Diabetes-related lower limb wounds: Antibiotic susceptibility pattern and biofilm formation

The expeditious incidence of diabetes mellitus in Riyadh, Saudi Arabia, there is a significant increase in the total number of people with diabetic foot ulcers. For diabetic lower limb wound infections (DLWs) to be effectively treated, information on the prevalence of bacteria that cause in this region as well as their patterns of antibiotic resistance is significant. Growing evidence indicates that biofilm formers are present in chronic DFU and that these biofilm formers promote the emergence of multi-drug antibiotic resistant (MDR) strains and therapeutic rejection. The current study targeted to isolate bacteria from wounds caused by diabetes specifically at hospitals in Riyadh and assess the bacterium's resistance to antibiotics and propensity to develop biofilms. Totally 63 pathogenic microbes were identified from 70 patients suffering from DFU. Sixteen (25.4%) of the 63 bacterial strains were gram-positive, and 47 (74.6%) were gram-negative. Most of the gram-negative bacteria were resistant to tigecycline, nitrofurantoin, ampicillin, amoxicillin, cefalotin, and cefoxitin. Several gram-negative bacteria are susceptible to piperacillin, meropenem, amikacin, gentamicin, imipenem, ciprofloxacin, and trimethoprim. The most significant antibiotic that demonstrated 100% susceptibility to all pathogens was meropenem. Serratia marcescens and Staphylococcus aureus were shown to have significant biofilm formers. MDR bacterial strains comprised about 87.5% of the biofilm former strains. To the best of our knowledge, Riyadh, Saudi Arabia is the first region where Serratia marcescens was the most common bacteria from DFU infections. Our research findings would deliver information on evidence-based alternative strategies to develop effective treatment approaches for DFU treatment.

Prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos comprehensive specialized hospital, Northwest Ethiopia, 2022, cross-sectional study

INTRODUCTION

Diabetes foot deformity is among the major causes of diabetic foot ulceration, resulting in lower limb amputation. However, the study on the distribution of foot deformity and its risk factor among diabetic patients in Ethiopia is limited. This study determined the overall prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.

METHODS

Hospital-based cross-sectional study was conducted among 392 diabetic patients using a systematic random sampling technique at Debre Markos Comprehensive Specialized Hospital. Data were collected by pre-tested, semi-structured questionnaires and diabetic foot assessment format. Multivariable binary logistic regression was used to determine the association between dependent and independent variables. Adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the strength of the association, and a variable with a p-value < 0.05 was statistically significant factors of diabetes foot deformity.

RESULT

The overall prevalence of foot deformity was 33.4% [95% CI: 28.9-38.3]. In the final logistic regression analysis, rural residency [AOR = 2.64, 95% CI: 1.31, 5.31], poor glycemic control [AOR = 2.41; 95% CI: 1.34, 4.33], diabetes duration ≥ 10 years [AOR = 2.74; 95% CI: 1.50, 5.02], inadequate footwear [AOR = 2.11; 95% CI: 1.17, 3.82] and presence of peripheral neuropathy [AOR = 8.21; 95% CI: 4.54, 14.84] were statistically significant associated factors with diabetes foot deformity.

CONCLUSION

The prevalence of foot deformity among adult diabetic patients was high. It is recommended to incorporate foot deformity screening in routine diabetic patient follow-ups especially for those with poor glycaemic control, rural residency, long diabetes duration, inadequate footwear, and diabetic peripheral neuropathy.

Diabetic foot ulcer with osteomyelitis, successfully treated with the holistic approach of multiple ayurvedic treatment modalities - A case report

INTRODUCTION

Diabetic foot ulcer (DFU) with osteomyelitis is the devastating condition, which is a challenge to surgeons in saving the limb of the patient and in many circumstances ends up with amputation, which leaves physical and psychosocial trauma for both the patient and patient's family.

PRESENTATION OF CASE

A 48-year-old female patient with uncontrolled type 2 diabetes presented with swelling and gangrenous deep circular ulcer of size approx. 3 × 4 cm on plantar aspect of great toe of her left foot with involvement of first webspace from last three months. Plain X ray showed disrupted and necrotic proximal phalanx suggestive of diabetic foot ulcer with osteomyelitis. Despite using antibiotics and antidiabetic drugs for past three months she didn't get significant response and was suggested for toe amputaion. Hence, she approached our hospital for further treatment. We successfully treated the patient with the holistic approach of surgical debridement, medicinal leech therapy (MLT), irrigation of the wound with triphala decoction, jatyadi tail dressings, oral ayurvedic antidiabetic drugs to control blood sugar levels and a mixture of herbo mineral drug which is having antimicrobial property.

DISCUSSION

DFU may lead to infection, gangrene, amputation, death of the patient. Hence it is the need of the hour to look for limb salvage treatment modalities.

CONCLUSION

The holistic approach of these ayurvedic treatment modalities are effective and safe in treating DFUs with osteomyelitis and in preventing amputation.

Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia

OBJECTIVE

We aimed to assess the prevalences of foot ulcer and foot self-care practices, and identify associated factors in adult patients with diabetes attending a referral hospital in south-east Ethiopia.

METHODS

We performed a cross-sectional study of 267 diabetic patients. Multivariable binary logistic regression was used to identify factors associated with diabetic foot ulcer and foot self-care practice.

RESULTS

The prevalence of diabetic foot ulcer was 11.2% (95% confidence interval [CI] 7.42-15.05). One hundred and forty-four (53.9%; 47.9, 59.9) patients demonstrated good foot self-care. Living rurally (adjusted odds ratio 2.27; 95% CI: 1.86-6.97), lack of regular exercise (3.91; 1.51-10.10), peripheral neuropathy (2.77; 1.05-7.33) and foot calluses (5.69; 1.74-18.59) were associated with diabetic foot ulcer. Urban inhabitants (2.01; 1.09-3.69), patients with diabetes for >10 years (2.92; 1.48-5.77), women (2.95; 1.66-5.22), and patients with a glucometer at home (2.05; 1.09-3.85) were more likely to have good foot self-care practice.

CONCLUSION

The prevalence of diabetic foot ulcer was 11.2%. This prevalence is lower than those identified in other Ethiopian studies. However, patient awareness regarding foot self-care practice and risk reduction should be improved.

Prevalence and risk factors of lower limb amputations in patients with diabetic foot ulcers: A systematic review and meta-analysis

BACKGROUND AND AIMS

The study aimed at determining prevalence and risk factors (RFs) of diabetic lower limb amputations (LLAs).

METHODS

Electronic databases including PubMed, Medline, Web of Science, and Cochrane Library were searched from January 2003 to April 2021.

RESULTS

Sixteen full-text published studies were reviewed. The prevalence of LLAs stood as high as 66%, with a combined prevalence of 19% (95% CI 10-29) using the random-effects model. The most prominent RFs for LLA were duration of diabetes mellitus (DM), age, renal impairment, and ethnic minority. Amongst Australians, Indigenous background is strongly associated with increased risk of the diabetic foot (DF) LLA.

CONCLUSIONS

LLAs are considerably prevalent amongst patients with the DF and occur at even higher rates in patients with multimorbidity.

Bacterial isolates from diabetic foot ulcers and their antimicrobial resistance profile from selected hospitals in Addis Ababa, Ethiopia

INTRODUCTION

Infected diabetic foot ulcer (IDFU) is a worldwide problem associated with diabetes mellitus. It could lead from soft tissue infection to bone infection and is a leading cause of lower limb amputation. Gram-negative and Gram-positive bacteria, including anaerobic bacteria and fungi, are considered potential causes of infection. The early diagnosis of DFU infection and appropriate treatment based on the identification of the pathogens and their antimicrobial susceptibility pattern is important for good prognosis. Therefore, the purpose of this study was to isolate the bacteria that infect foot ulcers in selected Hospitals and determine their antimicrobial resistance profile.

METHOD

An institutional-based multicenter, cross-sectional study was conducted in selected Hospitals in Addis Ababa, Ethiopia, from November 2020 to May 2021. A sterile swab was used to collect samples from the foot ulcer and a sterile needle to collect pus. Isolates were identified by culture, Gram-staining, and a series of biochemical tests. For each bacterial species identified, the antibiotic profiling was determined by the Kirby-Bauer disk diffusion method.

RESULTS

one hundred and twenty-seven pathogenic bacteria were isolated from samples taken from 130 patients with a diabetic foot ulcer. Sixty-eight percent had growth of multiple microorganisms. Two-thirds (66.7%) of the isolates were gram-negative bacteria. The predominant bacterial species were S. aureus 25.19% (32/127), Pseudomonas species 18.89% (24/127), and Escherichia coli 16.53% (21/127). Overall, 92.9% (118/127) of the isolates were identified as multi-drug resistant. Gram-positive isolates were susceptible to chloramphenicol, clindamycin, and amikacin. Gram-negative isolates were also sensitive to chloramphenicol, aztreonam, and amikacin.

CONCLUSION

The majority of bacteria isolated from patients presenting with Diabetic foot ulcer infections were found to be multi-drug resistant in the study sites of the current study. The results demonstrate the importance of timely identification of infection of diabetic foot ulcers, proper sample collection for identification of the pathogens and for determining their antibiotic susceptibility pattern before initiating antimicrobial treatment.

"Loss of a limb is not loss of a life". Knowledge and attitude on diabetic foot ulcer care and associated factors among diabetic mellitus patients on chronic care follow-up of southwestern Ethiopian hospitals: A multicenter cross-sectional study

BACKGROUND

Diabetic foot ulcer (DFU) is a full-thickness wound penetrating through the dermis located below the ankle in a diabetes patient. The incidence of diabetic foot ulcers has increased due to the worldwide prevalence of diabetic mellitus (DM) and the poor knowledge and attitude of diabetic foot self-care. Therefore, the study was aimed to assess the knowledge and attitude on diabetic foot ulcers and associated factors among diabetic mellitus patients of southwestern Ethiopian hospitals.

METHODS

A multicenter cross-sectional study design was used. All diabetic patients fulfilling the inclusion criteria and treated as outpatient in the study period from August 9, 2021 to September 5, 2021 G was interviewed through a semi-structured questionnaire at Bedele General Hospital and Mettu Karl Comprehensive Specialized Hospital. Data was analyzed using a statistical package for social science (SPSS 23 version).

RESULT

Out of 387 diabetic patients, 234(60.5) were male and 266(68.7%) were married. The mean age of the participants was 41.73(SD ± 15.637) years and the majority 87(22.5) of the patients age were greater than 55 years. A total of 11(28.7%) patients had a diabetes mellitus duration between 5 and 10 years and more than half 213(55%) of the patients had a co-morbidity. Regarding the diabetic foot care, a total of 180(46.5%) and 257(66.4%) of the patients had good knowledge and attitude, respectively. Educational level(AOR = 2.705(1.380-5.299), P = 0.004) and age[AOR = 1.254(0.768-2.048), P = 0.017] were the predictors of knowledge. Monthly income (AOR = 2.879(1.043-7.944), P = 0.041), educational level (AOR = 2.415(1.121-5.20), P = 0.024), previous information (AOR = 4.022(2.311-7.000), P < 0.001) and previous history of foot ulcers (AOR = 1.976(1.126-3.466), P = 0.018) were factors associated with the attitude of diabetic foot ulcer.

CONCLUSION

More than half of the study participants had poor knowledge while the majority of them had a good attitude. Educational level and age were significantly associated with knowledge. Monthly income, educational level, previous information, and previous history of foot ulcers were predictors of attitude towards diabetic foot care. Therefore, the health care providers should provide diabetic foot care education to reduce further complications of foot ulcers. Besides this, special attention should be given to patients who developed diabetic foot ulcers and have low socio-economic status.

Knowledge and Practice on Diabetic Foot Self-Care and Associated Factors Among Diabetic Patients at Dessie Referral Hospital, Northeast Ethiopia: Mixed Method

INTRODUCTION

Diabetic foot ulcer is a serious and disabling complication of diabetes mellitus that consists of lesions in the deep tissues resulting in lower extremity amputations. The incidence of diabetic foot ulcers has increased due to an increased prevalence of diabetes mellitus. This study assessed the knowledge and practice of diabetic foot self-care among diabetic patients attending Dessie referral hospital.

METHODS

A facility-based explanatory sequential mixed method was used from April 03/2019 to May 09/2019. The quantitative method employed an institutional-based cross-sectional study design using a structured questionnaire. A simple random sampling technique was employed to select the study participants. Descriptive and inferential statistics were made using the statistical package for social sciences version 20. Then, a phenomenological study was employed among key informants and content analysis was performed.

RESULTS

Sixty-eight (19.8%) of patients with diabetes developed complication, among them 97 (28%) had foot ulcer. Nearly two-third (217 (61.3%): 95% CI (57.6-68.3%)) and 134 (39%; 95% CI:34.3-45.1%) of patients with diabetes had good knowledge and practice on diabetic foot self-care, respectively. Diabetic nephropathy ((AOR): 0.03, 95% CI (0.00-0.27)) was associated with knowledge on foot self-care. Practice of foot self-care was associated with female ((AOR: 2.07, 95% CI (1.04-4.12)), age 21-30 ((AOR: 6.42, 95% CI (1.54-26.8)), 31-40 years ((AOR: 7.4, 95% CI (1.42-39.05)), 41-50 years ((AOR: 8.4, 95% CI (1.4-50.6)), single ((AOR: 0.35, 95% CI (0.150-0.81)), living in rural ((AOR: 0.31, 95% CI (0.18-0.545)) and no comorbidity ((AOR: 0.406, 95% CI (0.18-0.88)). Key informants were not compliant, confused and negligent to foot self-care.

CONCLUSION

Nearly two-third and more than one-third of patients with diabetes had good knowledge and practice on diabetic foot self-care, respectively. Patients lack proper knowledge regarding self-care and how it is practiced. Patient education and proper management of diabetic foot ulcers are recommended to reduce, delay, or prevent complications.

Determinants of Diabetic Nephropathy among Diabetic Patients in General Public Hospitals of Tigray, Ethiopia, 2018/19

BACKGROUND

Diabetic nephropathy is real damage resulting from having uncontrolled diabetes mellitus. Unmanaged diabetic nephropathy is one of the most leading causes of kidney failure. There is a scarcity of information on the determinants of diabetic nephropathy among diabetes mellitus patients in Ethiopia. Identification of the determinants can help devise a strategy to properly address the disease and its consequences. Therefore, this study was designed to assess the determinants of diabetic nephropathy among diabetes mellitus patients.

METHODS

Unmatched case-control study design with 168 cases and 672 controls with a mean age of 45.18 and 62.12, respectively, participated in the study. An interviewer-administered questionnaire was employed for data collection, and a systematic sampling technique was used to select the study participants. Data were entered into Epi data and exported to SPSS for data clarification and analysis. Binary logistic regression analysis was carried out to check the level of association between diabetic nephropathy and the independent variables.

RESULTS

Comorbidity (AOR: 4.96 at 95 CI: 1.77-13.87), hypertension (AOR: 6.33, 95% CI: 2.51-16.02), poor glycemic control (AOR: 3.27, 95% CI: 1.31, 8.21), age (AOR: 1.14, 95%: 1.09-1.19), duration with diabetes mellitus since diagnosis (AOR: 1.83, 95 CI: 1.62-2.06), and nonadherence to diabetic medication (AOR: 3.3, 95% CI: 1.34, 8.15), diet (AOR: 5.96, 95%: 1.92-18.54), and exercise (AOR: 5.60, 95% CI: 1.94-16.21) were the determinants of diabetic nephropathy.

CONCLUSION

Adherence to medication, diet, and exercise should be empowered to achieve glycemic control and to prevent diabetic nephropathy. More attention has to be also given for old aged diabetic patients, long duration since diagnosis of diabetes mellitus, hypertension, and other comorbidities.

Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients on Follow-Up Clinic at Jimma Medical Center, Southwest Ethiopia, 2019: An Institutional-Based Cross-Sectional Study

BACKGROUND

Diabetic foot ulceration is a devastating complication of diabetes mellitus and is a major source of morbidity and mortality. So far, there are few published data on diabetic foot ulcers and its determinants among diabetic patients on follow-up at Jimma Medical Center. Hence, the aim of this study was to assess the prevalence of diabetic foot ulcer and its determinants among patients with diabetes mellitus at Jimma Medical Center.

METHODS

A hospital-based cross-sectional study was conducted from June 1 to August 30, 2019, and systematic random sampling technique was applied. The total number of study subjects who participated in the study was 277. Data were collected using an interview-administered structured questionnaire. Data were entered into EpiData version 3.1 and exported to SPSS version 20 software for analysis. Analysis was done using descriptive statistics and logistic regression. A variable having a p value of <0.25 in the bivariate model was subjected to multivariate analysis to avoid confounding the variable's effect. Adjusted odds ratios (AOR) were calculated at 95% confidence interval and considered significant with a p value of <0.25 in the bivariate model was subjected to multivariate analysis to avoid confounding the variable's effect. Adjusted odds ratios (AOR) were calculated at 95% confidence interval and considered significant with a.

RESULT

The mean of age of participants was 50.1 ± 14.19 years. More than three-fourths of participants (82.7%) were type 2 DM. The mean duration of diabetic patients was 6.00 ± 5.07 years. The prevalence of diabetic foot ulcer was 11.6% among study participants. According to multivariate logistic regression analysis, previous history of ulceration (AOR = 5.77; 95% CI: 2.37, 14.0) and peripheral neuropathy (AOR = 11.2; 95% CI: 2.8, 44.4) were independent predictors of diabetic foot ulcer.

CONCLUSION

The prevalence of diabetic foot ulcer was 11.6%. Previous history of ulceration and peripheral neuropathy were associated with diabetic foot ulcer. The health care providers are recommended to thoroughly give emphasis during follow-up of patients who had previous history of ulceration and peripheral neuropathy in order to decrease the occurrence of diabetic foot ulcer.

Cutaneous manifestations of diabetic peripheral neuropathy

There is a rise in number of people diagnosed with Diabetes Mellitus. The incidence is rising in modern Indian society because of Industrial development and drastically changing lifestyles. Diabetic neuropathies are microvascular disorders that are usually associated with the duration of Diabetes. Among the various forms, the most common is Diabetic Peripheral Neuropathy. The disease if neglected leads to chronic ulcer formation leading to amputations frequently. Hence the aim of this study is to document the early cutaneous changes and create an early awareness in the importance of controlling Diabetes. The study consisted of 205 patients with Type 2 DM. Participant's neuropathy status was determined based on Neuropathy Disability Score and Diabetic Neuropathy Symptom Score. Among the Skin changes documented, the common changes seen were: Peripheral hair loss in 185 (90.2%), Xerosis in 168 (82%), Anhydrosis in 162 (79%), Plantar Fissures in 136 (66.3%), Plantar Ulcer in 80 (39%), common nail changes documented were Onychomycosis in 165 (80.5%) and Onychauxis in 53 (25.8%) patients in relation to the occupation and duration of Diabetes mellitus. In conclusion, it is important to control glycemic levels in the all stages of Diabetes and institute foot care measures to prevent the complications of neuropathy.