Judicious antibiotic use decides diabetic foot infection control

[Photo] [Audio podcasts] In an award-winning research paper presentation at the Amrita Diabetic Foot Conference (ADFC 2011), Dr Shibin T Sudevan, Department of Endocrinology and Podiatric Surgery, Amrita Institute of Medical Sciences and Research Centre (AIMS) presented the study 'Bacteriological profile of diabetic foot infections' making a clear conclusion: judicious use of antibiotics will decide the treatment outcome of diabetic foot infections. ADFC 2011 is being held in Kochi, India (6-7 May 2011). "The treatment of diabetic foot involves offloading, proper wound care and judicious use of antibiotics. Selecting an effective antibiotic regimen requires the knowledge of the prevailing microbial pattern" said Dr Shibin Sudevan.

Dr Shibin Sudevan was awarded the best research paper prize at ADFC 2011.

Eighty per cent of people with diabetes deal with diabetic foot. "The prevalence of infecting organisms varies depending on many factors. The antibiotic sensitivity pattern of the organisms is also continually changing. Hence there is a need for periodic analysis of the same" said Dr Shibin Sudevan.

In the research study done at AIMS in 2010, close to 600 patients of diabetic foot participated.

Speaking about the co-morbidities observed in the patients of diabetic foot, Dr Shibin said that 88.4% had peripheral neuropathy. Neuropathy associated with diabetes are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness - loss of feeling - in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. About 60 to 70 percent of people with diabetes have some form of neuropathy.

Another co-morbidity Dr Shibin found in this study involving close to 600 participants with diabetic foot, was hypertension. 71.2% percent people with diabetic foot in this study had hypertension. According to the studies, hypertension is twice as common in persons with diabetes compared to the general population. For people with diabetes, hypertension contributes to the development and progression of chronic complications, such as retinopathy, chronic kidney disease and peripheral vascular disease.

40.3% people with diabetic foot in this study had dyslipidemia which is when abnormal amount of lipids (example, cholesterol and/or fat) come in the blood, 38.4% Peripheral Occlusive Vascular Disease (POVD), 27.7% had coronary artery disease (CAD) which is a condition in which plaque builds up inside the coronary arteries, 26.3% had nephropathy (kidney related diseases), 23.9% had retinopathy (diseases related to retina of the eye),  and 6.3% reported with stroke or cerebrovascular accidents (CVA) which occurs when blood supply to part of the brain is disrupted.

Deep tissue sample cultures of these study participants with diabetic foot, resulted in alarming finding: 35.7% were polymicrobial infections.

"Out of the total 895 bacterial isolates, 58.5% were Gram negative bacteria and 41.5% were Gram positive bacteria" said Dr Shibin. "30.5% of these bacteria were multidrug resistant" said Dr Shibin.

Another alarming fact brought forth by Dr Shibin was when he compared his data of 2010 study with a similar study done in 2006 and found that overall incidence of multidrug-resistant organisms has remained fairly constant however sensitivity profiles have changed mainly for gram negative organisms leading to more drug resistance. "Hence we need to be more judicious in antibiotic selection and usage" said Dr Shibin Sudevan.

Bobby Ramakant - CNS 


Published in:
Citizen News Service(CNS), India/Thailand
Elites TV News, California, USA

4 comments:

  1. Congrats for the young doctor and hope will keep inform about the public health care issues in future too.

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  2. Ammachi,Sudheer, Beena,Sreekutty and sreekuttan02 July, 2011

    special congratulations....we all are proud of you.keep going like this.wishing you all the success and our prayers with you.

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  3. "Limb-threatening diabetic infections are usually polymicrobial involving multiple aerobic and anaerobic infections. Staphylococcus aureus, beta-hemolytic streptococcus, Enterobacteriaceae, Bacteroides fragilis, Peptococcus, and Peptostreptococcus may be cultured from diabetic ulcers. Malodorous wounds are likely to harbor aerobic and anaerobic organisms.[31]

    Choice of antimicrobials in the treatment of a limb-threatening diabetic foot ulcer infection should include those with activity against Gram-positive and Gram-negative organisms and provide aerobic and anaerobic coverage. The patient's overall wound and medical status as well as the patient's medical history determine the choice of oral versus intravenous antibiotics and the need for hospitalization. Clinicians may not have the luxury of awaiting culture or biopsy results prior to determining antibiotic choice. Treatment may be changed when dictated by the culture result or when the patient is not responding to treatment. Cultures are most reliable when a deep tissue specimen is obtained.[32] All organisms recovered from deep tissue cultures should be treated as pathogens unless there is evidence to support that the culture was contaminated from another source. Swab cultures usually grow out numerous surface contaminants and may not provide information on the pathogen(s) causing the deep tissue infection. The rapid deterioration of an infected wound in the diabetic patient necessitates immediate action by a clinician to prevent amputation and other complications."

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  4. Dr.Ashok Krishnan28 October, 2011

    Dear Dr.shibin,

    Great stuff! good research data.

    Dr.Ashok

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