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4. Pattern of antimicrobials used to treat infected diabetic foot in a tertiary care hospital in Kolar

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Author(s): M.B. Girish | T.N. Kumar | R. Srinivas

Journal: International Journal of Pharmaceutical and Biomedical Research (IJPBR)
ISSN 0976-0350

Volume: 01;
Issue: 02;
Start page: 48;
Date: 2010;
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Keywords: Antimicrobials | Early surgical intervention | Glycemic control | Infected diabetic foot

ABSTRACT
Foot infections are common among diabetic patients and their sequelae are the most common cause of disability and hospital admissions. The objectives in the treatment of diabetic foot infections are to avoid major limb loss and to retain function. In this prospective study including 60 patients with diabetic foot infection, relevant data was taken as per the proforma designed for the study. Empirical antimicrobials administered were recorded. Following culture and sensitivity report, antimicrobials were changed if required. In our study, 42 were males with mean age of 56.69  11.75 years and 18 females with mean age of 55.38  11.77 years. Ulcers of the foot were the most common presentations. Foot infections were of Meggit Wagner grade II to grade IV. Ciprofloxacin, chloramphenicol, cephalexin or combination therapy of ciprofloxacin + metronidazole or ceftriaxone + metronidazole was empirically used. Wound cultures revealed predominance of E.coli, Staphylococcus aureus, Pseudomonas and Klebsiella. Surgical intervention was done in 41 patients. In 22 patients, antimicrobials were changed to amikacin, ceftriaxone with metronidazole and ciprofloxacin with clindamycin. Those who underwent amputation had a significantly higher (P < 0.05) incidence of ischemic diabetic foot, HbA1C, blood sugar > 196 mg/dL and duration of administered antimicrobials for > 11 days. β lactam and aminoglycosides were the commonly used antimicrobials. Gram negative organisms were sensitive to amikacin, while MRSA to vancomycin, clindamycin and chloramphenicol. Additional local treatment of wound produced better outcome. Early surgical intervention with antimicrobials had a favorable outcome.
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