Surveillance on Multi Drug Resistant Organism (MDRO) associated with Diabetic Foot Ulcers in Pondicherry

摘要

Aims: The primary objective of the study was to establish the association of Multi Drug Resistant Organism (MDRO) in Diabetic Foot Ulcers (DFU) in the patients attending Aarupadai Veedu Medical College & Hospital, Pondicherry. Material & Methods: The study period was 2 years- where about 560 pus & debrided tissue samples from patients with diabetic foot infections were collected and processed. Results: Out of 560 samples (329 males & 231 females) evaluated, 68 (85 %) specimen showed presence of Multi Drug Resistant Organism (MDRO) isolates and it also includes mixed infection in 63 specimens (10.58%). Of these 560 specimens gram positive isolates constituted about 224 (47.1%) and gram negative isolates constituted about 371 (77.94%). Among the 224 gram positive isolates 126 (21.17%) isolates were Staphylococcus aureus of which 28 (22.2%) were Methicillin resistant Staphylococcus aureus (MRSA)and among the 371 gram negative isolates Proteus spp was the predominant isolate - 126 (21.17%). The others were Klebsiella spp– 84 (14.11%), Pseudomonas spp – 84 (14.11%), Escherichia.coli –63 (10.5 %),Enterococci spp.–56(9.41%) Coagulase Negative Staphylococcus – 28 (4.70%) Streptococci spp & Citrobacter spp 14 (2.35%) each respectively. All these isolates were found to be Multi Drug resistant Strains; among the gram positive isolates, all the isolates showed resistance to Erythromycin (100 %). Among the gram positive isolates Staphylococcus aureus showed high level of resistance to most of the antibiotics - Penicillin (88.9 %), Cotrimoxazole (77.8 %) and among the gram negative isolates Pseudomonas showed highest resistance – Ampicillin ( 83.3%), Cefuroxime – 58.3 %, Cotrimoxazole–44.4%. Conclusion: The commonest isolates were Staphylococcus aureus & Pseudomonas spp. The drug resistance rate was comparatively higher among the gram positive organism than the gram negative organism. Introduction In the developing countries like India, one of the most important health problem is Diabetes mellitus with significant population being affected across the country. Among the diabetic individuals, foot infections are the most frequent complication in the patient, accounting for 20 % of diabetic related hospital admissions 1 . Diabetic Foot Infection [DFI] or Diabetic Foot Ulcer [DFU] is defined as the infection caused by the introduction of infectious agent into other wise sterile soft tissue of the foot through minor skin break. Infectious agents are usually associated with worst out come, which might lead to amputation of the infected foot unless prompt treatment strategies are ensued. Though many studies have reported on the bacteriology of diabetic foot infections (DFIs) over the past 25 years, the results have varied and have often been contradictory. So, conducting surveillance study at equal intervals is a must to assess & update the condition prevailing. This study was designed to evaluate the current status of deep tissue microbiology of Diabetic Foot Ulcers and also to assess the drug resistance pattern of the Multi Drug Resistance Organism [MDRO] associated with DFI. Material and methods The study was planned for a period of 2 years, patients with diabetic foot infections were assessed for bacteriological spectrum and their drug resistance pattern to various antibiotics was also recorded. 560 pus specimens as well as debrided tissues from 329 male (58.75%) & 231 female (41.25%) patients belonging to Pondicherry were collected & processed as per the standard routine procedures. Simultaneously, during sample collection, the wounds were graded based on Wagner's grading of foot wounds 2 (Photo 1, 2,3)