analysis of diabetic foot ulcers in a tertiary care hospitala clinicomicrobiological perspective

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1、Analysisofdiabeticfootulcersinatertiarycarehospitalª²aclinicoª²microbiologicalperspective×÷ÕߣºShaziShakil,ShaistaAlvi,MujahidBeg,AsadU.Khan¡¾ÕªÒª¡¿¡¡¡¡Objective:Toassesspotentialriskfactorsfordiabeticfootulcersinfectedwithmultidrugª²resistantª²organisms(MDROs)andtoinvestigateantibioticsusceptibili

2、typatternsandextendedª²spectrumª²¦Âª²lactamase(ESBL)ª²productioninbacteriaisolatedfromtheseulcers.Methods:Seventyª²sevendiabeticfootulcerª²patientswerestudiedinaconsecutiveseries.Fortyª²fourstudyfactorswererecordedforeachpatient.Specimenswereobtainedbyscrapingtheulcerbaseorthedeepportionofthewounde

3、dgewithasterilecurette.Thesofttissuespecimenswerequicklysenttothelaboratoryandprocessedformicrobialpathogens.Gramª²negativebacterialisolatesweretestedforESBLproductionbydoubleª²discª²diffusionmethod.TheassociationofstudyvariableswithMDROandnonª²MDROinfectionstatusofulcerswastestedbyStudent'sttestor

4、Fisher'sexacttestusingSPSS21(version11.5,Chicago).Results:AnalarmingnumberofpatientswereMDROª²positive(72.7%).ESBLª²positivestrainsconstituted19.8%oftotalisolates.Staphylococcalisolatesidentifiedasmethicillinª²resistantStaphylococcusaureus(MRSA)andvancomycinª²resistantStaphylococcusaureus(VRSA),wer

5、e3.7%(n=8)and0.5%(n=1)respectively.Twentyª²twostudyfactorswerefoundtobesignificantlyassociatedwithMDROinfectionstatusofulcersintheunivariateanalysis.MultiplelogisticregressionsprovedthatMDROstatuswastheonlysignificant,independentpredictorofglycemiccontrol(Oddsratio=4.22,P<0.01).Conclusion:Itisco

6、ncludedthatMDROinfectedpatientshavepoorglycemiccontrol.Imipenemandlinezolidcanbesuggestedasthedrugsofchoiceinthedescribedsetting.¡¾¹Ø¼ü´Ê¡¿Diabeticfootulcers;Glycemiccontrol;Multidrugresistantorganisms¡¡¡¡INTRODUCTIONFootulcersareaverycommoncomplicationoftype1andtype2diabetes£Û1£Ý.Indevelopingcount

7、rieslikeIndia,the21matterisworsebecauseofpoorsanitationthatcreatesaninfectionª²proneenvironment£Û2£Ý.TheprevalenceofdiabetesinIndianpopulationisincreasing£Û3£Ý.Infectionswithmultidrugresistantstrainsofbacte