Evaluation of amputation risk in diabetic foot ulcer patients infected with Acinetobacter baumannii from a Tertiary Care Centre in South India

Abstract

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.

Keywords: Acinetobacter baumannii, Diabetes mellitus, deep tissue cultures, amputation.