Bacterial Infections in Diabetic Foot Ulcers and Their Association with Hyperglycemia

Abstract

Bacteria growth in diabetic foot ulcer is of public health concern worldwide. Their association or dependence on hyperglycemic condition of diabetic patient is significant in terms of virulence, prognosis and wound healing. This study aimed at identifying bacteria pathogens in diabetic foot ulcer, and statistically test their dependence on hyperglycemia. Foot ulcer samples were collected from consenting subjects and analyzed in microbiology laboratory applying standard techniques. From the result a total 238 diabetic foot ulcer patients were examined for bacteria colonization, out of which 47.1% were male while 52.9% were female (P=0.364). The minimum age of the respondents is 42 years while the maximum age is 89 years with mean±SD=63.3±9.6 years (P=0.0001) 1). 44.1% of the diabetic foot ulcers yielded positive result for bacteria growth while 55.9% showed no bacteria growth(P=0.070). According to Wagner classification of ulcer, different grades were encountered. 49.2% of the ulcers were ischemic while 50.8% were neuropathic (P=0.795). Co-morbidities were noted at varying frequencies. The organisms were isolated as single bacteria and polymicrobial growth. Staphylococcus aureus occurred at the highest frequency (14.7%) followed by Pseudomonas aeruginosa (8.4%), and Clostridium perfringens (6.3%). Prevalence of 4.2%, 5.5%, 3.4%, and 1.7% were recorded for Klebsiella pneumonia, Proteus morabilis, E. coli, and Enterococcus fecalis respectively. S. aureus occurred most (60.0%) at foot ulcer of patients whose blood glucose range is 151-200mg/dl while the least (5.7%) prevalence is recorded for blood glucose level 121-151mg/dl which is presumably prediabetic. Klebsiella spp also occurred most (50.0%) at elevated blood sugar level of 151-200mg/dl. There is preponderance of bacteria colonies at blood sugar level above 150mg/dl than below 150mg/dl. Moderate association and dependence is noted between bacteria colonization of diabetic ulcer and hyperglycemia (X2 =33.472, p=0.002; Phi=0.375, p=0.002; Cramer’s V=0.265, p=0.002). These findings are of great relevance to health professionals in clinical decision and judgment.