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Bacteriological profile and antibiotic sensitivity pattern in diabetic foot ulcer: A retrospective study

Tanvi Vinay Kasaravalli, Astha Singh, Nandini T, Meghana Manjunath.


Background: Diabetic foot ulcers (DFUs) pose a significant risk for individuals with long-standing diabetes mellitus, leading to hospitalizations and potential amputations. The prevalence of diabetes in India is expected to reach 57 million by 2025. DFUs are resolvable complications, with proper treatment resulting in healing rates of 75–80%, while a percentage of cases may require amputations. Effective management requires a multidisciplinary approach, including sterile dressing, meticulous foot care, and appropriate antibiotic therapy. The irrational use of antibiotics, often based on random choices before obtaining culture reports, contributes to the burden. DFUs impact the quality of life, exacerbate the economic burden, and affect low socioeconomic groups disproportionately. This study proposes an antibiotic policy to reduce irrational antibiotic use until sample reports are available, promoting more rational prescribing practices.

Aim and Objectives: The aim of the study was (i) to identify commonly infecting organisms in DFU cases; (ii) to look for the prevalence of antimicrobial resistance in cases of DFU; and (iii) to come up with a disease and region-specific antibiogram.

Materials and Methods: The culture and sensitivity reports of DFU swabs were retrospectively procured from multiple microbiology labs between September 2018 and September 2019. The data collected were tabulated into Excel worksheet and analyzed. The results were then simplified into pie and bar charts. Many descriptive statistical tools such as percentage and mean were used to come to a conclusion.

Results: 159 cases of DFUs were examined, revealing that 81% of cases occurred in men and the incidence increased with age, with 65% of cases being over the age of 50 years. Staphylococcus aureus was the most common infecting organism (20.75%), followed by Klebsiella, Escherichia coli, and Pseudomonas. Non-healing ulcers in 9.7% of cases showed no bacterial growth. Amikacin exhibited the highest sensitivity (60%), whereas ceftazidime demonstrated the highest resistance (66%). Over 80% of patients had long-standing diabetes for over 15 years.

Conclusion: The study highlights the prevalence of antibiotic-resistant organisms and the need for a well-defined antibiotic protocol. Uncontrolled diabetes increases the risk of DFUs. Empirical antibiotic treatment is crucial before culture reports, and amikacin, cefazolin, and vancomycin combination therapy is effective. Ceftazidime, amoxicillin/clavulunate, and cefotaxime should be avoided. The patient education on foot care is vital.

Key words: Diabetic Foot Ulcer; Antibiotics; Sensitivity; Empirical Treatment

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