Profile, Bacteriology, and Risk Factors for Foot Ulcers among Diabetics in a Tertiary Hospital in Calabar, Nigeria

Abstract

Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend.

Outcome of diabetic foot ulcer admissions at the medical wards of University of Nigeria Teaching Hospital Enugu, Nigeria

“…Long duration of hospital stay was observed among the patients similar to observations reported by other workers [16,19,34]. Ajayi et al [34] reported a mean duration of hospital stay of about 25 days, whereas in Calabar, a mean duration of 38.5 days was reported [16].…”

“…Ajayi et al [34] reported a mean duration of hospital stay of about 25 days, whereas in Calabar, a mean duration of 38.5 days was reported [16]. Long duration of hospital stay may be due to slow healing rate of the ulcers.…”

“…A lifetime risk as high as 15 to 25 % has also been reported [11,12]. The prevalence of DFU among diabetic patients varies widely from about 14.8 % in Ethiopia to 21.2 % in Calabar, Nigeria [13][14][15][16]. In Lagos, Nigeria, Ogbera et al [17] found a high prevalence of 41.5 % for DFU.…”

“…Several determinants affect the outcome of DFU ranging from the pathogenesis of the ulcer (neuropathic vs. ischemic), glycemic control (usually poor in many cases), surgical interventions and wound care techniques employed, and presence or absence of infections [23][24][25]. In our environment, socioeconomic and sociocultural factors such as poverty, poor hygiene, walking barefooted, and ignorance are issues to contend with also [2,16,24]. Some factors reported to influence the development of DFU include rural residence, presence of comorbidity, duration of diabetes, mean arterial blood pressure, and occupation [13].…”

Diabetic Foot Infections: Characterization and Antibiotic Resistance Pattern of Aerobic Bacterial Isolates in a Tertiary Care Hospital of North Kerala

“…The single strain of Candida tropicalis isolated was sensitive to nyststin, amphotericin B, itraconazole, ketoconazole, fluconazole and voriconazole. Diabetic foot disease is a major medical, social and economic problem that is seen in every continent and constitutes a major burden to the patient and the health care system (Otu et al, 2013). People with diabetes have about a 25% chance of developing a foot ulcer in their lifetime (Spichler et al, 2015).…”