Diabetic foot infections are common in patients with diabetes which leads to hospitalization and it is the most frequent cause of non-traumatic lower extremity amputation. Diagnosis of foot infections based on clinical signs and symptoms of inflammation. Infected lesion culturing discloses the pathogen and their susceptibilities. The predominant pathogen responsible for infection is gram-positive cocci, especially Staphylococci and also Streptococci. Gram-negative bacilli and anaerobes are mainly found in chronic or previously treated wounds. The infected wounds require antibiotic therapy, the agents, and duration of treatment are predicted based in the severity of infection and initial management of diabetic foot infection should do by empirical therapy which based on the susceptibility data. Preventive measures to control diabetic foot infections are patient education on foot care, glycemic control, use of prescription footwear, intensive care from a podiatrist, and evaluation of surgical interventions indicated. This article explains about Pathophysiology classification, assessing the severity and treatment of diabetic foot infections.
redness, swelling and a rise in the temperature. Most DFIs are polymicrobial, with aerobic Gram positive cocci (GPC), and especially staphylococci, the most common causative organisms. Aerobic Gram negative bacilli are frequently copathogens in ischemic or necrotic wounds. Diabetes mellitus nerves may not work as well as normal because even a slightly high blood sugar level can, over time, damage some of your nerves. This is a complication of diabetes, called peripheral neuropathy of diabetes. The nerves that take messages of sensation and pain from the feet are commonly affected. If you lose sensation in parts of your feet, you may not know if you damage your feet. For example, if you tread on something sharp or develop a blister due to a tight shoe. This means that you are also more prone to problems such as minor cuts, bruises or blisters. Also, if you cannot feel pain so well from the foot, you do not protect these small wounds by not walking on them. Therefore, they can quickly become worse and develop into ulcers. The arteries in the legs are quite commonly affected. This can cause a reduced blood supply (poor circulation) to the feet. Skin with a poor blood supply does not heal as well as normal and is more likely to be damaged. Therefore, if get a minor cut or injury, it may take longer to heal and be prone to becoming worse and developing into a ulcer. Pain, that can be moderate to severe or throbbing type if pus is present, swelling, redness of the skin, fever and a local increase in temperature at the site infection are the symptoms. If reduced sensation to your feet. The risk of this occurring increase the longer diabetes and the older. Also, if your diabetics poorly controlled. This is one of the reasons why it is very important to keep your blood sugar level as normal as possible.
Natural remedies are more acceptable in the treatment of different types of diseases when compared to synthetic ones. Why because it was believed that herbal remedies are safer with fewer side effects. So the demand of herbal formulations has growing in the world market. The present study deals with the formulation and evaluation of Anti microbial activity of Poly herbal formulation containing ethanolic extract of Gymnema sylvestre, Allium sativum, Psidium guava, Centella asiatica, Curcuma longa, Trigonella foenum, Acalypha indica, Momordica charantia, Zingiber officinale, Rosmarinus officinalis. These plants have been reported in the literature having good anti diabetic, anti microbial, anti oxidant, anti inflammatory, wound healing activity, anti fungal, anti cancer, anti ulcer, analgesic and anti diuretic activity. So there is need to selection of such drugs and formulated as poly herbal formulation in the treatment of diabetic foot infection. The prepared poly herbal extract was tested for the anti microbial activity against micro organisms such as gram positive bacteria include Staphylococcus aureus, Bacillius subtilis, gram negative bacteria such as Escherichia coli, Pseudomonas aeruginosa respectively by using modified agar well diffusion method. The prepared poly herbal extract was effectively tested against microorganism which was well comparable with standard antibiotic. The ethanolic poly herbal extract showed the zone of inhibition indicating that the plants used in the formulation were fight against these microorganisms due to the presence of tannins and also it could be better alternative to the modern medicine. In majority of traditional systems of medicine, diabetes is better managed by the combination of herbs (Polyherbal) instead of single herb because of synergism and less side effects.
Diabetic foot infections are frequently occurring, complicated and costly problems in the lifetime of a diabetic. 3 It ranks first among the most common diabetes related cause of lower limb amputation making upto 20% of all hospital admissions and prolonged hospital stay. Approximately 20% of the diabetic patients develop foot problems in the course of their lifetime and illness. To add further to the burden about 40% of them come back for readmission. 4
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Back ground: Postoperative SSI is the most common nosocomial infections in surgical patients. They lead to increased morbidity and mortality, prolonged hospital, and on average double the cost of medical care. Objective:- To assess of the bacteriological rate in the post - operative surgical site infection and meropenem resistant in Baquba teaching hospital. Materials and Methods: This study was done in the Baquba teaching hospital in Diyala province for the period from November 2017 to June 2018. 80 swabs were taken from different surgical site infection included:- Wound infection, Burn infection, Diabetic foot infection, Blast injury, Abdominal surgery, Testicular abscess, Protectomy, Cystectomy, Splenectomy, Breast surgery, Appendectomy, Hysterectomy, Colorectomy, Oophorectomy and others surgery. Swabs were taken cultured on different culture media and submitted to a serial of different biochemical tests for the diagnosis of type of bacteria. Results: In this study, 80 swabs were taken from different surgical site infections. The result showed that the higher rate of infection in wound infection was 16(20.0%), 15(18.8%) burn infection, 12(15.0%) diabetic foot infection, 7(8.8) blast injury, 5(6.2%) abdominal surgery and 3(3.8%) testicular abscess. The infection in males was (60%) more than females was (40%) in all types of surgery. The result also showed was 48 (60.0%) swabs show positive results for bacterial growth as single and mixed isolate, and 32(40.0%) were negative (no growth). The result also showed that the higher frequency rate of bacterial isolate from all type of surgery was 16(20.0%) Staphylococcus aureus, 13(16.2%) Acinetobacter.Spp and 10(12.5%) E.coli. The total rate of sensitive bacterial isolate was 28(58.3%) compared with resistant bacterial isolate was 18(37.5%) and 2(4.2%) one type resistant and other sensitive. Conclusion: There was predominance of Gram negative from SSIs, with Staphylococcus aureus being the most common isolates. The present study also found Acinetobacter baumannii, Staphylococcus aureus and E.coli were the most resistant microorganism to meropenem drug in Baquba Teaching Hospital.
Abstract: Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gram- negative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbio- logical outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is also important to achieve metabolic control. Thus infection in the diabetic foot needs full multidisciplinary treatment.
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Patients aged ≥18 years were eligible for this study if they were: hospitalized with signs and symptoms of infection consistent with a diagnosis of diabetic foot infection (DFI), surgical site infection (SSI), deep soft tissue abscess (DSTA), or cellulitis, as defined in the protocol; had an expected inpatient stay for treatment of the study infection of ≥48 h; and, were treated with intravenous antibiotic agents as the primary regimen during the inpatient episode. Patients were excluded from the study if they: had been treated with intravenous antibiotic for >24 h prior to enrollment; were expected to undergo amputation or complete resection of the infected site; had any diagnosis of necrotizing soft tissue infection, burn, gangrene, decubitus ulcer, animal or human bites, known or suspected osteomyelitis, or mediastinitis; were transferred from another hospital within the previous 24 h; were pregnant; had any other known or suspected condition that might jeopardize their adherence to protocol; were employees of, or in an- other study under, the local investigator or study hospital; and were or wished to be simultaneously participating in any other interventional clinical trial.
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Purpose: The aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations. Patients and methods: This is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations. The predominant clinical presentations of DF problems (ulcer, sepsis or gangrene) were integrated with the clinical criteria for diabetic foot infection (DFI) diagnosis and classification of Infectious Diseases Association of America (IDSA)/Interna- tional Working Group on Diabetic Foot (IWGDF) to redefine the clinical spectra of DFS. Related risk characteristics and amputation rate at all levels were compared between the three RCS. Results: In this study, there were 95 (47.0%) septic DFS (SDFS) patients, 65 (32.2%) ulcerative DFS (UDFS) patients and 42 (20.8%) gangrenous DFS (GDFS) patients. Poor glycemic control (HbA1c >7.5%), hypertension, history of the same foot problems, duration of symptoms, revas- cularizations and ischemic severity were significantly different between the three RCS. UDFS had the highest rate of limb salvage without amputations (70.8%). GDFS had the highest rate for final toe amputations (52.4%) and major amputations (23.8%). Final minor amputation rate was around 20% for both SDFS and GDFS.
The diabetic foot infection is a global concern and develops in regions with improper foot care and increases the lifetime risk for developing foot ulceration . This wound infection begins superficially, but with delay in treatment and impaired body defense mechanisms, can spread to the other subcutaneous tissues and to deeper structures ultimately leading to dreaded complications such as gangrene and amputations . These infections are polymicrobial in nature. Escherichia coli, Proteus spp., Pseudomonas spp., Staphylococcus aureus and Enterococcus spp., are reported as frequent organism isolated from cases of diabetic foot infections . The presence of MRSA and ESBL strains further worsen the prognosis and increase the risk of amputation . Hence there arises the need to evaluate these infecting microorganisms on a routine basis in addition to administering regular glycemic control, wound care, surgical debridement, pressure-offloading and maintaining adequate blood supply . So proper management of diabetic foot ulcer requires selection of appropriate antibiotics based on the culture and the antimicrobial testing. The microbial pattern of these diabetic foot infections have been studied widely from various regions indicating area- specific studies for assessing the problem of these infections . This study is one such to evaluate the clinical and the microbial characteristic of diabetic foot infection in the patients of Salem district, Tamil Nadu, India.
Diabetic foot ulcers are highly prevalent and cause con- siderable morbidity at both the individual and popula- tion level. 1 8 10 The combination of a chronic wound and impaired immune defences that may occur in dia- betes frequently results in infection; although the seque- lae of these complications range in severity, diabetic foot infection precedes 80% of non-traumatic lower limb amputations. 6 13 14 Part of the effective treatment of these infections is providing targeted antibiotic therapy to improve patient outcome and reduce resistance to broad spectrum antibiotics. 15–17 Despite this, there is a lack of robust evidence to advise clinicians on the best technique to identify pathogens in diabetic foot ulcers.
Effective diabetic foot infection treatment requires an understanding of the formation and composition of the diabetic foot ulcer microbiota (bacteria associated with infection). Our knowledge of this is largely based on culture-based studies that have revealed that bacterial colonization evolves from precursor bacteria into complex polymicrobial communities. Ulcer duration and depth are positively correlated with microbial diversity and are associated with specific pathogens  Figure 1 shows how species number and composition change with disease state and severity . In brief foot ulcers are associated with a complex polymicrobial community, in which Staphylcoccus aureus is a dominant early coloniser of wounds together with
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A standard questionnaire was used to enquire about knowledge and practice of foot care. Knowledge was assessed through open-ended questions, without mul- tiple choice answers, as suggested by K. Kaliyaperumal in the guideline for conducting a knowledge, attitude, and practice study . Patients were categorized ac- cording to their response on pre-determined answers. Foot self-care practices were adopted from the Summary of Diabetes Self-Care Activities (SDSCA) measure, which identifies the number of days in the past week a person has performed diabetes self-care activities . Each subject underwent foot examination to identify PN, PVD, DFU, or any other pathology that would be used to categorize the feet into risk categories.
Diabetic ketoacidosis (DKA) is a metabolic derangement distinguished by hyperglycemia, metabolic acidosis and ketoacidosis. It mostly occur in patients with diabetes who have lack of insulin, such as in type 2 diabetes mellitus or absolute depletion of insulin, such as in type 1 diabetes mellitus in the presence of increased counter regulatory hormones (cortisol, growth hormone, epinephrine and glucagon). Dehydration, increase in insulin counter- regulatory hormones and worsening of peripheral insulin resistance can contribute to a the development of diabetic ketoacidosis which is mainly caused by infections, acute medical illness involving the cardiovascular system (CVS) and gastrointestinal tract (GIT), diseases of the endocrine axis like acromegaly, cushing syndrome.
Diabetic neuropathy affects the somatic motor, sensory and the autonomic nervous system. Sensory neuropathy can lead to extrinsic neuropathic foot ulceration following trauma. The initial trauma is often minor and may be due to ill-fitting footwear, thermal, foreign bodies in shoes, toenail cutting and thorn pricks. Sensory neuropathy paradoxically produces pain and paraesthesias.
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showed that only 20% of the sample populations were wearing appropriate foot wear while the remaining 80% required recommendations for wearing shoes or chappals that cause less stress to their feet. In order to find out the association between pre-test knowledge score and selected demographic variables cross tabulations were carried out which revealed that greater chance of getting diabetes foot complications with more risk was seen in the age group of 51-70. While the risk behavior was reduced in the age groups between 35-50 and not seen with the patients having 71 years or older. The nature of occupation was related to the awareness of foot care. Majority of the sample was labourers (32) and most of them had very poor level of awareness. This was followed by farmers among which at least 7 had below average awareness out of 28 farmers. Only one out of 8 drivers was aware about foot care. When looking into the retired group of the sample most (19)
Clostridium spp. are other frequent pathogens from surgical infections as Kamble et al. found as the pre- dominant isolates in wound infections (3). Gorbach et al. have also shown that the major source of Clostridial infections could be intraabdominal sepsis associated with trauma or prior intestinal surgery (25). Clostridi- um spp. were commonly found in association with di- abetic foot infections in our study and C. perfringens was isolated from three cases of gas gangrene (4.4%). In our study the majority of the anaerobic microorgan-
As the first foot and ankle journal to fully embrace open access publishing, JFAR has been an early adopter of inno- vations in academic publishing. Consistent with BMC’s ethos of transparency, we operate an open peer review process (where authors’ and reviewers’ identities are dis- closed), and we publish all peer reviews on our website. The BMC platform also allows for non-traditional content to be uploaded to support manuscripts, including video files  and downloadable 3-dimensional models .
Pharmacists play a more active role in the prevention of diabetic ulcers. They are involved in providing patient education on the importance of adherence to diabetic medication to ensure that blood glucose levels are controlled, which is a major factor that may prevent diabetes-associated complications. 33,38 Pharmacists’
Frequent education of patients and family members is essential. This includes knowledge regarding glycaemic control, diet plans , proper foot wear and need for early identification of early foot lesions. Primary, Secondary and tertiary levels of care are required to be imparted into the patients knowledge so as not to burden the clinician alone with the sole responsibility of care of the patient. Health care personnel education is equally important. A recent study from Chennai reported that of 1259 patients at previous high risk and who presented with foot ulcers, healing occurred in 82% who were judged to have adhered to foot ulcer care advice, compared to 50% of those who did not 73 . Patients should be given ample advice on glycaemic control, smoking reduction, regular exercise, dietary pattern changes, use of low-dose aspirin and statin therapy.
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DOI: 10.4236/jdm.2017.74021 268 Journal of Diabetes Mellitus thorization from the private clinic staff, the complete set-up of the clinical re- cords was analysed. The following variables were studied: age (measured in years), gender, origin, lesion Wagner’s classification, cultures, isolated microor- ganism, and antibiogram report. Analysis and data processing were performed through descriptive statistics with Origin, Statgrahics Plus Version 5.0. statistics package. The hypothesis stablished was: there is a high diabetic foot incidence with presence of both, Gram-positive bacteria Staphylococcus aureus and gram-negative bacteria Escherichia coli .
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