RESUMO
Abstract Introduction The present study attempts to examine the microbial profile and antibiotic susceptibility of diabetic foot infections in the intensive care unit of a tertiary referral centre for diabetic foot. As part of the study, we also attempted to find the prevalence of blaNDM-like gene among carbapenem-resistant gram negative infections. Methodology A prospective study of 261 patients with diabetic foot infections was performed during the period between January 2014 and June 2014. Results A total of 289 isolates were obtained from 178 tissue samples from 261 patients, 156 (59.7%) males and 105 (40.2%) females, with a mean age of 58 years (-15 years), having diabetic foot infection. No growth was seen in thirty eight (17.6%) tissue samples. Out of the total samples, 44.3% were monomicrobial and 55.7% were polymicrobial. Gram negative pathogens were predominant (58.5%). Seven of the total isolates were fungal; 0.7% showed pure fungal growth and 1.7% were mixed, grown along with some bacteria. The most frequently isolated bacteria were Staphylococcus aureus (26.9%), followed by Pseudomonas aeruginosa (20.9%). Of the 58.5% gram negative pathogens, 16.5% were Enterobacteriaceae resistant to carbapenems. Among these isolates, 4 (25%) were positive for blaNDM-like gene. Among the rest, 18.6% were carbapenem-resistant Pseudomonas, among which 4 (36.3%) were blaNDM. Among the Staphylococci, 23.7% were methicillin-resistant Staphylococcus aureus. Conclusions Our results support the recent view that gram negative organisms, depending on the geographical location, may be predominant in DFIs. There is an increase in multidrug-resistant pathogens, especially carbapenem resistance and this is creeping rapidly. We need to be more judicious while using empiric antibiotics.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Infecções Bacterianas/epidemiologia , Pé Diabético/complicações , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Micoses/epidemiologia , Infecções Bacterianas/microbiologia , Proteínas de Bactérias/genética , beta-Lactamases/genética , Coinfecção/epidemiologia , Coinfecção/microbiologia , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Índia , Resistência a Meticilina , Testes de Sensibilidade Microbiana , Micoses/microbiologia , Prevalência , Estudos Prospectivos , Centros de Atenção TerciáriaRESUMO
Of total diabetic population, 15-20% have foot problems and 30% have peripheral vascular disease. The fundamental strategy for foot salvaging is 'early conservative amputation and radical debridement' of diabetic foot infection. For this strategy, concept of foot spaces is to be well understood. Guidelines for 'early conservative amputation and radical debridment' are discussed in this article. As regarding diabetic foot care ten valuable points are to be remembered which are also discussed.