ABSTRACT

Objective: To determine the causative bacterial organisms and their antimicrobial sensitivity among patients of diabetic foot infection of Wagner’s grade 1 and II.

Methodology: This descriptive case study was conducted in medical OPD and wards of Liaquat University Hospital Hyderabad/Jamshoro; during August 2007 to July 2008. All diabetic patients with Wagner's grade 1 and 2 foot infections were enrolled in this study. The ulcerated foot specimens were collected under clear vision through scraping the ulcer base or possibly deepest section of wound edge using sterile cotton swab. The specimens were sent towards hospital laboratory as soon as possible for sensitivity and culture. All the data was collected via study proforma and analysis was done by using SPSS version 20.

Results: A total of 60 diabetic patients with Wagner's grade 1 and 2 foot ulcers were studied, their mean age was 50.65+11.36 years and males were in majority (70%). Most of patients (71.7%) had Gram-positive species, Gram negative culture was found in 20% of the patients and 8.3% had mixed infection. Of all isolates, the most common organism was Staphylococcus aureus (50%), followed by Streptococci 11.7% and Enterococci 10%, of the patients, Pseudomonas remained the commonest gram-negative species in 10% cases followed by Klebsiella 5%, E.coli 3.3% and Proteus 1.7%. In 5(8.3%) of the patients, there was a mixed trend of both gram-positive and gram-negative aerobes. Amoxicillin/clavulanate, ampicillin, imipenem, vancomycin, amikacin, and erythromycin were all found to be effective against Staphylococcus aureus, Enterococci, and Streptococci. Ceftazidime, ciprofloxacin, tazobactam/piperacillin, and ceftriaxone were all effective against Gram negative Pseudomonas, E. coli, Klebsiella, and Proteus. All gram-positive species were resistant against Clindamycin and Metronidazole, while all gram-negative species were resistant against Penicillin G, Imipenem, and Erythromycin.

Conclusion: The most common specie was Staphylococcus aureus, followed by Streptococci, Enterococci, and Pseudomonas, E.coli, Klebsiella, and Proteus. imipenem, clavulanate/amoxicillin, vancomycin, erythromycin, ampicillin, and Amikacin were found to be the most sensitive against gram-positive aerobes. 3rd generation cephalosporins (ceftazidime and ceftriaxone) were the most sensitive antibiotics against gram-negative bacteria, followed by ciprofloxacin, tazobactam/piperacillin, and Amikacin.

Keywords: Diabetes, foot, infection, Antimicrobial sensitivity.