Prevalence of ESBL producing enterobacteriaceae in diabetic foot ulcers

Introduction: Diabetic foot ulcer is one of the dreaded complications among the diabetic patients which are disabling, leading to repeated hospitalizations and even amputation, drastically reducing the quality of life. Hence proper management of diabetic foot infections by choosing appropriate antibiotic is crucial. The aim of the study: This study was undertaken to know about the prevalence of ESBL producing Enterobacteriaceae in Diabetic foot ulcers and their antibiotic sensitivity pattern to aid in the effective treatment of infection. Materials and methods: A total of 200 Pus samples were collected from the patients admitted and/ or attending in-patient or out-patient departments of Rajah Muthiah Medical College and Hospital. Only Enterobacteriaceae were isolated and antibiotic sensitivity testing was done according to CLSI guidelines. All the isolates were screened for ESBL and confirmed by phenotypic confirmatory tests. Results: A total of 60 Enterobacteriaceae were isolated from diabetic foot ulcer patients among which 27 (45%) isolates were ESBL producers. ESBL production is predominantly seen in E.coli (48.1%) followed by Klebsiella (44.4%), P. mirabilis (3.3%) and P. vulgaris (3.3%). ESBL producers were sensitive to Imipenam (88.9%), Amikacin (77.8%) and Gentamicin (55.6%) whereas highly resistant to Ampicillin, Amoxyclav, Cefuroxime and Ceftriaxone. Conclusion: This study shows the higher prevalence of ESBL producing Enterobacteriaceae in diabetic foot ulcers. Imipenam, Amikacin and Gentamicin can be used for empirical treatment but early identification and treatment according to antibiotic sensitivity pattern helps in preventing the emergence and propagation of multidrug resistance strains.

Bacteriology of diabetic foot lesions.

Clinical grading and bacteriological study of 107 patients with diabetic foot lesions revealed polymicrobial aetiology in 69 (64.4%) and single aetiology in 21 (19.6%). Among 107 patients 62 had ulcer. Of these 31 had mixed aerobes. Twenty six patients with cellulitis and 12 with gangrene had more than 5 types of aerobes and anaerobes such as E.coli, Klebsiella spp., Pseudomonas spp., Proteus spp., Enterobactor spp., Enterococci spp., Clostridium perfringens, Bacteroides spp., Prevotella spp. and Peptostreptococcus spp. It was noted that 50 out of 62 patients with ulcer, and all the patients with cellulitis and gangrene were given surgical management and treated with appropriate antibiotics based on antimicrobial susceptibility testing.

Effect of Azadirachta indica (neem) on the growth pattern of dermatophytes.

PURPOSE: To determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) for the extracts of the leaves and seeds of the plant Azadirachta indica against various dermatophytes. METHODS: Clinical isolates of dermatophytes(Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum nanum) were treated with extracts of leaves and seeds of the plant Azadirachta indica (neem) for antifungal activity by in vitro tube dilution technique. RESULTS: The MIC of neem seed extracts was 31 microg/mL for all the dermatophytes tested. The neem seed extract at 15 microg/mL concentration (below MIC) was observed to be sufficient for distorting the growth pattern of the organisms tested. CONCLUSIONS: The changes in growth curve of the treated dermatophytes were found to be statistically significant with reference to the untreated fungi.

Anti dermatophytic activity of Azardirachta indica (neem) by invitro study.

The leaf and seed extracts of the Plant Azardirachta indica were tested for antidermatophytic activity against dermatophytes such as Trichophyton ruberum, Trichophyton, Mentagrophytes, Trichophyton violaceum, Microsporum nanum and Epidermophyton floccosum by tube dilution technique. The minimum Inhibitory concentration (MIC) of neem seed extract was found to be lower tan that of neem leaf when tested against different species of Dermatophytes.

Stimulation of valyl- and isoleucyl-tRNA synthetase reactions by polyamines.

The aminoacylation of tRNA catalysed by valyl-tRNA synthetase (EC 6.1.1.9) and isoleucyl-tRNA synthetase (EC 6.1.1.5) from Mycobacterium smegmatis is dependent on the presence of divalent metal ions. Polyamines alone, in the absence of metal ions, do not bring about aminoacylation. In the presence of suboptimal concentrations of Mg2+, polyamines significantly stimulate the reaction. Of the cations tested, only Mn2+, Co2+ and Ca2+ can partially substitute for Mg2+ in aminoacylation, and spermine stimulates aminoacylation in the presence of these cations also. At neutral pH, spermine deacylates nonenzymatically aminoacyl tRNA. AMP and pyrophosphate-dependent enzymatic deacylation of aminoacyltRNA (reverse reaction) is also stimulated by spermine. The inhibitory effect of high concentration of KCl on aminoacylation is counteracted, by spermine. The low level of activity between pH 8·5-9·0 at 1·2 mM Mg2+ is restored to normal level on the addition of spermine. The inhibitory effect of high pH on aminoacylation in the presence of low concentration of Mg2+ is also prevntedvby spemine.