The importance of risk factors and microbiological diagnosis in the treatment of diabetic foot infections

In this study, the risk factors, development of complication, causative agents and their antibiotic sensitivities, and the factors affecting prognosis in patients with diabetic foot infection who were hospitalized in Gazi University Faculty of Medicine, Infectious Disease and Clinical Microbiology Department have been investigated.In our study, microorganisms isolated from infected wounds, antimicrobial susceptibility test results, duration of diabetes, presence of complications (neuropathy, nephropathy, retinopathy and vascular problems, osteomyelitis, amputation), risk factors (poor blood glucose regulation, high body mass index, smoking, alcohol usage) and outcomes were assessed in patients with diabetic foot infection. 136 patients were enrolled in the study, which 82 (%60,3) of them were male, and 54 (39,7%) female. Mean age was 60,32±10,29. According to PEDIS classification method, patients were classified as 5.9% (Grade 1), 21.3% (Grade 2), 66.9% (Grade 3) and 5.9% (Grade 4). Lesions due to pressure were determined as the most common triggering factor for diabetic foot (46.3%). Osteomyelitis rate was 61% among the patients and 29 patients (21.3%) were amputated. Staphylococcus spp. was the most common isolated organism among gram-positives and methicillin-resistant S. aureus rate was 34.7%. All gram-positive microorganiss were sensitive to glycopeptides and linezolid. E. coli (35.5%) and Pseudomonas spp.(29%) were respectively the most common isolated organisms among gram-negatives. Tissue biopsies were performed in 15 patients and 10 of them yielded anaerobic bacteria which all were gram-positive cocci.Lenghtened duration of diabetes, poor blood glucose regulation, presence of vasculopathy and neuropathy were found to be related to poor prognosis. Polymicrobial and gram negative agents were isolated more frequently from patients with non-regulated diabetes, increased age, history of prior foot infection or amputation. As a result, in terms of preventing poor prognosis, it is necessary to correct factors such as poor blood glucose regulation, neuropathy, vasculopathy. Also for patients who have long term diabetes mellitus, prior hospitalization and amputation history, hospital acquired infections with multi-resistant microorganisms should be considered.