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

ABSTRACT

[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