The study is on “Isolation and Characterization of Bacteria among Diabetic Foot Ulcer Patients Attending Abia State University Teaching Hospital, Aba, Abia State”. The study has four objectives. The study was designed to be a hospital based cross sectional descriptive study on diabetic foot ulcer patients attending Abia State University Teaching Hospital (ABSUTH), Aba. The study population included 50 adult diabetic patients with diabetic foot ulcers from medical wards and diabetic outpatient clinic. Data were analyzed by a statistician using the Statistical Package for Social Sciences (SPSS) version 17. The findings show that a total of 50 aerobic bacterial isolates were encountered in the 50 subjects accounting for an average of 1.00 isolate per subject, Staphylococcus aureus was the predominant bacteria isolated with 13(32%), Also in this study subjects aged 56-63 years were more susceptible to diabetic foot ulcers, Subjects with duration of ulcer 1-4 months had the highest number of bacterial infection, fasting blood glucose levels has been found to be a strong predictive of subsequent ulceration and amputation. The study therefore recommended among others that Surface wound swabbing and deep tissue swabbing are reliable for collection of sample from diabetic wounds. Future studies should focus on the role of Staphylococcus aureus and other Enterobacteriaceae in the causation of diabetic foot wound infection and non- healing wounds. Antibiotic therapy should be guided with antibiograms results. Studies on the emergence of antibiotic resistance in the bacteria commonly isolated from diabetic foot ulcer should be correlated to community center for drug statistic methodology.
1.1 BACKGROUND OF STUDY
Diabetes is considered a major health problem facing the world as a life threatening disease. Diabetes mellitus (DM) the most common non communicable disease is now increasing globally at an alarming rate (Ridker et al., 2000). Diabetes is more in developing countries compared to developed ones. It is a clinical metabolic syndrome characterized by chronic hyperglycemia (high levels of glucose in the blood) resulting from either inadequate insulin production, reduced tissue sensitivity to insulin or both (Kumar, 1994). Chronic hyperglycemia leads to diabetic complications frequently affecting the eyes, kidneys, nervous system and blood vessels like peripheral neuropathy, peripheral vascular disease, increased risk of infection and poor wound healing, kidney failure (Frier et al., 1999).
Diabetes mellitus is the most important risk factor of diabetic foot ulcer (DFUs). Patients with diabetes are more likely than others to have problems with their feet. These problems can lead to dangerous infections of the foot. Recognizing and treating foot problems early can help diabetic patients avoid serious complications.
In 2000, according to according to the World Health Organization (WHO) at least 171 million people worldwide suffered from diabetes.
Diabetes affects the foot in two ways; it causes nerve damage and it can also cause hardening of blood vessels. Because of the abnormal increase of blood sugar in the blood, nerves of the body can be damaged, this is known as diabetic neuropathy. Diabetes also affects the blood vessels of the feet causing them to narrow and this is known as diabetic vasculopathy. With less blood, the foot will not have enough nutrients to heal and fight infections causing the foot to become flatter. When both the nerves and arteries are damaged, the diabetic patient might not notice simple wounds, which soon becomes seriously infected that can threaten the whole foot and even the leg. If not stopped, the infection can threaten the whole body (Anandi et al., 2004). Redness, swelling and increased temperature of the foot are signs of infection.
Diabetic foot ulcer (DFU) is the major cause of hospital bed occupancy by diabetic patients than for all other aspect of the disease combined and it influences a person’s quality of life, resulting to a decline to social, physical and psychological function. More than 60% of diabetic foot ulcers (DFU) are as a result of underlying neuropathy caused by hyperglycemic induced metabolic disorders.
Diabetic foot ulcer can be caused by both Type 1 and Type II diabetes. It is estimated that approximately 15.25% of diabetes patients develop diabetic foot ulcers during the course of the disease which is highly susceptible to infections and that spreads rapidly leading to tissue destruction and subsequent amputation (Khanolkar et al., 2008). People with diabetes can progress into chronic ulcers often leading to amputation if not treated promptly. Nonetheless, amputation in diabetes could be delayed or prevented by effective medical supervision, nursing and appropriate antibiotic therapy. Patients with diabetic foot ulcers are often under frequent antibiotic treatment without any investigation to confirm infection. This practice can lead to development of resistance.
The primary cause of diabetic foot ulcer is microbial agents and their early diagnosis is essential to use appropriate antimicrobial therapy. A thorough knowledge of microbial agents found in foot ulcer is important for the containment of the infection. The presence of infection depend on the number of microorganisms residing in the wound. Ulcerations are prone to colonization by nearly every microorganism that can come in contact with the surface. Usually ulceration contain mixed flora consisting of different strains of the bacteria and the healing process depend on the type of bacterial strain and the pathogenicity. The mechanism by which bacteria delay the healing process is not completely understood (Gadpelli et al., 2006). It is suggested that the main role is played by the pathogenic virulence factors of the bacteria such as adhesins, exoenzymes and toxins.
However, the choices of right antibiotic therapy rely on proper isolation and identification of the causative microorganism and the performance of antibiotic sensitivity testing before commencement of antibiotic therapy.
1.2 STATEMENT OF PROBLEM
Diabetic foot ulcers are important cause of morbidity and mortality among persons with diabetes mellitus. The vast majority of diabetic foot complications resulting in amputation begin with the formation of foot ulcers. Diabetic foot ulcers are the leading cause of non-traumatic amputation worldwide. The risk of lower extremity amputation is higher in patients with diabetes than in persons who do not have diabetes mellitus. Early detection and appropriate treatment of these ulcers may prevent up to 85% of amputation. As there is no single etiological agent for the causation of diabetic foot ulcers, it becomes important to find out the different bacteria involved in diabetic foot ulcers and also to know its antibiotic sensitivity pattern in a particular area, hence this study was intended to isolate and identify the bacteria from diabetic foot ulcers.
1.3 AIMS AND OBJECTIVES
To isolate and identify bacteria spectrum associated with diabetic foot ulcer.
- To evaluate the age distribution of the bacterial isolates from diabetic foot ulcers.
- To evaluate the duration of the diabetic foot ulcer from this study.
- To evaluate the glucose levels of the subjects.
- To evaluate the antibiotic susceptibility pattern of bacterial isolates from the diabetic foot ulcer.
1.4 JUSTIFICATION OF STUDY
Diabetic foot ulcer has become a public health problem facing those who have diabetes mellitus and it affects two-third of adults who are in their fourth decade of life and upwards with diabetes. It is a chronic situation that contributes significantly to morbidity and mortality of individuals. Patients with diabetic foot ulcers (DFU) are commonly treated with broad spectrum antibiotics without proper isolation of the causative microorganism. Microorganisms in diabetic foot ulcers are often polymicrobial in nature. Therefore understanding the current microbial profile in diabetic foot ulcers and their sensitivity pattern will be helpful in prescribing the right antibiotics, reducing hospital stay, preventing major surgical interventions and thereby saving scarce resources.
1.5 SIGNIFICANCE OF THE STUDY
This study will fill gap in knowledge by providing data on the bacterial pathogens associated with diabetic foot ulcers at Abia State University Teaching Hospital (ABSUTH).
This study will be helpful to the patient who will benefit from the effective and efficient management of their cases based on the information derived from this study.
The outcome of this study will be documented to supplement as literature and a source of additional reference information to research on this topic or related concepts.
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