Nagaya Raghul, R Priyadharshini, Deva Reka, Jagadeesh Yogeshwari, Emmanuel Pascal, Narayan Gaurang
Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Cureus. 2024 May 12;16(5):e60139. doi: 10.7759/cureus.60139. eCollection 2024 May.
Diabetic foot infections (DFIs) represent a significant complication of diabetes mellitus, contributing to increased morbidity and mortality. Understanding antibiotic prescribing patterns and microbial susceptibility is crucial for effective management.
This study aimed to assess antibiotic prescribing trends and microbial susceptibility patterns in DFIs in a tertiary care center in Puducherry.
A prospective observational study was conducted over two months, involving patients with DFIs attending surgery OPD and admitted inpatient wards. Data on demographics, comorbidities, ulcer characteristics, antibiotic prescriptions, and microbial culture results were collected. Descriptive statistics and appropriate statistical tests were used for analysis.
Of 110 patients included, most were males (80, 72.7%) aged 51-60 years (43, 39.1%). Common risk factors included poor glycemic control (85, 77.3%), barefoot walking (29, 26.4%), and a family history of diabetes (46, 41.8%). Gram-negative organisms (78, 70.9%) predominated, with (17, 15.5%), (12, 10.9%), and (10, 9.1%) being common isolates. Polypharmacy was observed, with (63) 57.3% receiving multiple antibiotics, mainly via the parenteral route (16, 64.5%). Ceftriaxone (31, 28.2%) and cefotaxime (21, 19.1%) were frequently prescribed. Antibiotic resistance varied among isolates.
This study underscores the predominance of gram-negative organisms in DFIs and highlights the need for rational antibiotic prescribing. Cephalosporins were commonly used, emphasizing the importance of empirical therapy. Understanding local microbial patterns and susceptibility is crucial for guiding antibiotic selection and optimizing clinical outcomes. In addition, addressing modifiable risk factors is imperative for preventing DFIs and reducing associated complications. This study provides valuable insights for strengthening antimicrobial stewardship programs and improving patient care in diabetic foot management. Furthermore, the present study highlights the importance of essentially deprescribing the prescriptions both from the patient, their primary carer, and the treating physician/surgeon's perspective.
糖尿病足感染（DFIs）是糖尿病的一种严重并发症，会导致发病率和死亡率上升。了解抗生素的处方模式和微生物敏感性对于有效管理至关重要。
本研究旨在评估本地一家三级护理中心糖尿病足感染患者的抗生素处方趋势和微生物敏感性模式。
进行了一项为期两个月的前瞻性观察研究，纳入在外科门诊就诊及入住住院病房的糖尿病足感染患者。收集了人口统计学、合并症、溃疡特征、抗生素处方和微生物培养结果的数据。采用描述性统计和适当的统计检验进行分析。
纳入的110例患者中，大多数为男性（80例，72.7%），年龄在51 - 60岁之间（43例，39.1%）。常见的危险因素包括血糖控制不佳（85例，77.3%）、赤足行走（29例，26.4%）和糖尿病家族史（46例，41.8%）。革兰氏阴性菌（78例，70.9%）占主导，常见分离菌包括[此处原文可能有误，未明确具体菌名]（17例，15.5%）、[此处原文可能有误，未明确具体菌名]（12例，10.9%）和[此处原文可能有误，未明确具体菌名]（10例，9.1%）。观察到联合用药情况，63例（57.3%）患者接受多种抗生素治疗，主要通过肠外途径（16例，64.5%）。头孢曲松（31例，28.2%）和头孢噻肟（21例，19.1%）是常用的抗生素。不同分离菌的抗生素耐药性各不相同。
本研究强调了革兰氏阴性菌在糖尿病足感染中的主导地位，并突出了合理使用抗生素的必要性。头孢菌素类药物常用，强调了经验性治疗的重要性。了解当地微生物模式和敏感性对于指导抗生素选择和优化临床结果至关重要。此外，解决可改变的危险因素对于预防糖尿病足感染和减少相关并发症至关重要。本研究为加强抗菌药物管理计划和改善糖尿病足管理中的患者护理提供了有价值的见解。此外，本研究从患者、其主要护理人员以及治疗医生/外科医生的角度强调了合理减少处方的重要性。
