Hitam, Sharifah Aisyah Sayed
(2016)
Association between polymicrobial infections and severity of diabetic foot infection among patients in Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Foot infections are a major complication of patients with
diabetes mellitus (DM). The causative microorganisms are usually
polymicrobial.The aim of the study is to determine the percentage of microorganism
in diabetic foot infection, its susceptibility to antibiotic, association between
polymicrobial infection and severity of diabetic foot infection and to determine the
outcome of diabetic foot infection among patients infected with polymicrobial
organisms in Hospital USM.
Materials and methods: This is a retrospective analysis conducted for one
year duration starting from June 2014. A total of 104 patients selected from this
study. Their folders were reviewed and assessed for severity and outcome of foot
infection in association with polymicrobial infections. Parameters such as glycated
haemoglobin (HbA1c), random blood sugar (RBS), total white cell (TWC) and
haemoglobin (Hb) were analysed. The result were presented as descriptive and
statistically analysed by Fisher exact test.Results: There were 104 patients involved in this study, with a total 133
microorganisms were isolated with an average of 1.28 organisms per lesion. Gram
negative (GN) and Gram positive (GP) microorganisms were 62% and 38%respectively.The most frequently isolated GN microorganism includes Pseudomonas
spp (28%), Proteus spp (11%), Klebsiella spp (8%) and E. coli (4%). Staphylococcus
aureus was the predominant (54%) among GP microorganisms followed by Group B
Streptococci (26%) and Enterococcus spp (6%). GN isolates were sensitive to
carbapenem and aminoglycoside groups while vancomycin showed good activity to
GP microorganism. There was significant association between quantity of
microorganisms and severity of diabetic foot infection using Fisher’s Exact test
(p=0.003). Thirty patients had polymicrobial infections. In severe diabetic foot
infection, 77.8% with polymicrobial organisms undergone amputation, meanwhile
monomicrobial infection was 33.3%. Majority of polymicrobial or monomicrobial
infection was discharged well, 84.0% and 91.1% respectively. There was no
significant association between polymicrobial or monomicrobial infection with
patient’s outcome of severe diabetic foot infection including amputation and
discharge of patient (p=0.136 and p=0.465). The mean (SD) for HbA1c, RBS, TWC
and Hb in severe polymicrobial infections were 11.8(2.1) %, 16.3 (5.2) mmol/L, 16.6
(2.4) x 109 and 9.0 (1.3) g/dL respectively.
Conclusion: GN microorganisms were predominantly isolated from diabetic
foot infections and antibiogram showed that the common organisms remain sensitive
to a number of widely used agents. Polymicrobial infections were associated with theseverity of its infection meanwhile quantities of organisms was not associated with
patient’s outcome of diabetic foot infection. There were higher glucose level and
TWC count with lower Hb in severe polymicrobial diabetic foot infection.
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