Effects of granulocyte‐colony stimulating factor in the treatment of diabetic foot infection

Yönem, Arif; Cakir, Bertan; Güler, Selma; Azal, Ömer; Çorakçı, Ahmet

doi:10.1046/j.1463-1326.2001.00142.x

Cited by 66 publications

(59 citation statements)

References 26 publications

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“…DFI were more common in cases with duration of diabetes >10 years in our study which was also reported by Yonem A in his study that more the duration more the development of DFI. 13 Poor glycaemic controls with raised levels of HbA1c, long duration of hypertension were significant risk factors for development of DFI in our study and statistically significant association was found with these risk factors. Similar findings were reported by Lavery LA and Oyibo SO in their studies.…”

Section: Resultssupporting

confidence: 61%

Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

Malepati

Vakamudi

Kandati³

et al. 2017

Int Surg J

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Background: Diabetes is considered as one of the most important and rapidly evolving non-communicable disease which requires top priority around the world. 10-25% of diabetics develop foot infections [DFI’s] during the course of their disease period ranging from simple calluses to major Osteomyelitis. 3 Microbial infections of the diabetic foot ulcers are difficult to manage because of multiple factors associated in response including overall glycaemic control, associated complications like vascular disease and neuropathy. The present study was done to assess the microbial flora according to Wagner’s classification for diabetic foot disease. To isolate, identify the aerobic bacterial pathogens and their drug sensitivity pattern with reference to ESBL productionMethods: A prospective study was conducted at a tertiary care hospital by department of general surgery among Diabetics presenting with diabetic foot infections. All the enrolled cases were classified based on Wagner’s classification and socio demographic data was noted. Specimens from the ulcer were collected and processed for isolation, identification of pathogens based on standard CLSI guidelines. The antibiotic sensitivity of the isolates was done and ESBL production was demonstrated by standard guidelines.Results: 346 cases were enrolled in study and grade-3 Wagner’s ulcers were predominant. Males were predominant, 46-55 years age group was common with mean age of 55.3±1.4 years. Peripheral arterial disease was more common than peripheral neuropathy and both were found significantly associated with development of ulcers. Methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa were most common isolates. MRSA exhibited maximum sensitivity to vancomycin, clindamycin and linezolid. Gram negative isolates exhibited maximum sensitivity to meropenems, piperacillin-tazobactam. The prevalence of ESBL producers in the study was 16.24%.Conclusions: DFI are a serious concern in uncontrolled diabetics and require proper management. Outcome of the infection depends upon the grading of the ulcer as per Wagner’s classification and also the nature of the infection either polymicrobial or with a single organism. Our study highlights and suggests that prospective multicentre studies are required to assess the appropriate antibiotic regimen in diabetic foot ulcers and proper management of antibiotics must be implemented to decrease the incidence and development of multi drug resistant organisms.

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Section: Resultssupporting

confidence: 61%

Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

Malepati

Vakamudi

Kandati³

et al. 2017

Int Surg J

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“…In the second trial dealing with this subject, the beneficial effect of G-CSF could not be confirmed. G-CSF had no effect on the time until resolution of infection, nor on the duration of parenteral antibiotic administration or the duration of hospitalisation, despite an increased neutrophil function [6]. In contrast to these two studies, we quantified cellulitis and ulcer volume, ensured that all participants spent the same time period in the hospital, and insisted on bed-rest during the study period in order to guarantee consistent non-weight-bearing conditions for the ulcerated foot.…”

Section: Discussionmentioning

confidence: 99%

“…Two randomised controlled clinical trials have investigated the therapeutic effects of G-CSF in infected diabetic foot ulceration, and yielded contradictory results [5,6]. The aim of our study was to re-evaluate the potential therapeutic effect of G-CSF in patients with infected foot ulcers.…”

mentioning

confidence: 99%

Evaluation of granulocyte-colony stimulating factor (Filgrastim) in infected diabetic foot ulcers

et al. 2003

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Aims/hypothesis. To re-evaluate the use of Granulocyte-Colony Stimulating Factor (G-CSF) in the treatment of infected diabetic foot ulcers. Methods. Thirty-seven diabetic subjects were randomised to Granulocyte-Colony Stimulating Factor (G-CSF) (n=20) or placebo (n=17). The primary endpoint was resolution of cellulitis, which was evaluated clinically and with an infection summary score. Patients were hospitalised for 10 days and received subcutaneously either 5 µg/kg G-CSF or placebo daily. Ulcers were treated with a standard wound protocol and the patients were instructed to stay in bed. All subjects received antibiotics (clindamycin and ciprofloxacin) intravenously until the inflammation had subsided.

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“…Secondly, and probably of greater clinical relevance, granulocyte-colony stimulating factor (G-CSF) has been used as adjuvant therapy in diabetic patients with foot infections. G-CSF induces terminal differentiation and release of PMN from the bone marrow and improves PMN function, particularly superoxide production [26][27][28]. In one trial [26], diabetic patients with lower limb infections who received G-CSF showed earlier microbial eradication from wound swabs, quicker resolution of cellulitis, and shorter duration of intravenous antibiotic administration and hospitalisation.…”

Section: Innate Immunitymentioning

confidence: 99%

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Peleg

Weerarathna

McCarthy

et al. 2006

Diabetes Metabolism Res

506

406

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SummarySpecific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hyporesponsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community-and hospitalacquired infections.

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Effects of granulocyte‐colony stimulating factor in the treatment of diabetic foot infection

Abstract: Although G-CSF improves neutrophil function as well as increasing the absolute numbers, this improvement is not associated with shortening of duration of antibiotic administration, duration of hospital stay or need for amputation in diabetic foot infection.

Cited by 66 publications

References 26 publications

Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

Evaluation of granulocyte-colony stimulating factor (Filgrastim) in infected diabetic foot ulcers

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

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