Bacterial Wound Infections in Diabetic Patients and Their Therapeutic Implications

摘要

Objective : To identify the bacterial pathogens associated with diabetic wounds and testing the antibiotic susceptibility of main antibiotics against predominant anaerobic bacterial types in comparison with some plant extracts.Methods : A total of 27 diabetic patients of each type; Insulin dependent (IDDM) and non-insulin dependent NIDDM and 30 non-diabetic patients with wound infection were introduce in the present study that was conducted between October – December 2007.Results : It has been found that wounds are highly infected by aerobic and anaerobic bacterial types; propionibacterium granulosum – as anaerobic bacteria- was a predominant pathogens in diabetic wound infections, in comparison with ps.aeruginosa which is predominant in non-diabetic wounds. Amoxycillin/ calvulanic acid was the best effective antibiotic which gave 20mm inhibition zone in comparison with other standard antibiotics, and aqueous extracts of Myrtus communis and Nerium oleander gave II and 10mm inhibition zone respectively.Conclusion : Three isolated pathogens have a greater percentage as made of isolation in diabetic wounds while double pathogens were greater in non-diabetic wounds. Amoxycillin/ calvulanic acid was the best effective antibiotic against common bacterial type , while aqueous extracts of Myrtus communis and Nerium oleander have the variable antibacterial activity . Introduction There is a general consensus among clinicians that diabetic patients are at increased risk of developing infection. (1) This special vulnerability has been attributed to impaired leukocyte function associated vascular diseases, poor glucose control and altered host response. (2 & 3) Onco infection occurs, it is difficult to treat since the clinical course of the infection is more fulminant and severe, and posses a greater threat to the glycemic status of the patient. (4 & 5) With the advent of the new strategies and approaches in the prevention of these infections as with the introduction of new insulin preparation for good glycemic control, presumption in the altered patient behaviour may reduce the incidence of infections or alter the type of infection. (6 & 7) There are several well accepted predisposing factors that place patients with diabetes at high risk for a lower-extremity amputation. The most common components in the causal pathway to limb loose include peripheral neuropathy, ulceration, infection and peripheral vascular disease.(8) The development of wounds is a serious complication for patients with diabetes. Numerous factors related to diabetes can impair wound healing, including wound hypoxia (inadequate oxygen delivered to the wound) infection, nutrition deficiencies, and the disease itself. (9) Fluctating blood sugar and hypoxia from poor circulation may impair the ability of white blood cells to destroy pathogenic bacteria and fungi, increasing infection risk. (10) The aims of the present study were determine role of insulin and or/ antibiotics in wound infection of diabetic patients, identify the bacterial pathogens associated with diabetic wounds and testing the antibiotic susceptibility of main antibiotics against predominant anaerobic bacterial types in comparison with some plant extracts. Materials & Methods Patients: 27 diabetic patients were included in this study in both sexes (males and females), the patients arranged into two groups:IDDM: Insulin dependent diabetic mellitus.NIDDM: non-insulin dependent diabetes mellitus and 30 non diabetic patients with wound infection.Sampling: A sterile swabs were taken from various location of wounds from diabetic patients then brain heart infusion added to swab for enrichment, and incubated for 2-4 hrs.Bacteriological studyLoop full of inoculated brain heart infusion cultured by streaking onto nutrient agar and blood agar (oxoid) and kept in anaerobic candle jar to supply anaerobic condition, another loopfull streaking onto same media in aerobic condition and incubated for 24-48 hrs in 37oc.Clas