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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
4
VOLUME 15 NUMBER 1 • JULY 2018
Profile, bacteriology and antibiotic susceptibility pattern
of diabetic foot ulcers at the Federal Medical Centre,
Makurdi, Nigeria
JE Ojobi, P Mbaave, A Ubumneme, M Abonyi
Correspondence to: JE Ojobi
Medicine Department, Federal Medical Centre, Makurdi, Benue State, Nigeria
e-mail:
ojobijoe@yahoo.comP Mbaave
Medicine Department, Benue State University Teaching Hospital, Benue
State, Nigeria
A Ubumneme
Medicine Department, Emeka Odumegwu Ojukwu Teaching Hospital,
Anambra State, Nigeria
M Abonyi
Medicine Department, Enugu State University Teaching Hospital, Enugu
State, Nigeria
S Afr J Diabetes Vasc Dis
2018;
15
: 4–7
Abstract
Objectives:
The projected increase in the prevalence of
diabetes mellitus (DM) is expected to be accompanied
by a corresponding increase in associated complications.
Foot problems are an increasingly important public health
complication of DM. A major obstacle in the management
of foot ulcers in diabetes is the colonisation of wounds by
virulent pathogens, causing increasing rates of morbidity
and mortality. In this article, we present a review of the
profile, bacteriology and antibiotic susceptibility pattern of
foot ulcers in individuals living with type 2 diabetes mellitus
(T2DM), hospitalised at the Federal Medical Centre (FMC),
to aid planning of services and provide a sensible approach
to empirical antibiotic therapy while awaiting culture and
sensitivity reports.
Methods:
Thiswasahospital-based, retrospective, descriptive
study that reviewed the profile, bacteriology and antibiotic
susceptibility pattern of foot ulcers in individuals living with
T2DM who were admitted for foot ulcer(s) over a three-
year period (2012–2014) at the FMC. Approval for the study
was obtained from the ethics committee of the institution.
Relevant data (gender, age, residence, occupation, DM
duration, ulcer duration, glycosylated haemoglobin status)
were extracted from the files.
Results:
One hundred and nine T2DM case files, made up
of 44 females and 65 males (1:1.5) with a mean age of 53.5
± 11.4 years, were extracted. They were mostly farmers in
their fifties with poor glycaemic control who had had T2DM
for more than a decade and foot ulcers for more than six
months.
Staphylococcus aureus
was the commonest organism
isolated from swabs of foot ulcers. There was a high level of
sensitivity to quinolones and resistance to penicillins.
Conclusion:
Late presentation, poor glycaemic control,
high rate of wound infection with
S aureus
, resistance to
penicillins and sensitivity to quinolones were noted.
Keywords:
profile, diabetes mellitus, ulcer, bacteriology, antibiotic
susceptibility pattern
Background
Reliable estimates have projected an astronomical increase in the
prevalence of diabetes mellitus worldwide in the near future.
1
The
rise in prevalence will be associated with a corresponding increment
in associated complications. Foot problems are an increasingly
important complication of diabetes mellitus (DM), ranging from
mild discomfort to debilitating paraesthesiae and fungating ulcers.
They are known to be a leading cause of admission to hospitals
and prolonged stay on admission, straining manpower, draining
resources and often associated with unnecessary and untimely
death.
2,3
Diabetes-associated foot conditions constitute different
percentages of diabetes admissions from different reports, even
in the same country.
2-5
A major obstacle in the management of
diabetes-related foot ulcer is the colonisation of wounds by virulent
bacterial pathogens,
5
leading to increasing costs and morbidity and
mortality rates.
In this article, we present a review of the profile, bacteriology
and antibiotic susceptibility pattern of foot ulcers in type 2 DM
patients (T2DM) hospitalised at the Federal Medical Centre
(FMC), Makurdi. This will engender better understanding of the
patients that presented, and the bacteriological and antimicrobial
susceptibility patterns of foot ulcer(s), with a view to providing a
sensible approach to empirical antibiotic therapy while awaiting
results of wound swab microscopy, culture and sensitivity.
Methods
This was a retrospective, descriptive, hospital-based study to
determine the profile, bacteriology and antibiotic susceptibility
of foot ulcer(s) in individuals with T2DM over a three-year period
(2012–2014) at FMC, a 400-bed tertiary referral centre in Makurdi,
Benue State, Nigeria. Benue state is located in the north-central
region of Nigeria on geographical co-ordinates of latitude 7° 42’
and 10° 0’ east, longitude 6° 25’ and 6° 8’ north. Approval for the
study was obtained from the ethics committee of the institution.
Relevant data (gender, age, residence, occupation, duration of
DM, ulcer duration, glycaemic control at presentation using HbA
1c
level, co-morbid conditions) were extracted from the case files.
As a hospital policy, all wounds were swabbed using sterile swab
sticks and taken to the laboratory within the hour. All swabs were
subjected to Gram staining, microscopic examination and culture.
Blood, MacConkey and chocolate agar were used as primary