A CLINICAL STUDY OF DIABETIC FOOT ULCER AND ITS OUTCOME BASED ON DRUG TREATMENT IN A TERTAIRY CARE TEACHING HOSPITAL
Hema P.* and Amudhan Arvind
Introduction: Diabetes is a lifelong problem, and the incidence of diabetic foot complications increases with age and duration of the disease. Ulceration, infection, gangrene, and amputation are significant complications of the disease. One of the most common complications of diabetes in the lower extremity is the diabetic foot ulcer with superadded infections. An estimated 15% of patients with diabetes will develop a lower extremity ulcer during the course of their disease. Charcot foot, which of itself can lead to limb-threatening disorders, is another serious complication of long-standing diabetes. These complications frequently result in extensive morbidity, repeated hospitalizations, and mortality. Not all foot complications can be prevented, dramatic reductions in frequently have been achieved by taking a multidisciplinary approach to patients. Objectives of the study: To understand the pathology of diabetic foot and relative distribution of this condition according to age, sex, among diabetic patients. To study the benefit and outcome of the different drug treatment modalities for diabetic foot thereby reduce the risk of lower limb complications in people with diabetes by strict diabetic control and appropriate antibiotic therapy. This study was conducted comprising of 100 patients of diabetic foot in Coimbatore Medical College form period of Jan 2019-Jan 2020. RESULTS: Commonest presenting lesion was ulcers (44%), followed by gangrene and cellulitis. Commonest site of the lesion was dorsum of the foot (32%), followed by fore foot (28%), and toes (22%). More than half of the patients 82% had infection. Most common microorganism grown from culture was staphylococcus aureus (30%), A total of 100 strains were cultivated, including 35 (35%) strains of gram-positive organisms (GPOs), 51 (51.0%) gram-negative bacilli (GNB), and. The susceptibility tests showed that the Staphylococcus genus was more susceptible to Cefotaxime, linezolid, and Doxycycline. Gentamycin was the most effective drug for the treatment of Escherichia coli, followed by imipenem and cefotaxime. Most of the remaining GNB were susceptible to antibiotics such as carbapenems, aminoglycosides, fluoroquinolones, ceftazidime, cefepime, and piperacillin-tazobactam. Prognosis was good in 72 (72%) patients. 2(2%) patients died due to septicemia. Conclusion: Diabetic patients at risk for foot lesions must be educated about risk factors. The multidisciplinary team approach to diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in the high-risk diabetic patient. Early identification of organism and starting appropriate antibiotic therapy will help in red ucing surgical intervention.
Keywords: Diabetes, foot ulcers, drug sensitivity.
[Full Text Article]