SLR - October 2020 - Samuel Mason

Prevalence and Interrelationships of Foot Ulcer, Risk-Factors and Antibiotic Resistance in Foot Ulcers in Diabetic Populations: A Systematic Review and Meta-Analysis

Reference: Mohammad Zubair. Prevalence and Interrelationships of Foot Ulcer, Risk-Factors and Antibiotic Resistance in Foot Ulcers in Diabetic Populations: A Systematic Review and Meta-Analysis. World J Diabetes 2020 March 15; 11(3): 78-89

Scientific Literature Review

Reviewed By: Samuel Mason, DPM
Residency Program: Northwest Medical Center – Margate, FL

Podiatric Relevance: Diabetic foot ulcers (DFUs) are a common malady that affect millions of people worldwide. Infection of these ulcerations is one of the most common causes of diabetic morbidity and mortality. With an increasing rate of bacteria developing antimicrobial resistance and a growing prevalence of patient comorbidities, the ability to properly evaluate and treat infections with appropriate antibiotic therapy is paramount for proper care in the podiatric patient population. This article aims to educate physicians on common risk factors in diabetic patients and the most prevalent causative organisms found in DFUs.

Methods: PubMed, Medline, ERIC, and Google scholar were used to find relevant studies pertaining to the topic of the study. Exclusion and inclusion criteria were then applied. These criteria were based on date of publication and complete relevance to the topic, and the articles were limited to review articles. Keywords used were prevalence of diabetic foot ulcer, risk factors, antibiotic resistance, nephropathy and diabetic foot ulcers. A total of 2150 studies were extracted. Cross sectional, prospective, and retrospective studies were included. After inclusion criteria was applied, 725 articles remained. The inclusion criteria were applied again, reducing the number of relevant articles down to 125. The remaining 125 were evaluated to assure significance and only 10 were found to be completely relevant. Each article was then separately assessed and discussed prior to comparison with the data retrieved from other relevant articles.

Results: Of the studies that met the criteria, DFUs and associated comorbidities were examined. Few studies examined the most common infecting organisms of diabetic foot ulcers. The author found that neuropathy and hypertension were the two most commonly associated factors for diabetic foot infections. They also found that gram negative bacteria were the associated causative bacterial pathogens in diabetic foot ulcerations in diabetic foot ulcers. 

Conclusions: Due to the inclusion of 10 articles, there were many different conclusions discussed. According to Quilici et al, hypertension and neuropathy were found to be the most prevalent risk factors and there is a 42 percent prevalence of amputation in patients that had previous antimicrobial therapy. Studies by Jeffcoate et al and Roth-Albin et al showed that emphasizing focus on improving self-care for patients with DFU’s can aid in a better outcome. The study from Commons et al shows that P. Aeruginosa and Methicillin Resistant Staphylococcus Aureus infections require longer term antibiotic courses and increase hospital stay. According to Xie et al and Dwedar et al, Gram negative infections are more common than gram positive. The most effective antibiotics for gram negative infections include colistin, imipenem, and amikacin. For Gram positive infections, Vancomycin was the most effective antibiotic. In gram positive infections, the most resistance was seen against Clindamycin and Cephalexin. They concluded that early tissue sampling with concomitant use of oral antibiotics can be effective in outpatient diabetic foot infections, while also being judicious to not prescribe antibiotics for non-infected wounds. 

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