Munawar Jamil, Zaheer Amin, Tariq Hassan Chaudhary, Jamil Shaheen, Zia ur Rehman Alvi.
Management of Diabetic Foot Infections.
J Coll Physicians Surg Pak Jan ;11(10):606-10.

Objective: To determine the infecting agent in diabetic foot infection with the susceptibility pattern, and to evaluate the effect of wound infection, vasculopathy, neuropathy and control of diabetes mellitus on the outcome of the patients. Design : A descriptive and observational study. Place and Duration of Study: Patients with diabetic foot, admitted in Surgical Unit I, B.V. Hospital, Bahawalpur, from April 1999 to April 2000, were included in this study. Subjects and Methods: A total of 60 known diabetic patients were studied, out of these 47 were males and 13 females. They were assessed for angiopathy, neuropathy and extent of foot involvement. Necessary investigations, including x-ray foot, ECG, serum urea and creatinine, pus culture and sensitivity were carried out. Diabetes was controlled on insulin on the basis of serum sugar and urine sugar chart and treated accordingly. Results: The most common age of foot involvement was between 40-70 years. Right side was involved more often than the left (67%: 37%). Most of the infections were due to Staphylococcus (50%), Pseudomonas (25%) and Streptococci (8%). Antibiotic was started based on sensitivity report. Fluoroquinolone plus clindamycin was used in 50%, fluoroquinolone plus metronidazole in 20% and amoxycillin/clavulanate in 23%. Most of the patients (61.7%) were in grade III or IV of Meggit Wagner classification of diabetic foot. Three patients (5%) were treated by below knee amputations while 1(1.7%) patient by above knee amputation. In twenty-four (40%) patients some form of toe amputation/ray amputation had to be done, while 32(53.3%) patients had complete healing of wound without any amputation. Mortality was 3.33%. All the 4 patients (6.7%) who presented late, having uncontrolled diabetes, with angiopathy (absent foot pulses), neuropathy, infection of the foot (grade III or above) resulted in major amputation sooner or later. The 32 patients (53.3%) having controlled diabetes mellitus with no angiopathy or neuropathy of the limb got well with antibiotic on culture and sensitivity, wound wash and debridement; and the limb was saved. Conclusion: In patients, having controlled diabetes mellitus and not having neuropathy and angiopathy, the wound infection is controlled early with good outcome.

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