Clinical and bacteriological study of severe foot infection in diabetic patients

ABSTRACT

Forty eight diabetic patients underwent emergency procedures for severe foot infection and were subjected for different techniques for isolation and identification of both aerobic and anaerobic bacteria. The isolates were further tested for susceptibility to different antimicrobial agents. None of the patients underwent arterial reconstruction. Twenty patients required major amputation, 11 below the knee, 8 above the knee and one hip disarticualtion. The patients most likely to require a major amputation were those with an absent dorsalis pedis pulse and polymicrobial infection. The amputation rate was higher for patients with non palpable pedal pulses [P<0.05]. There were a total of 105 bacterial isolates [60 aerobes and 45 anaerobes] representing an average of 2.2 isolates per specimen [1.3 aerobes and 0.9 anaerobes]. The most frequent aerobic isolates were Staph. aureus, proteus species [sp.] and enterococci representing 23.3% 15% of the total aerobic isolates respectively. Major anaerobes were Bacteroides sp. and peptococci representing 48.5% and 22.2% of the total anaerobic isolates respectively. The highest results of anaerobes were yielded by enrichment in liquid media and subculture on selective media and by direct plating on non selective media. The most active antimicrobial agents against aerobes were amikacin [81.7%], ofloxacin [80%] and cefotaxime [61.7%] whereas metronidazole [86.7%] and clindamycin [73.3] were the most active antimicrobial agents against an aerobes. Data in the current study suggest that early major amputation in a subset of patients would prevent delay in the rehabilitation process of the amputee, decrease long term morbidity and reduce health care cost. Knowledge about the bacterial agents in this setting and their sensitivity to different antimicrobial agents would help in proper management of these cases