Bacterial Isolates from Diabetic Foot Ulcer with Antibiotic Sensitivity Pattern

A cross-sectional, descriptive study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, between October 2014 and September 2015, to determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcer. A total of 130 patients of diabetic foot ulcer were included in the study according to inclusion and exclusion criteria. Samples of pus were collected from those patients and sent for culture and sensitivity tests. Out of 130 cases, the highest number of patients 55(42.4%) were in 50-59 years age group. The mean age was 60.1±9.8 years. Most of the patients (70%) were male. 90(69.2%) samples yielded growth, while 40(30.8%) did not show any bacterial growth. Out of those 90 samples with growths, 112 bacteria were isolated. Of them, 59(52.7%) organisms were gram-positive, while 28(25%) were gram-negative and 25(22.3%) organisms were both gram-positive and gram-negative. Out of 59 gram-positive isolates, 35(59.3%) were S. aureus , 18(30.5%) were Enterococci , and 6(10.2%) were Streptococci. In 28 gram-negative isolates, 15(53.7%) were E. coli , 6(21.4%) were Pseudomonas , 4(14.2%) were klebsiella , and 3(10.7%) were proteus . Regarding antibiotic sensitivity, all gram-positive bacteria (100%) were sensitive to vancomycin. S. aureus was 80% sensitive to ceftriaxone, 71.4% to flucloxacillin, 65.7% to clavulanic acid, 54.2% to ampicillin, 48.5% to amoxicillin, and 28.5% to cotrimoxazole. Enterococci spp . was 61.1% sensitive to ceftriaxone, 33.3% to clavulanic acid, (27.7%) to ampicillin, and 16.6% to both amoxicillin and cotrimoxazole. Streptococcus spp . showed 83.3% sensitivity to ceftriaxone, 66.6% to flucloxacillin, 33.3% to clavulanic acid, and 16.6% to cotrimoxazole. Among gram-negative bacteria, E. coli was found to be sensitive to imipenem (100%), ceftriaxone (86%), amikacin (100%), cefuroxime (73.3%), ampicillin (33.3%), ciprofloxacin (60%), and gentamycin (60%). Pseudomonas was found to be sensitive to imipenem (50%), ceftriaxone (66.6%), amikacin (83.3%), and cefuroxime (66.6%). Klebsiella was found to be sensitive to imipenem (100%), ceftriaxone (75%), amikacin (75%), cefuroxime (50%), and ciprofloxacin (25%). Proteus was found to be sensitive to imipenem (100%), ceftriaxone (66.6%), amikacin (66.6%), cefuroxime (33.3%), ciprofloxacin (66.6%), and gentamycin (66.6%).


Introduction
Diabetes mellitus (DM) is an epidemic disease worldwide, making it one of the most challenging health problems in the 21st century.Diabetic foot is defined as the foot of diabetic patients with ulceration, infection and/ or destruction of the deep tissues associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. 1 Diabetic foot is the most common complication of diabetes mellitus, and is greater than retinopathy, nephropathy, heart attack and stroke combined.
A patient with diabetic foot has major negative effects on quality of life due to loss of mobility, CBMJ 2024 January: Vol. 13 No. 01 loss of work and reduction of social activities.

Conclusion
Based on the study findings, it can be concluded that in diabetic foot infections responsible microorganisms may include gram positive, gram negative and mixed types of organisms.

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Our study was of short duration and conducted only at one hospital with a small sample size and non-random sampling technique which limits the generalization of the findings.Hence, we recommend conduction of a large scale study on diabetic foot for generalization of the findings.
Escherichia coli are usually the most common organisms involved in diabetic foot infection.Polymicrobial infection with multi-drug resistance cases are frequently found.More sensitive antibiotics are imipenem, ceftriaxone, and amikacin.Conservative treatment, debridement and dressing, off-loading, culture-guided intellectual use of antibiotics therapy are the most successful treatment modalities.Educating our diabetic patients on how to prevent foot infection can create impacts on lowering such morbidities and mortalities.CBMJ 2024 January: Vol. 13 No. 01 9. Mir G. Diabetic foot ulcer healing with a silver dressing combined with soft silicone technology.Wounds Int.2013;4(3):15-8.10.Pittet D, Wyssa B, Herter-Clavel C, Kursteiner K, Vaucher J, Lew PD.Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term followup.Arch Intern Med.1999;159(8):851-6.11.Pandurengan K. Diabetic foot: vasculopathy assessment and analysis of risk factors of amputation.Int J Res Med Sci.2015;3(1):70-6.CBMJ 2024 January: Vol. 13 No. 01

Table I :
Distribution of bacterial isolates from diabetic foot ulcers (n=130) Address of Correspondence:Email: suttamkumarbiswas@gmail.com overweight, hyperglycemic having DM for more than 10 years.Ulcer is the most common presentation of diabetic foot.Neuropathic ulcers occur in 78.4% patients and the rest of the 22.6% had neuroischemic ulcers.24Diabeticfootinfectionsareoften polymicrobial.Staphylococcus aureus and Pseudomonas aeruginosa are the most common organisms responsible for diabetic foot infections.5 Anaerobic organisms are also common causes of diabetic foot infection, but the prevalence is less.6Properantibiotics according to culture and sensitivity should be used to management protocol. 7ftriaxone, flucloxacillin are the most Methods This cross-sectional, descriptive type study was conducted in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, from October 2014 to September 2015.All diabetic patients with foot ulcers admitted into the Department of Surgery were the study population.However, a total of 130 patients were finally selected based on inclusion and exclusion criteria.Inclusion criteria included type 2 diabetic patients with foot ulcers admitted in the hospital and age more than 40 years.Exclusion criteria included patients having type 1 diabetes mellitus and with previous amputation.We adopted a purposive type of nonrandom sampling technique.From each patient, treatment for short duration.Since it was difficult to eradicate the etiological factors of diabetic foot infection, treatment was protracted.Moreover, it was difficult to achieve and maintain healing without continued care.This demands proper hygiene and sound financial background as most of the treatment needs out-of-pocket expenses.ResultsA total of 130 patients were selected for this study.The mean age of the patients was 60.1±9.8years.Most of the respondents (42.4%) were in the 50-59 years age group.Male-female 3(10.7%) were proteus (Table-I).Regarding antibiotic sensitivity, all gram-positive bacteria CBMJ 2024 January: Vol. 13 No. 01 (100%) were sensitive to vancomycin.

Table II :
Distribution of antibiotic sensitivityIn our study, the age range of the patients was 40-79 years with a mean age of 60.1±9.8years.