CLINICAL CHARACTERISTICS OF PATIENTS WITH DIABETIC FOOT ULCERS AND PATHOGENS ISOLATED FROM WOUND CULTURES

Abstract

Objective: Diabetic foot ulcers (DFUs) are a major cause of morbidity and mortality and develop in the presence of peripheral vascular ischemia and neuropathy. Poorly controlled diabetes is an additional risk factor. DFUs are often polymicrobial. The types of isolated microorganisms (MOs) show regional variations: Gram-negative MOs are more common in temperate climate regions such as Africa and Asia and Gram-positive pathogens are more prevalent in western regions. We conducted a retrospective review of microorganisms isolated from 24 patients with DFUs.

Methodology: Twenty-four patients (17 males, 7 females) with a mean (±SD) age of 64.5±8.7 years were included. There was no significant difference in age between males and females. All patients had type 2 Diabetes Mellitus (DM) with a mean disease duration of 15±7 years.

Results: Considering the type of ulceration, 5 patients had superficial infections such as cellulitis, 16 patients had ulcers with the involvement of subcutaneous tissues and 3 patients had gangrenous ulcers. The diameter of ulcer was less than 2 cm in 9 patients, 2 to 4 cm in 11 patients and greater than 4 cm in 4 patients. The growth of the following MOs as single agents were detected in the wound cultures: Staphylococcus aureus in 5 patients, Escherichi acoli in 4, Morganella morganii in 4, Pseudomonas aeruginosa in 3, Klebsiella pneumoniae in 1, Serratia marcescens in 1, Proteus mirabilis in 1, Enterococcus faecalis in 1, and Stenotrophomonas maltophilia in 1 patient. Three patients showed concomitant growth of 2 pathogens (Enterobacter aerogenes+Escherichia coli; Enterobacter aerogenes+Staphylococcus aureus; Pseudomonas aeruginosa+Staphylococcus aureus). Peripheral artery disease (PAD) was present in 10 patients. Six microorganismsElbuken G. et al., Med. Res. Chronicles., 6(2), 68-76 2019 The corresponding author* patients were being treated with antibiotics (ABs) and local wound care including regular dressing changes and 18 patients required surgical treatment (debridement and local flap in 14 and amputation in 4). Of 4 amputated patients, 2 had a history of toe amputation. The average length of hospitalization was 12.9 ±7.1 days, mean HbA1c level was 8.1±1.6%, and mean duration of AB treatment was 11.7±3.2 days.

Discussion and Conclusion: Despite earlier diagnosis of DM and current availability of more effective therapeutic options, DFUs are still the leading cause of amputation. Along with blood glucose regulation, careful follow-up of diabetic complications and timely implementation of preventive actions would substantially reduce hospitalization and loss of productivity.