Microbial Profile and Antibiotic Susceptibility Pattern in Diabetic Patients with Mild, Moderate, and Severe Foot Infections in Tehran

It is estimated that 10-25% of diabetic patients will encounter diabetic foot ulcers (DFU) during their lifetime. This study evaluated the microbiology of DFUs and determined the antibiotic resistance pattern of bacterial isolates based on the severity of wounds and infections in different grades of ulcer. The specimens were collected from115 diabetic foot infections (DFI) deep tissue by needle aspiration and biopsy. The aerobic and anaerobic cultures and antimicrobial susceptibility testing were carried out. The presence of resistance genes including metallo-beta-lactamases (MBL), extended-spectrum β-lactamase (ESBL), ermA, ermC, and mecA was also determined. A total of 222 microorganisms were isolated. The prevalence of poly-microbial infections was 69.6%. Bacterial isolates comprised 64.2% Gram-positive bacteria (GPB), 33.5% Gram-negative bacteria (GNB), and five isolates of anaerobic bacteria were also detected. The most prevalent GPB and GNB were Staphylococcus spp. (52.2%) and Escherichia coli (33.3%), respectively. The prevalence of poly-microbial infections and GNB was positively associated with increased grades of Wagner and IDSA classifications. Among Staphylococcus aureus isolates, resistance to clindamycin (73.5%), ciprofloxacin (70.6%), and erythromycin (70.6%) were noticeable. GNB was also highly resistant to cephalosporins and ciprofloxacin. ESBL genes were detected in approximately 40% of isolates of Enterobacteriaceae. The prevalence of ermA, ermC, and mecA genes in S. aureus isolates were 8.8%, 32.3%, and 14.7%, respectively. In conclusion, our data suggest that GPBs are the most common isolates from DFIs. Furthermore, with the development of wounds and infection, the prevalence of GNB in DFIs are increased.

Comparison home care service hospital-based care ulcer economic evaluation study

Introduction

Providing health care to patients at home could be causing the mortality and readmission rates reduction in addition to satisfaction of both patients and health care providers increase. The aim of this study was to assess the cost-effectiveness of home care service compared to hospital based care in patients with diabetic foot ulcer.

Methods

An economic evaluation study and a trial study were simultaneously conducted in Iran. In trial phase, patients with diabetic foot ulcer were randomly assigned to the home care or hospital care. The Cost and Quality of life data were determined as measures of the study. Incremental cost-effectiveness ratio was calculated for comparative purposes. The model consisted of five stages of the disease. The Tree Age Pro 2009 and R software's were used for data analysis.

Results

120 patients were enrolled in our trial; among which 30 patients were in home care service group and 90 patients in hospital based care group. The rate of ulcer size reduction in hospital based care was significant (P value = 0.003) in comparison with home care service. The total cost of the home care and hospital strategies were 1720.4 US$, 3940.3 US$ and the total effectiveness were 0.31 and 0.29, respectively. The incremental cost-effectiveness ratio (ICER) was 117,300 US$ per quality-adjusted life year for home care intervention compared to hospital based care. Based on ICER plane home care treatment will be placed on the southeastern quadrant of the Cost-Effectiveness Plane, and is suggested as a more dominant treatment alternative.

Conclusions

Regarding current evidence, home care strategy for patients suffering diabetic foot ulcer enjoys more cost effectiveness compared to hospital care. It is suggested that healthcare policy makers determine the tariff for health care services for disease groups according to the activity based costing approach.

Does endurance training affect IGF-1/IGFBP-3 and insulin sensitivity in patients with type 2 diabetes?

AIM

The aim of the present study was to determine whether six weeks of submaximal endurance training using a cycle ergometer would result in a modified serum insulin-like growth factor-1 (IGF-1), an insulin-like growth factor binding protein 3 (IGFBP-3), and insulin resistance in middle-aged men with type 2 diabetes (T2D).

METHODS

Twenty male patients with T2D voluntarily participated in this study and were randomly divided into two groups: the training group (N.=10) and the control group (N.=10). The training protocol consisted of a 45-minutes cycling session/day, three days/week for six weeks with intensity 60-70% of the maximum heart rate. To examine the IGF-1 and the IGFBP-3, fasting blood glucose levels, and insulin resistance, blood sampling was performed before and immediately after the first and 18th sessions. The homeostatic model assessment (HOMA-IR) method was used to determine insulin resistance.

RESULTS

Before the study began, no significant difference between the two groups was observed in the anthropometric and blood factors. After a session of aerobic exercise, IGF-1 and IGFBP-3 levels were significantly increased (153.79% and 64.3%, respectively), and fasting glucose and insulin resistance levels were significantly decreased (15.82% and 27.82%, respectively); however, the changes resulting from a six-week training period were not significant.

CONCLUSION

According to the present study, one session of aerobic exercise for middle-aged men with T2D leads to increased IGF-1 and IGFBP-3, and to decreased fasting glucose and insulin resistance. Considering the lack of changes after a six-week training, it seems that the amount of change depends on subjects' fitness level and exercise parameters. From a clinical point of view, the beneficial effects of acute exercise inT2D subjects show that such exercises should be part of the daily program for them.