la población y de variables relacionadas con diagnóstico, tratamiento y resultados tempranos intrahospitalarios. Resultados Entre enero de 2009 y diciembre de 2013 ingresaron 118 pacientes con 145 úlceras infectadas por pie diabético, el 90% con HbAc>6.5, el 52% con disfunción renal, el 51% con enfermedad arterial periférica. El 57% tenía úlceras grado 3 o mayor en la clasificación de Wagner, la infección fue polimicrobiana en el 63%. El 58% requirió amputación, el 62% de las amputaciones fueron amputaciones menores. La mortalidad fue del 10%, la mortalidad atribuible a infección del pie diabético o complicaciones derivadas de la amputación fue del 1,7%. Discusión Los pacientes con pie diabético que ingresaron a urgencias de un hospital de alta complejidad en Colombia tienen una enfermedad sistémica avanzada, relacionada con disfunción renal y vascular periférica, lesiones locales graves con compromiso óseo y articular avanzado; dada la gravedad de estas condiciones, la prevalencia de amputaciones mayores puede ser superior a la reportada en la literatura. Nivel de Evidencia: IV

Background Infected diabetic foot is a frequent complication of diabetes and a marker of patient deterioration. There is little information in Colombia on the characteristics of patients that enter the highly complex emergency services with this condition and their outcomes, such as amputation and microbiological profile. Materials Case series of patients admitted to the emergency department of Pablo Tobón Uribe Hospital whose main consultation was infected diabetic foot. The medical records were retrospectively analysed and descriptive statistical tools were used to characterise the population, as well as the variables related to diagnosis, treatment, and early in-hospital outcomes. Results Between January 2009 and December 2013, 118 patients with 145 ulcers due to an infected diabetic foot were admitted. The HbA1c was> 6.5 in 90%, and 52% had renal dysfunction, 51% with peripheral arterial disease, and 57% had ulcers grade 3 or higher in the Wagner classification. The infection was polymicrobial in 63%, and 58% required amputation, with 62% of amputations being classed as minor. Mortality was 10%, and mortality attributable to diabetic foot infection or complications derived from amputation was 1.7%. Discussion Patients with diabetic foot admitted to the emergency room of a high complexity hospital in Colombia have an advanced systemic disease, related to renal and peripheral vascular dysfunction, and serious local injuries with advanced bone and joint involvement. Given the severity of these conditions, the prevalence of major amputations may be higher than that reported in the literature. Evidence Level: IV

Infecciones en pie diabético: Elección del tratamiento antibiótico empírico / Infections in diabetic foot. Choice of empirical antibiotic regimen

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Bacterial genus is a risk factor for major amputation in patients with diabetic foot / Gênero bacteriano é fator de risco para amputação maior em pacientes com pé diabético

ABSTRACT Objective: to evaluate whether bacterial genus is a risk factor for major amputation in patients with diabetic foot and infected ulcer. Methods: we conducted a case-control, observational study of 189 patients with infected ulcers in diabetic feet admitted to the Vascular Surgery Service of the Risoleta Tolentino Neves Hospital, from January 2007 to December 2012. The bacteriological evaluation was performed in deep tissue cultures from the lesions and amputation was considered major when performed above the foot'smiddle tarsus. Results: the patients'mean age was 61.9±12.7 years; 122 (64.6%) were men. The cultures were positive in 86.8%, being monomicrobial in 72% of the cases. In patients with major amputation, Acinetobacter spp. (24.4%), Morganella spp. (24.4%), Proteus spp. (23.1%) and Enterococcus spp. (19.2%) were the most frequent types of bacteria. The most commonly isolated species were Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa and Proteus mirabilis. As predictors of major amputation, we identified the isolation of the generaAcinetobacter spp. and Klebsiella spp., serum creatinine ≥1.3mg/dl and hemoglobin <11g/dl. Conclusion: the bacterial genera Acinetobacter spp. and Klebsiella spp. identified in infected ulcers of patients with diabetic foot were associated with a higher incidence of major amputation.

RESUMO Objetivo: avaliar se gênero bacteriano é fator de risco para amputação maior em pacientes com pé diabético e úlcera infectada. Método: estudo observacional do tipo caso-controle de 189 pacientes com úlcera infectada em pé diabético admitidos pelo Serviço de Cirurgia Vascular do Hospital Risoleta Tolentino Neves, no período de janeiro de 2007 a dezembro de 2012. A avaliação bacteriológica foi realizada em cultura de tecido profundo das lesões e a amputação foi considerada como maior quando realizada acima do médio tarso do pé. Resultados: a média de idade dos pacientes foi 61,9±12,7 anos e 122 (64,6%) eram homens. As culturas foram positivas em 86,8%, sendo monomicrobianas em 72% dos casos. Nos pacientes com amputação maior, os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%), Proteus spp. (23,1%) e Enterococcus spp. (19,2%) e as espécies mais isoladas foram Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa e Proteus mirabilis. Identificou-se como fatores preditivos para amputação maior o isolamento dos gêneros Acinetobacter spp. e Klebsiella spp.,e níveis séricos de creatinina ≥1,3mg/dl e de hemoglobina <11g/dl. Conclusão: os gêneros bacterianos Acinetobacter spp. e Klebsiella spp. identificados nas úlceras infectadas dos pacientes com pé diabético associaram-se a maior incidência de amputação maior.

Aerobic bacterial profile and antibiotic resistance in patients with diabetic foot infections

ABSTRACTINTRODUCTION: This study aimed to determine the frequencies of bacterial isolates cultured from diabetic foot infections and assess their resistance and susceptibility to commonly used antibiotics.METHODS: This prospective study included 41 patients with diabetic foot lesions. Bacteria were isolated from foot lesions, and their antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method and/or broth method [minimum inhibitory concentration (MIC)].RESULTS: The most common location of ulceration was the toe (54%), followed by the plantar surface (27%) and dorsal portion (19%). A total of 89 bacterial isolates were obtained from 30 patients. The infections were predominantly due to Gram-positive bacteria and polymicrobial bacteremia. The most commonly isolated Gram-positive bacteria were Staphylococcus aureus, followed by Staphylococcus saprophyticus, Staphylococcus epidermidis, Streptococcus agalactiae, and Streptococcus pneumoniae. The most commonly isolated Gram-negative bacteria were Proteus spp. and Enterobacterspp., followed by Escherichia coli, Pseudomonasspp., and Citrobacterspp. Nine cases of methicillin-resistant Staphylococcus aureus (MRSA) had cefoxitin resistance, and among these MRSA isolates, 3 were resistant to vancomycin with the MIC technique. The antibiotic imipenem was the most effective against both Gram-positive and Gram-negative bacteria, and gentamicin was effective against Gram-negative bacteria.CONCLUSIONS: The present study confirmed the high prevalence of multidrug-resistant pathogens in diabetic foot ulcers. It is necessary to evaluate the different microorganisms infecting the wound and to know the antibiotic susceptibility patterns of the isolates from the infected wound. This knowledge is crucial for planning treatment with the appropriate antibiotics, reducing resistance patterns, and minimizing healthcare costs.

Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections / Perfil microbiológico e de resistência antimicrobiana no pé diabético infectado

Introduction: Diabetic foot infections are a difficult problem to solve, often requiring hospitalization and exposing patients to the risk of amputations. Identification of the most prevalent pathogens is useful for administration of antibiotic therapy, and can reduce mutilations. Objective: To identify the microbiological profile and resistance to antimicrobial drugs in a series of patients with infected diabetic feet. Material and methods: an epidemiological, retrospective and descriptive study based on analysis of medical records from diabetic patients with plantar lesions who underwent surgical treatment over a 24-month period at a public hospital. Data were collected on age, sex, length of hospital stay, cultures from lesions, antibiotic therapy administered, bacterial resistance and surgeries conducted, with statistical analysis of means and standard deviations. Results: There were 66 admissions of diabetic patients, the majority elderly people (77%). Hospital stays ranged from 2 to 29 days, with a mean of 12.42. There were 91 surgical procedures, resulting in some kind of amputation in 65% of cases. The most common bacterial group was enterobacteria (47%), followed by staphylococci (27%). Three patients (4.5%) had multi-resistant organisms. Resistance to clindamycin was the most common at 39 admissions (59%), followed by resistance to cephalexin, seen in 24 admissions (36%). Conclusions: Diabetic foot infections were most often caused by germs found in the community, in particular the enterococci. Bacterial resistance was very widespread and was most commonly associated with drugs for oral administration, in particular clindamycin and cephalexin. .

Introdução: As infecções no pé diabético são um problema de difícil solução, que costumam exigir internação hospitalar e expõem os pacientes ao risco de amputações. Determinar os patógenos mais prevalentes auxilia na escolha de antimicrobianos, podendo reduzir mutilações. Objetivo: Determinar o perfil microbiológico e a resistência a antimicrobianos em uma série de pacientes com pé diabético infectado. Material e métodos: estudo epidemiológico, retrospectivo e descritivo, através da análise de prontuários de pacientes diabéticos, com lesões plantares, submetidos a tratamento cirúrgico, num período de 24 meses, em um hospital público. Foram coletados dados referentes a idade, sexo, tempo de internamento, cultura da lesão, antimicrobianos utilizados, resistência bacteriana e cirurgias realizadas, com análise estatística da média e desvio padrão. Resultados: Em 66 internações de pacientes diabéticos, na maioria de idosos (77%), o tempo de internação variou de 02 a 29 dias, com média de 12,42; exigiram-se 91 procedimentos cirúrgicos, resultando algum tipo de amputação em 65% dos casos. O grupo de bactérias mais frequente foi das enterobactérias (47%), seguido por estafilococos (27%). Três pacientes (4,5%) apresentaram germes multirresistentes. Dentre os antimicrobianos utilizados, a clindamicina foi o que apresentou resistência no maior número de vezes, em 39 internações (59%), seguido da cefalexina, em 24 internações (36%). Conclusões: As infecções no pé diabético estiveram mais relacionadas a germes encontrados na comunidade, em especial os enterococcus. A resistência bacteriana foi bastante ampla, sendo mais comumente associada a drogas de uso oral, em particular clindamicina e cefalexima. .

Crecimiento bacteriano en la úlcera del pie diabético previo al uso de Heberprot-P / Bacterial growth in diabetic foot ulcer prior to Heberprot-P

OBJETIVO: determinar el comportamiento del crecimiento microbiológico en las úlceras de pie diabético, previo al uso del Heberprot-P. MÉTODOS: estudio descriptivo mediante la revisión de las historias clínicas de 52 pacientes, incluidos en los ensayos clínicos fase I y II del Heberprot-P en la úlcera de pie diabético. Se tomaron 63 muestras y se consideró el estudio microbiológico realizado en cualquier momento de su evolución, en el período de estudio. RESULTADOS: cuatro muestras resultaron negativas y 29 positivas a Staphylococcus aureus meticillin resistente, que fue el germen más frecuentemente cultivado, por lo que un tercio de los pacientes requirió tratamiento antimicrobiano. CONCLUSIONES: se recomienda realizar estudio microbiológico a todos los pacientes con úlcera de pie diabético, previo al uso de Heberprot-P aun cuando no existan evidencias clínicas de infección local.

OBJECTIVE: to determine the microbiological growth behavior in diabetic foot ulcers, pre Heberprot-P. METHODS: descriptive study was conducted by reviewing the medical records of 52 patients enrolled in Heberprot-P clinical trials phase I and II of diabetic foot ulcer. 63 samples were taken and microbiological study was considered at any point in its evolution in the study period. RESULTS: four samples were negative and 29 positive to Staphylococcus aureus meticillin resistant, which was the most frequently cultivated germ, so that one third of the patients required antibiotic treatment. CONCLUSIONS: microbiological study is recommended to all patients with diabetic foot ulcer, prior to the use of Heberprot-P even when there is no clinical evidence of local infection.

First Korean Case of Helcococcus kunzii Bacteremia in a Patient with Diabetes

No abstract available.

Diabetic foot infections

The objective of this study is to know the frequency of methicillin resistant Staphylococcus aureus and its antibiotic sensitivity in diabetic foot infections in our setup. Cross sectional descriptive study. Surgical Department, Khyber Teaching Hospital, Peshawar. January 2008 to January 2010. A total of 84 patients, including 64 males and 20 females. Patient's identity, age, gender and the bacterial isolate on culture and sensitivity report were noted on a standardized proforma and analyzed on SPSS version 16.0. Patients of 18 years and both gender with type I and II Diabetes mellitus, diabetic foot ulcers of Wagner Classification System Grade 1 to 5 of 3 weeks duration, with infection and with no evidence of healing were enrolled in the study. The overall mean age of patients was 60.8 years +/- 6.5SD with 9.2 +/- 0.5% HbA1c level. Frequency of methicillin resistant Staphylococcus aureus was 28.57%. Methicillin sensitive Staphylococcal aureus [51.19%], Pseudomonas aeruginosa [48.80%] and Escherichia coli [46.42%] were the common organism cultured. Methicillin resistant Staphylococcus aureus showed 100% sensitivity to Vancomicin, Linezolid, Meropenem, Imepenem and Pipracillin/tazobaclam. There is an alarming trend of increase in methicillin resistant Staphylococcus aureus because of indiscriminate use of antibiotics in our set up which should be discouraged and a detailed knowledge of bacterial susceptibility to antimicrobial agents is necessary

Isolation of bacteriophages to multi-drug resistant Enterococci obtained from diabetic foot: A novel antimicrobial agent waiting in the shelf.

Introduction: While foot infections in persons with diabetes are initially treated empirically, therapy directed at known causative organisms may improve the outcome. Many studies have reported on the bacteriology of diabetic foot infections (DFIs), but the results have varied and have often been contradictory. The purpose of the research work is to call attention to a frightening twist in the antibiotic-resistant Enterococci problem in diabetic foot that has not received adequate attention from the medical fraternity and also the pharmaceutical pipeline for new antibiotics is drying up. Materials and Methods: Adult diabetic patients admitted for lower extremity infections from July 2008 to December 2009 in the medical wards and intensive care unit of medical teaching hospitals were included in the study. The extent of the lower extremity infection on admission was assessed based on Wagner's classification from grades I to V. Specimens were collected from the lesions upon admission prior to the initiation of antibiotic therapy or within the first 48 h of admission. Results: During the 18-month prospective study, 32 strains of Enterococcus spp. (26 Enterococcus faecalis and 06 E. faecium) were recovered. Antibiotic sensitivity testing was done by Kirby-Bauer's disk diffusion method. Isolates were screened for high-level aminoglycoside resistance (HLAR). A total of 65.6% of Enterococcus species showed HLAR. Multidrug resistance and concomitant resistance of HLAR strains to other antibiotics were quite high. None of the Enterococcus species was resistant to vancomycin. Conclusion: Multidrug-resistant Enterococci are a real problem and continuous surveillance is necessary. Today, resistance has rendered most of the original antibiotics obsolete for many infections, mandating the development of alternative anti-infection modalities. One of such alternatives stemming up from an old idea is the bacteriophage therapy. In the present study, we could able to demonstrate the viable phages against MDR E. faecalis.

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

Antibacterial effect of nsaids on clinical isolates of urinary tract infection and diabetic foot infection

Non Steroidal Anti-inflammatory Drugs [NSAIDS] are a group of chemically dissimilar agents that have primary effect of inhibition of prostaglandin's synthesis. Aspirin [Acetyl Salicylic Acid] is used as an analgesic, anti pyretic, anti-inflammatory agent and also have an anticoagulant effect. Tylenol [acetaminophen] is used as pain reliever. The objective of this study was to determine the effect of Aspirin and Tylenol against clinical isolates of urinary tract infection [UTI] and diabetic foot infections. A total of 100 clinical isolates were analyzed. Out of these 50 were urine samples from diabetic patients with UTI and 50 pus samples from diabetic foot infection. Bacteriological study was done by inoculating urine samples on Cysteine Lactose Electrolyte deficient [CLED] media. Pus samples were inoculated on Blood agar and MacConkey's agar. Identification was done by colony characteristics, gram staining and standard biochemical tests and Quick Test Strip [QTS-20] DESTO Laboratories, Karachi. Antibacterial effect of Aspirin and Tylenol were tested against 100 clinical isolates by Replica plate method, Agar well diffusion method and tube dilution method. Concentrations of Aspirin and Tylenol [10 micro g, 50 micro g, 100 micro g, 500 micro g, 1000 micro g] were made in Muller Hinton media. Bacteria isolated from urine samples were Escherichia coli 30%, Staphyloccus aureus 20%, Entrococcus faecalis 10%, S.saprophyticus l0%, Proteus spp 6%, Pseudomonas spp.6%, S. pyogenes 6%, S. agalactiae 6%, S.epidermidis 4%, and Klebsiella spp. 2%. Bacteria isolated from pus samples were S aureus 30%, Pseudomonas aeruginosa 18%, S.epidermidis 14%, Klebsiellapneumonia 12%, Proteus mirabilis 12%, E. coli 10%, P.vulgaris 4%. Aspirin was effective at 100-500 ug concentration against all isolates. Tylenol has marked effect on pathogens at 100 micro g concentration. Aspirin and Tylenol along with analgesic, anti-pyretic, anti-inflammatory properties also have marked anti bacterial effect on isolates from UTI and Diabetic foot infections and inhibits the growth of both gram negative and gram positive bacteria, and both can be used synergistically with antibiotics for effective treatment

Spectrum of microbial flora in diabetic foot ulcers.

A prospective study was carried out on patients with diabetic foot lesions to determine their clinical characteristics, the spectrum of aerobic microbial flora and to assess their comparative in vitro susceptibility to the commonly used antibiotics. A total of 157 organisms (143 bacteria and 14 fungi) were isolated and an average of 1.52 isolates per case was reported. Polymicrobial infection was found in 35% of the patients. In this study, Pseudomonas aeruginosa among the gram-negative (22%) and Staphylococcus aureus among the gram-positive (19%) were the predominantly isolated organisms, while Candida was the most predominantly isolated fungus. Antimicrobial sensitivity pattern of the isolates is discussed in detail. There was a linear increase in the prevalence of organisms with increase in Wagner's grade. Neuropathy (76%) and peripheral vascular disease (57.28%) was a common feature among the patients. Poor glycemic control was found in 67% of the patients. Awareness about lower limb complications of diabetes was very low (23%) among the patients.

Diabetic foot: clinical presentation and management in Al-Gamhuoria Teaching Hospital

The aim of this study is to determine the mode of presentation, medical and surgical treatment. and prevention of diabetic foot. This is a prospective descriptive study performed in the period from June 2004-December 2005. Eighty-three patients with diabetic foot lesion were presented to Al-Gamhorea Teaching Hospital. Data of these patient were collected for sex, age, duration of diabetes, blood sugar control, mode of presentation, presence of peripheral neuropathy, peripheral vascular disease, concurrent medical illness [ischemic heart disease and chronic renal failure], microbial flora, treatment by antibiotics, surgical treatment and duration of healing. Majority of patients were male above 50 years 68.7%, mean age 58.3 +/- 12 and female 3 1.3%. Most of them were type 2 on oral hypoglycemic drugs [89.16%]. Blood sugar was uncontrolled in 77.1% of them. History of trauma preceding diabetic foot infection was present in 74.7%. Foot ulcer was the most common presentation in 47% of patients. There was a significant association between the peripheral neuropathy and the following risk factors: duration of diabetes more than ten years 100% [p = 0.0000], poor glycemic control 95.3% p.000] and trauma 83.9% [p = 0.0000]. There was also a significant relationship between the major limb amputation and some predictive variables: previous foot ulcer 35.3% [p=0.0000]. poor glycemic control 17.2% [p = 0.04], peripheral neuropathy 17.7% [p = 0.03], peripheral vascular disease 75% [p = 0.000], and heart disease 33.3% [p = 0.01]. Debridement done for 9.4% and toe/s amputation for 30.2%, however 11 patients [13,3%] had major amputation. Staphylococcus aureus was the most common organism isolated in 34.9%. Duration of healing was 9-16 weeks for most of the patients 63.4%. Diabetic foot infection is a common health problem in Al-Gamhorea Teaching Hospital, particularly among men. Poor glycemic control, as well as peripheral neuropathy and peripheral vascular disease are the most precipitating factors. which can be prevented. Control of blood sugar, good debridement, and proper dressing can lead to early and complete healing in most of diabetic foot lesions

Diabetic foot infections; role of granulocyte colony stimulating factor [G- CSF]

[1] To evaluate the effects of G-CSF in eliminating infection in diabetic foot wound [2] To compare the effects with conventional diabetic foot management. Prospective, open, randomized comparative study. Medical and Surgical Department of Allied, DHQ Hospital and Nawaz Medicare Faisalabad. From Jan 2000 to Nov 2000. Fifty diabetic patients with foot infections were included in this study. The mean age was 52 years ranging from 27 to 60 years. They were divided into two equal groups [Group A and Group B], The male patients were 41 [82%] and female 9 [18%]. Forty six percent of patients were on oral hypoglycaemic drugs, and 54% on insulin. The trauma preceding infection was 20%, Peripheral neuropathy 94% and peripheral vascular disease 34%. Thirty two percent of patients were smoker. Group A were subjected to G-CSF [Neupogen] therapy [n=25] subcutanously daily for 5days in addition to conventional measures. Whereas patients in Group B received only conventional therapy. Both groups received similar antibiotic and insulin treatment. G-CSF therapy was associated with earlier eradication of pathogens from the infected ulcer [median 5 [range 2-11] vs11 [6-31] days in the group B; [p=<0.0001], quicker resolution of cellulitis [6 vs 14 days; p<0.0001], shorter hospital stay [8 vs16 days; p<0.0001], and a shorter duration of intravenous antibiotic treatment [7 vs 14 days ;p<0.0001]. No G-CSF treated patient needed surgery, whereas three patients in group B underwent toe amputation and six had extensive debridement under anaesthesia [p<0.0001]. G-CSF therapy was generally well tolerated. Granulocyte colony stimulating factor [G-CSF] may be used as a good adjuvant therapy along with conventional measures for the management of diabetic foot infection, as it promotes the healing of diabetic foot ulcer/cellulitis and consequently prevents many hazardous complications like amputation of limbs, long hospital stays, extensive and prolonged antibiotic use and last but not the least the total misery of the patients

Risk factors for primary major amputation in diabetic patients

CONTEXTO E OBJETIVO: Os pacientes diabéticos apresentam risco elevado de amputação ao longo da vida, devido a isquemia ou infecção. Objetivou-se identificar e quantificar os fatores de risco para amputações maiores em pacientes diabéticos, com lesões infectadas de extremidades. TIPO DE ESTUDO E LOCAL: Estudo clínico-cirúrgico retrospectivo realizado na Disciplina de Cirurgia Vascular da Santa Casa de São Paulo. MÉTODOS: Analisamos comparativamente 99 pacientes (129 internações) com o diagnóstico de pé diabético infectado, divididos em dois grupos, de acordo com o tipo de procedimento cirúrgico. No grupo 1, pacientes submetidos a amputações maiores e, no grupo 2, pacientes com amputações menores. Os pacientes eram predominantemente do sexo masculino, na sexta década de vida e diabéticos tipo 2. Fatores de risco analisados: idade, presença de insuficiência arterial, tempo de diagnóstico do diabetes, linfangite ascendente, lesões no calcâneo, classificação de Wagner, exames laboratoriais e presença de diferentes microorganismos na cultura. RESULTADOS: Fatores de risco que se correlacionaram significativamente com amputações maiores: idade e linfangite ascendente (razão de chances, RC: 2,5), lesão do calcâneo (RC: 10,5), classificação de Wagner grau 5 (RC: 3,4), insuficiência arterial crônica sem possibilidade de revascularização (RC: 5,4), tempo do diagnóstico de diabetes e presença de bactérias Gram-positivas na cultura. Leucograma, glicemia, uréia e creatinina não se correlacionaram a risco aumentado de amputações maiores. CONCLUSÕES: Idade, tempo de diagnóstico do diabetes, infecção por Gram-positivos, linfangite ascendente, lesões de calcâneo e grau 5 de Wagner e insuficiência arterial constituem fatores de risco para amputações maiores em pacientes diabéticos.

Pathogenesis and management of diabetic foot--a review.

In the present article, the pathophysiology, evaluation and management guidelines of diabetic foot infections are reviewed with a view to reducing the medical morbidity, psychological distress and financial costs.

Pé diabético: análise bacteriológica de 141 casos / Diabetic foot infection: bacteriologic analysis of 141 patients

Diabetes mellitus (DM) é uma doença progressiva que apresenta complicações freqüentes, em especial a infecção nos pés. Realizamos um estudo prospectivo com 141 pacientes com DM e úlceras infectadas nos pés, conduzido no Centro Integrado de Diabetes e Hipertensão da UFC no período de março/2000 a novembro/2001. A maioria apresentava infecção avaliada como graus I e II da classificação de Wagner. As amostras foram cultivadas utilizando-se meios seletivos, e a identificação bacteriana e os antibiogramas foram realizados através de metodologia convencional e automatizados. Os patógenos mais freqüentemente isolados foram as enterobactérias (83,7 por cento), Staphylococcus aureus (43,3 por cento) e bactérias anaeróbias (17 por cento). Cepas de Streptococcus pyogenes foram isoladas de 7,8 por cento dos pacientes. Cepas produtoras de beta-lactamase de espectro ampliado e cepas de Staphylococcus aureus resistentes à oxacilina foram isoladas de 6 por cento e 11,6 por cento dos pacientes, respectivamente. A resistência aos antimicrobianos vem se tornando cada vez mais comum, mesmo em pacientes com infecção adquirida na comunidade. Investimentos em diagnóstico etiológico das infecções e estratégias racionais no uso de antimicrobianos fazem-se necessários na tentativa de evitar tratamentos inadequados e suas já conhecidas conseqüências.