STUDIES ON DIABETIC FOOT ULCERS IN PATIENTS AT JOS UNIVERSITY TEACHING HOSPITAL, NIGERIA

Abstract

An epidemiologcal and microbiological studies of diabetic foot ulcers were carried out in our hospital, with a view to reducing the amputation and mortality rate associated with the disease. Wound swabs from 38 Diabetes Mellitus (DM) foot ulcer patients were investigated using culture methods for both strict aerobes and anaerobes. The bacterial isolates were subjected to antibiotic susceptibility tests using the disc diffusion method. Baseline biochemical and haematological analysis were also carried out. The prevalence of the disease was stratified in relation to some clinical and laboratory parameters, gender, age, educational and occupational status of the patients. The prevalence of the disease was 24.7%, with amputation and mortality rates of 18.4% and 15.8% respectively. Only 13% had DM for less than 1 year, while 53% for more than 10 years. 28.9% have regular shoe-wearing habits. Duration of healing ranged from 2 weeks to 24 weeks (mean = 2.7months). 31% of the patients with marked periosteal reaction had lower extremity amputation or died before amputation could be done. Staphylococus aureus (31%), Proteus spp (16%), Pseudomonas aeruginosa (10%), Klebsiella spp (6%), Peptococcus spp (6%), Bacteroides fragilis (3%), Streptococcus pyogenes (3%), Escherichia coli (3%), Candida albicans (3%), Streptococcus viridans (1%), Flavobacterium spp (1.5%) and Bacteroides melaninogenicus (1%) were isolated. Most of the bacteria isolates were sensitive to pefloxacin. Our results demonstrate a very high rate of diabetic foot ulcer with the corresponding high rate of amputation and mortality. A multi-disciplinary approach to the management of DM foot ulcers is advocated. Efforts should be made to carry out cultures of samples from refractory ulcers to rule out yeast colonization, which if not treated will delay wound healing.


Key words: Diabetic foot ulcers, Microbial and antimicrobial surveillance, Refractory ulcers.


(Af J Clinical & Exp Microbiology: 2003 4(2): 52-61)