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 

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