Evaluation of amputation risk in diabetic foot ulcer patients infected with Acinetobacter baumannii from a Tertiary Care Centre in South India
DOI:
https://doi.org/10.21276/vpbdz129Keywords:
Acinetobacter baumannii, Diabetes mellitus, deep tissue cultures, amputationAbstract
Back ground: Foot complications are found to be a significant frequent, complication of Diabetes mellitus. Carbapenem-resistant Acinetobacter baumannii is gradually becoming dominant among Diabetes patients in urban population. The purpose of this study was to evaluate the clinical relationship of these gram negative bacteria and their resistance mechanisms in patients with diabetic foot and infected ulcer in India.
Methods: An observational study of 532 patients with infected ulcers in diabetic feet was conducted in Hycare for Wounds a tertiary care centre exclusively dedicated for Wound care and Management between May, 2017 and April, 2018. Processing and identification was done as per standard guidelines. The bacteriological assessment was performed in deep tissue cultures and amputation was considered major when performed above the foot’s middle tarsus.
Results: Out of 532 patients studied 350 were positive for bacterial growth. Commonest isolate was Pseudomonas aeruginosa followed by Staphylococcus aureus (MSSA) species, Klebsiella and E. coli. We observed that 14 patients were infected with Acinetobacter baumannii and 50 % were carbapenamase producers.
Clinical Outcomes: Out of 14 patients 6 were major amputees and 5 were minor amputees and the rest 3 patients are under medical management.
Conclusion: Carbapenem-resistant Acinetobacter baumannii is a serious threat to Diabetic patients and can be considered as a risk factor for major amputation.
Downloads
References
IDF Diabetes Atlas, 8th Ed. Brussels, Belgium: International Diabetes
Federation, 2017.
http://www.diabetesatlas.org/resources/2017atlas.html. Accessed 29
October 2018.
Shanmugam P, Jeya M. The bacteriology of diabetic foot ulcers, with
a special reference to multidrug resistant strains. J Clin Diagn Res.
;7(3):441.
Smolyakov R, Borer A, Reisenberg K, Schlaeffer F, Alkan M, Porath
A, et al. Nosocomial multi-drug resistant Acinetobacter baumannii
blood stream infection: risk factors and outcome with ampicillinsulbactam treatment. J Hosp Infect 2003;54: 32-8.
L. Dent, D.R. Marshall, S. Pratap, R.B. Hulette.Multidrug resistant
Acinetobacter baumannii: a descriptive study in a city hospital.BMC
Infect. Dis., 10 (2010), p. 196.
Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer
AW, LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS. Diagnosis
and treatment of diabetic foot infections. Clinical Infectious Diseases.
Oct 1;39(7):885-910.
Clinical and laboratory standards institute. Performance standards for
Antimicrobial susceptibility testing. M02 – A12, M07 – A10 and M11 –
A8. M100 S. 26th Edition.
Lipsky BA, Aragon-Sanchez J, Diggle M, Embil J, Kono S, Lavery L,
et al. International Working Group on the Diabetic Foot (IWGDF),
Peters EJ. IWGDF guidance on the diagnosis and management of foot
infections in persons with diabetes. Diabetes Metab Res Rev
;24(Suppl 1):45–74.
Sekhar S, Vyas N, Unnikrishnan M, Rodrigues G, Mukhopadhyay C.
Antimicrobial susceptibility pattern in diabetic foot ulcer: a pilot study.
Ann Med Health Sci Res. 2014; 4:742-5.
Shahi SK, Singh VK, Kumar A, Khan AU. Detection of Escherichia coli
and Associated β-Lactamases Genes from Diabetic Foot Ulcers by
Multiplex PCR and Molecular Modeling and Docking of SHV-1, TEM1, and OXA-1 β-Lactamases with Clindamycin and Piperacillin
Tazobactam. PLoS One. 2013;8(7):e68234.
Mills JL, Sr., Conte MS, Armstrong DG, Pomposelli FB, Schanzer A,
Sidawy AN, et al. The Society for Vascular Surgery Lower Extremity
Threatened Limb Classification System: risk stratification based on
wound, ischemia, and foot infection (WIfI). J Vasc Surg.
;59(1):220-34.e1-2.
Martins AF, Barth AL. Acinetobacter multi resistente - um desafio para
a saúde pública. Sci Med. 2013;23(1):56-62.
Karageorgopoulos DE, Falagas ME. Current control and treatment of
multidrug-resistant Acinetobacter baumannii infections. Lancet Infect
Dis. 2008;8(12):751–762.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 International Archives of BioMedical and Clinical Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors are required to sign and submit the completed “Copyright transfer Form” upon acceptance of publication of the paper. This is determined by a publishing agreement between the author and International Archives of Biomedical and Clinical Research. These rights might include the right to publish, communicate and distribute online. Author(s) retain the copyright of their work. International Archives of Biomedical and Clinical Research supports the need for authors to share, disseminate and maximize the impact of their research.
