Diabetic Foot Ulcer in India: Aetiological Trends and Bacterial Diversity

Abstract

Diabetes is one of the most prevalent epidemic metabolic disorders, responsible for a significant amount of physical, psychological and economic loss in human society. Diabetic foot ulcer (DFU) is one of the extreme pathophysiological consequences of diabetes. Bacterial infection is the most important cause of chronic DFU. Bacterial species or their biofilms show multidrug resistance, which complicates DFU and consequently leads to amputation of the infected part. Since the Indian population comprises diverse ethnic and cultural groups, this could influence the aetiology of diabetic foot infections and bacterial diversity. We reviewed 56 articles published from 2005 to 2022 on the microbiology of DFU and extracted the data on study location, number of patients analysed in the study, pathophysiological complications, age of the patients, sex of the patient, type of bacteria, type of infection (mono or polymicrobial), predominant bacteria (Gram-positive or Gram-negative), predominant isolates and multiple drug resistance (tested or not). We analysed data and described aetiological trends in diabetic foot infections and bacterial diversity. The study revealed that Gram-negative bacteria are predominant as compared to Gram-positive bacteria in individuals with diabetes with DFU in India. Escherichia coli , Pseudomonas aeruginosa , Klebsiella sp. and Proteus sp. were the most predominant Gram-negative bacteria, while Staphylococcus aureus and Enterococcus sp. were the major Gram-positive bacteria in DFU. We discuss bacterial infections in DFU in the context of bacterial diversity, sampling methods, demography and aetiology.

Development and validation of an interprofessional collaborative educational module on the self-management of foot for individuals with type II diabetes mellitus

“…Diabetes affects approximately 8.9% of the Indian population and is associated with an estimated one million deaths annually. 4,5 The worldwide occurrence of DFUs varies between 5% and 7.5% among individuals with diabetic neuropathy. In India, a survey conducted within the community found the prevalence of diabetic foot ulcers to be 6.38%.…”

“…11 This diversity can significantly impact the causes of diabetes, its outcomes, such as diabetic foot ulcers, and individuals' responses to diabetes treatments. 4,12 Diabetic care-related practices may also vary based on ethnicity, lifestyle practices, socio-economic status, and the prevalence of diabetes. It may further contribute to an increase in the occurrence of DFUs in India.…”

“Comparison between topical Platelet Rich Plasma and Normal Saline dressing, in conjunction with Total Contact Casting in Treatment of Diabetic Foot Ulcer– a Randomized Control Trial”

“…The global prevalence of DFU is 6.3% in the overall population and is expected to increase in the future [13]. In India, the prevalence of diabetic foot ulcers is 4-5%, which is much lower than that reported in western countries [14].…”

Effect of Topical Silver Nanoparticle Formulation on Wound Bacteria Clearance and Healing in Patients With Infected Wounds Compared to Standard Topical Antibiotic Application: A Randomized Open-Label Parallel Clinical Trial

“…With multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacterial infections, the mortality risk increases multifold depending on the degree of resistance, the organism, and associated risk factors [ 3 ]. Acute and chronic wound infections are significant problems, and 20% of surgical sites and 40% of diabetic wounds infected with resistant bacteria have been reported from India [ 4 , 5 ]. The common organisms isolated from the wound infections are Staphylococcus aureus , Escherichia coli , Pseudomonas aeruginosa , Acinetobacter baumannii , and Klebsiella pneumonia [ 5 ].…”

“…Acute and chronic wound infections are significant problems, and 20% of surgical sites and 40% of diabetic wounds infected with resistant bacteria have been reported from India [ 4 , 5 ]. The common organisms isolated from the wound infections are Staphylococcus aureus , Escherichia coli , Pseudomonas aeruginosa , Acinetobacter baumannii , and Klebsiella pneumonia [ 5 ].…”