A Cross Sectional Study To Know The Bacterial And Fungal Pathogens Causing Diabetic Foot Ulcer

Abstract

Background: ABSTRACT Diabetes mellitus is a chronic disorder affecting a large segment of population. Diabetic foot ulcer is one of the commonest complication of longstanding diabetes. The triad of problems leading onto diabetic foot is neuropathy, vascular changes and infections, which constitute the diabetic foot syndrome. Objectives: The present study was undertaken to- 1. To isolate the aerobic, anaerobic and fungal pathogens of diabetic foot ulcer 2. To study the antimicrobial susceptibility of the aerobes isolated. Material and methods: The present study was conducted in the Department of Microbiology, JNMC, Belgaum. Material was collected from the deep tissue biopsy in patients with grade 1- 3 ( Megitt Wagner classification) diabetic foot ulcer attending the surgery OPD & those who were admitted in surgery ward at KLEs Dr.Prabhakar Kore hospital & medical research centre, Belgaum over a period of one year from Jan 2011 –Dec 2011. The study comprised of 75 cases of clinically diagnosed cases of diabetic foot ulcer. Clinical samples were transported to the laboratory in fluid thioglycollate medium. Initially gram’s stain and KOH wet mount was done. Aerobic, anaerobic and fungal cultures were put up. For aerobic, 5% sheep blood agar, Macconkey agar and for anaerobic, blood agar with haemin and vitamin K, Kanamycin, Vancomycin laked blood agar ( KVLB ) and Bacteroides Bile Esculin agar ( BBE ) were used. The media were placed in McIntosh Fildes jar with Internal Gas Generating System and incubated at 37ºC for minimum of 3-5days. Anaerobic growth was identified using standard techniques. Antibiotic sensitivity testing of aerobic organisms were carried IV out by the Kirby Bauer’s disk diffusion technique. MRSA and ESBL producers were directed using standard methods. For fungal culture, samples were inoculated onto SDA with and without antibiotics and incubated at 25º C and 37º C for four weeks. The isolates were identified using standard methods. Results: Seventy five samples yielded 139 isolates of which 57.34% were polymicrobial, 46.27% were monomicrobial . Out of 139 isolates, aerobes constituted for 76.98% of isolates , anerobes for 22.30% of isolates and fungus for 0.71% of isolates in this study. Staphylococcus aureus was the most common aerobe isolated. Bacteroides fragilis was the most common isolate among anaerobes. Aspergillus flavus was the only fungal isolate. MRSA accounted for 29.41%. ESBL accounted for 32.35%. Conclusion: This study has shown that diabetic foot ulcers harbour polymicrobial infections. Isolation of these organisms and their antibiotic susceptibility should be determined to start appropriate antibiotic therapy as early as possible to overcome the morbidity and mortality associated with this disease and to prevent the development of resistant strains.