The SA Journal Diabetes & Vascular Disease Vol 15 No 1 (July 2018)

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SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE
VOLUME 15 NUMBER 1 • JULY 2018 7
instance, where pathogen yield is a major determinant, wound
biopsy is superior to wound swab. However, the centre where this
study was undertaken lacked punch biopsy capability at the time
these patients were documented.
The patients in tertiary hospitals in poor countries often have
attempted home management8,24 or unorthodox involvement8,11,24
before they finally seek attention or are referred to primary/secondary
centres.8,11,24,25 Along this delivery chain of presentation to the tertiary
centre, it has been observed that antibiotic use (and misuse) is very
common in individuals living with DM nursing an ulcer.5
Since this was a retrospective study, it was difficult to interrogate
prior antibiotic use among the study population. The type(s),
duration and timing in relation to the onset of ulcer are important.
Documented references to prior antibiotic use were scanty in this
study, with patients not knowing the types of drugs used before
presentation. This may also have affected the types of bacteria
cultured while they were being managed in this facility.
Fastidious organisms, strict aerobes and anaerobes and the
procedure through which swabs were taken, stored and handled
were important determinants of the types of bacterial yield
observed. Because of the retrospective nature of this study, it was
not possible to assess anaerobic culture documentation.
Conclusion
In these patients, there was a high degree of late presentation
as well as poor glycaemic control and a high rate of wound
infection due to colonisation by opportunistic pathogens,
especially bacteria. Staphylococcus aureus was the commonest
organism isolated from swabs of foot ulcers in this study. Most
of the organisms identified from swab cultures were sensitive to
quinolones and resistant to penicillins. This is a major challenge in
the management of foot ulcers in individuals living with diabetes
where culture and sensitivity tests are not available or reliable,
as the correct choice of antibiotics should be made only after
antibiotic sensitivity testing. We therefore advocate the use of a
quinolone while awaiting sensitivity results.
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