Bacteriological study of diabetic foot ulcers - abstract

ABSTRACT

This study was undertaken to evaluate the type of infection in ulcers of diabetic foot and to establish the optimal anti microbial therapy for these patients. Sixty-one patients from U.H.W.I. and Mona Rehabilitation Centre were studied for one year ( Oct. '78 - Sept. '79). Their ages ranged from 40 - 80 years. Thirty-four had diabetes for more than 12 years. Sixty wound swabs, 12 tissue specimens from gangrenous lesions and 48 wound swabs from non-gangrenous ulcers were cultured. Disc sensitivity tests were performed. Gangrenous lesions showed a higher incidence of mixed infection. The predominant organisms isolated in these lesions were enterococci (43), proteus sp. and enterococci in four patients. Two had pure anaerobic streptococcus. In non-gangrenous ulcers, the single causative organism in ten patients was Staph. pyogenes and in two was streptococci group A. Anaerobes were more frequently found in gangrene (13) than in non-gangrenous ulcers (3). Sensitivity tests showed that the gram positive organisms were sensitive to co-trimoxazole (99.1 percent), cephaloridine (95.4 percent), ampicillin (79.3 percent), and penicillin (78.3 percent). The gram negative organisms were sensitive to gentamycin and showed resistance to penicillin (93.8 percent), ampicillin (76.5 percent), cephaloridine (60.9 percent) and tetracycline (56.1 percent). All anaerobic organisms were sensitive to metronidazole, clindamycin and chloramphenicol. We recommend the anti microbial therapy of choice for patients with gangrenous lesions with spreading infection is combination of gentamycin, ampicillin and metronidazole. Non-gangrenous ulcers can be adequately treated by meticulous wound cleaning and antibiotic of choice depends upon the local or general complications (AU)