الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Diabetes Mellitus (DM) is a serious public health problem and remains an important cause of morbidity and mortality worldwide. With the rise of diabetes mellitus prevalence there is increasing problem of diabetic foot infection. The risk of lower limb amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus. Furthermore, foot complications are the most frequent reason for hospitalization in patient with diabetes.
Severe diabetic foot infections usually yield polymicrobial isolates whereas mild infections are frequently monomicrobial. In cases of a severe diabetic foot infection, three to five organisms may be cultured. The Wagner classification classifies the severity and depth of tissue injury into five grades.
The superficial grades Wagner I and II with no bone involvement. Wagner grades III to V with deep lesions (with bone involvement and localized or extensive gangrene).
The aim of this study was determining the prevalence of aerobic and anaerobic pathogens in diabetic foot infection, detecting susceptibility of bacterial isolates against different antimicrobial agents, investigating the microbiological profiles of diabetic foot infections in relation to different grades of Wagner classification and evaluating risk factors for diabetic foot infections.
In this study subjects were classified into three groups:
Group (1): included 50 patients had type I (IDDM).
Group (2): included 50 patients had type II (NIDDM).
Group (3): included 50 non diabetic patients.
All subjects in this study were admitted to medical and surgical wards or attending the outpatient clinics of surgery at Menoufia University hospital and Sheben-Elkom teaching hospital with infected foot lesions.
All patients were subjected to full personal and clinical history taking clinical general and local examination of the affected foot lesion.
Tissue, pus or swab samples were obtained from foot lesion (parts of the collected specimens were placed in cooked meat broth for anaerobic cultures).
All specimens were undergoing to direct gram stain and primary aerobic cultures. Specimens transported into cooked meat broth were cultivated and immediately incubated anaerobically.
Isolation, identification of the causative organisms and susceptibility testing were done according to the standard microbiological methods.
MICs of vancomycin were determined for all staphylococcal isolates.
Phenotypic confirmatory (DDST) was performed for detection of ESβL production in Gram negative organisms detected by screening disk diffusion test.
The results obtained in this study revealed that:
Mean age was higher in type II (58.3 ±5.6) than type I (35.9 ±7.4) diabetic cases and in total diabetic cases (47.1 ±1.0) than non diabetics (41.5 ±15.9).Male cases (68%in IDDM patients, 62% in NIDDM patients and 66% in non diabetic patients) were more than females.
Ulcer duration was >1month in 54% of total diabetic patients and only 8% of non diabetics. Foreign bodies and preceding trauma were found in 2% and 29%respectively of total diabetic foot lesions and in 12%and 50% respectively of non diabetic foot lesions. Prevalence of hypertension was57% of total diabetics compared to only 30% in non diabetics. Prevalence of ischemic heart disease was14% in type I diabetics, 34% of type II diabetics, 24% in total diabetics and 8% in non diabetics. Hyperlipidemia was found in 2% of type I diabetics, in 26% of type II diabetics and in 6% of non diabetics. The majority of type I (74%) and type II diabetics (78%) had high random blood sugar (≥ 200mg/dl) at time of admission. Neuropathy was more common in IDDM (76%)than NIDDM cases (52%), nephropathy was found in 28%of IDDM and 6% of NIDDM cases and retinopathy was found in 42%of IDDM and 18%of NIDDM.
There were previous ulcerations in 34% of IDDM cases and 12% of NIDDM cases. So, in this study risk factors for DFI among type I and type II diabetic patients were long duration of diabetes, high random blood sugar, trauma previous ulceration and amputation, and the occurrence of diabetes related comorbidities specially neuropathy and vascular insufficiency.