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A comparative study of proportion of resistance to multiple antibiotics in infected wounds of diabetic versus non-diabetic patients in a tertiary care hospital

Prashanth SP, Vishwanath M, Murgesh JV.


Abstract

Background: Infectious diseases are more frequent and serious in patients with diabetes mellitus and contribute potentially to increased morbidity and mortality. Multidrug-resistant organisms (MDROs) are bacteria resistant to current antibiotic therapy and difficult to treat. Healthy people are at low risk for developing MDRO infections. Wound infection by MDRO in diabetic patients makes them recalcitrant to healing.

Aims and Objectives: This study aims to compare the proportion of resistance to multiple antibiotics in infected wounds of diabetic versus non-diabetic patients.

Materials and Methods: A total of 200 diabetic and non-diabetic patients with infected wounds aged between 18 and 89 years, attending the surgical outpatient department or admitted to surgical wards, having positive wound cultures were enrolled in the study after obtaining consent. Other laboratory reports such as hemoglobin percentage, random blood sugar (RBS), and total leukocyte count were noted. Data obtained were analyzed using SPSS.v.20.

Results: The diabetics (n = 100) had significantly higher RBS levels [186.86 (±75.37) mg/dl] compared to non-diabetics (n = 100) [93.87 (±41.59) mg/dl] (P < 0.0001). The diabetics had significant history of previous antibiotic usage in the past (72%), compared to non-diabetics (58%) (P = 0.003). Gram-negative bacilli most commonly infected diabetics compared to Gram-positive cocci in non-diabetics. Staphylococcus aureus (67%) was the most commonly isolated organism among both diabetics (24%) and non-diabetics (43%). Pseudomonal infections were higher in diabetics (22%) compared to nondiabetics (10%). Diabetics (87%) showed significantly higher prevalence of resistance to multiple antibiotics compared to non-diabetics (69%) (P = 0.002). Antimicrobial agent most frequently reported sensitive, and resistant to most infection causing organisms was amikacin (75%) and ampicillin (93%), respectively, in both groups.

Conclusion: S. aureus is the most commonly isolated organism among both groups. Resistance to multiple antibiotics is higher in diabetics. Infection causing organisms is frequently sensitive to amikacin in both groups; however, its use needs care due to increased chance of nephrotoxicity in diabetics.

Key words: Diabetes Mellitus; Infected Wounds; Multiple Antibiotics; Sensitivity Pattern; Multidrug Resistance






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