Pseudomonas aeruginosa is an invasive organism that frequently causes severe tissue damage in diabetic foot ulcers. A major problem in P. aeruginosa infection may be that this pathogen exhibits a high degree of resistance to a broad spectrum of antibiotics. The study aimed to isolate and determine the antimicrobial susceptibility patterns of the P. aeruginosa population from diabetes patients with foot ulcers attending tertiary care hospitals in and around Coimbatore and their antimicrobial susceptibility pattern. The study was carried out at the Department of Microbiology, Dr. N.G.P. Arts and Science College, Coimbatore, for a period of one year (June 2006 to April 2007). The present study comprised 270 pus specimens collected from diabetic patients with foot ulcers. All pus samples were subjected to gram staining; bacterial culture and subsequently the antibiotic sensitivity to 15 different antibiotics for the confirmed P. aeruginosa were performed as per the standard procedures. Eighteen strains (14.28%) of P. aeruginosa from 270 diabetic foot ulcers were detected. Almost all the strains exhibited a varying degree of resistance to the antibiotics tested. Multidrug resistance for about 8 to 11 antibiotics was observed among the 55.5% of the isolates. Disk diffusion results show 100% resistance to ampicillin, cefoperazone, erythromycin, norfloxacin, and only cefotaxime, ciprofloxacin exhibited greater activity against Pseudomonas aeruginosa. 1. Introduction Diabetes is a chronic disorder that affects a large segment of population and is a major public health problem. Diabetes and foot problems are almost synonymous [1]. A recent WHO report indicates that India has the largest diabetic population (19 million in 1995) that is expected to rise to 57 million by 2025 [2]. A commonly accepted definition of foot infection is the presence of systemic signs of infection (e.g., fever and leucocytosis) or purulent secretions or two or more local symptoms or signs (redness, warmth, indurations, pain, or tenderness) [3]. Viswanathan et al. [4] reported that 25% of diabetic individuals are anticipated to develop severe foot problems at some point in their lifetime that often end with amputation. Diabetic foot infections are more severe and more difficult to treat than infections in nondiabetics. Polymicrobial etiology has been implicated in the infected diabetic foot. Gram-negative infections are three-times more frequent in the diabetic than in non-diabetic individuals [5]. Most infections with Pseudomonas species occur in compromised hosts. The pathogenicity of
References
[1]
R. G. Frykberg, “Diabetic foot ulcers: current concepts,” Journal of Foot and Ankle Surgery, vol. 37, no. 5, pp. 440–446, 1998.
[2]
J. A. Mayhfield, G. E. Reiber, L. J. Sanders, D. Janisse, and L. M. Pogach, “Preventive foot care in people with diabetes,” Diabetes Care, vol. 21, no. 12, pp. 2161–2177, 1998.
[3]
R. Kahn, “Consensus development conference on diabetic foot wound care,” Diabetes Care, vol. 22, no. 8, pp. 1354–1360, 1999.
[4]
V. Viswanathan, J. J. Jasmine, C. Snehalatha, and A. Ramachandran, “Prevalence of pathogens in diabetic foot infection in south Indian type 2 diabetic patients,” Journal of Association of Physicians of India, vol. 50, no. 8, pp. 1013–1016, 2002.
[5]
G. Dhanasekaran, N. G. Sastry, and V. Mohan, “Microbial pattern of soft-tissue infections in diabetic patients in South India,” Asian Journal of Diabetology, vol. 5, no. 5-6, pp. 8–10, 2003.
[6]
R. S. Baltimore, “Pseudomonas,” in Nelson Textbook of Pediatrics, pp. 862–864, 2000.
[7]
M. Toda, S. Okubo, R. Hiyoshi, and T. Shimamura, “The bactericidal activity of tea and coffee,” Letters in Applied Microbiology, vol. 8, no. 4, pp. 123–125, 1989.
[8]
B. Erdem, “Pseudomonas,” in Basic Clinical Microbiology, S. Ustacelebi, Ed., pp. 551–558, Genes Publication, Ankara, Turkey, 1999.
[9]
E. Mike, “The use of antibiotics in the diabetic foot,” American Journal of Surgery, vol. 187, no. 5, supplement 1, pp. S25–S28, 2004.
[10]
P. de Man, E. van der Veeke, M. Leemreijze et al., “Enterobacter species in a pediatric hospital: horizontal transfer or selection in individual patients?” Journal of Infectious Diseases, vol. 184, no. 2, pp. 211–214, 2001.
[11]
G. Bonfiglio, V. Carciotto, G. Russo et al., “Antibiotic resistance in Pseudomonas aeruginosa: an Italian survey,” Journal of Antimicrobial Chemotherapy, vol. 41, no. 2, pp. 307–310, 1998.
[12]
G. Valentina and M. K. Lalitha, “Isolation and identification of bacteria from pus (including drainage tube, catheter, ear, eye and genital swabs),” in Mysers, Koshi’s Manual of Diagnostic Procedures in Medical Microbiology and Immunology/Serology, R. M. Myers and G. Koshi, Eds., pp. 38–49, CMC, Vellore, India, 1989.
[13]
Clinical and Laboratory Standards Institute, “Performance standards for antimicrobial disk susceptibility testing,” in Proceedings of the 17th International Supplement, vol. 21, Wayne, Ind, USA, M100-311, 2000.
[14]
R. Malikunnisa and R. Begum, “Bacteriology of diabetic foot: antibiogram, MIC studies, MRSA screening and evaluation of wound cleansing agent,” Indian Journal of Applied Microbiology, pp. 73–77, 2005.
[15]
E. M. Shankar, V. Mohan, G. Premalatha, R. S. Srinivasan, and A. R. Usha, “Bacterial etiology of diabetic foot infections in South India,” European Journal of Internal Medicine, vol. 16, no. 8, pp. 567–570, 2005.
[16]
R. Lidia, M. A. Dominguez, R. Neus, and V. Miguel, “Relationship between clinical and environmental isolates of Pseudomonas aeruginosa in a hospital setting,” Archives of Medical Research, vol. 35, no. 3, pp. 251–257, 2004.
