Introduction: Foot infections are one of the major complications of diabetes mellitus and a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. Materials and Methods: A retrospective study of 75 patients with diabetic foot infections admitted to RIPAS hospital between June 2008 and June 2010 was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Results: Overall, 40 (54%) patients had subcutaneous infections, 22 (29%) had infected superficial ulcers, seven (9%) had infected deep ulcers involving muscle tissues and six (8%) had osteomyelitis. A total of 98 pathogens were isolated. Forty percent of the patients had polymicrobial infection, 39 (52%) had single organism and 6(8%) had no growth. Gram-negative bacteria (67%) were more commonly isolated than gram-positive bacteria (30%). The three most frequently found gram-negative organisms were Pseudomonas aeruginosa (19.4%), Klebsiella pneumoniae (15.3%), and Acinetobacter spp. (10.2%) and gram-positive organisms were Staphylococcus aureus (10.2%), Streptococcus pyogenes (7.1%) and Methicillin resistant Staphylococcus aureus [MRSA] (7.1%). Vancomycin was found to be the most effective against gram-positive bacteria while amikacin was the most effective against gram-negative bacteria based on antibiotic testing. Conclusion: In 40% of diabetic feet infection was polymicrobial. Staphylococcus aureus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative organisms respectively. This study helps us to choose the empirical antibiotics for cases of diabetic foot infections.
Diabetic Complications ; Diabetic Foot ; Microbiology ; Bacteriology

Introduction: Colonoscopy is an investigation for the evaluation of lower gastrointestinal symptoms. Just like any other conditions, it is important to be aware of the spectrum of findings so that appropriate referral and decisions can be made. Materials and Methods: Patients (mean age 52.3 ± 15.3 years old with almost equal proportion of genders) referred for colonoscopy in RIPAS Hospital over a five year period (January 2003 to December 2007) were retrospectively identified and studied. Results: The most common indication for colonoscopy was bleeding per rectum (22.9%), followed by evaluation of abdominal pain (18.6%), anaemia (11.7%), colorectal cancer screening (11.7%), evaluation of constipation (5.9%) and altered bowel habits (3.8%). A large proportion (58.4%) colonoscopy was normal. The most common positive finding was haemorrhoids (30.3%), majority of which were categorised as grade I. This was followed by colonic polyps (17.6%), diverticular disease (12.1%), non-specific colitis (4.0%), colorectal cancers (4.0%) and ulcers (3.6%), melanosis coli (0.4%) and telangiectasia (0.1%). Colorectal cancer was most common among the Malays (4.4%), followed by the Chinese (4.0%), the indigenous (2.8%) and the others (1.2%). Conclusions: Our study showed that the most common indication was for the evaluation of bleeding per rectum. Majority had normal colonoscopy and the most common positive finding was haemorrhoids. Importantly colorectal neoplasms accounted for one fifth of procedures with colorectal cancers accounting for four percent.
Diabetic Complications ; Diabetic Foot ; Microbiology ; Bacteriology

There is a rare case of an elderly diabetic with diabetic foot infection at Hainan General Hospital in September 2021, which was diagnosed as Corynebacterium diphtheriae infection incidentally on routine culture with conventional methods and molecular biological approaches, to aid in diagnosis in clinical practice. Owing to smear staining, Albert staining and VITEK 2 system, automated identification systems viz matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) confirmed combing with 16S ribosomal RNA (16S rRNA) gene has been used for the taxonomic classification of bacteria. Otherwise, toxin gene tox was done for diphtheria toxin synthesis. The isolate was Gram-stain-positive, rod-like arrangement with irregular thickness, with characteristic metachromatic granules, ferment most sugars and homology of 16S rRNA analyses with C. diphtheriae NCTC11397^T (MW682323.1) was greater than a 100% possibility, toxin gene tox was negative. The findings lay the foundation to clinical identify and trace of non-toxigenic C. diphtheriae. Moreover, this work provides insights into the non-toxigenic C.diphtheriae that contribute to recognized risk of non-toxigenic C.diphtheriae infections.
Aged ; Corynebacterium/genetics* ; Corynebacterium diphtheriae/genetics* ; Diabetes Mellitus ; Diabetic Foot ; Diphtheria/microbiology* ; Humans ; RNA, Ribosomal, 16S/genetics*

OBJECTIVETo explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis (DFO) and analyze the risk factors causing osteomyelitis.

METHODSA total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis (OM group) and 169 without osteomyelitis (non-OM group), were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis.

RESULTSGram-negative bacteria were the predominant pathogens (53.7%) in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found (56.7%) in non-OM group (P=0.001). Among the Gram-positive bacteria, Staphylococcus was the dominating flora (35.1%). The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group (64.9% and 68.5%, respectively) was significantly higher than that in non-OM group (29.2% and 32.6%, respectively; P<0.05). Among the gram-negative bacteria, Enterobacteriaceae was the dominating flora (62.4%), with a higher resistance rate to Cefepime and Aztreonam in OM group (30.1% and 38.6%, respectively) than in non-OM group (15.1% and 22.2%, respectively; P<0.05). Logistic regression analysis indicated that the infection by multi-drug resistant bacteria and an wounds area >4 cm(2) were the risk factors for osteomyelitis in patients with diabetic foot infections (P<0.05).

CONCLUSIONIn addition to an empirical anti-infection therapy, clinicians should choose specific antibiotics against Gram-negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi-drug resistant bacteria and those with a wound area exceeding 4 cm(2) are exposed to an increased risk of osteomyelitis.

Anti-Bacterial Agents ; Cephalosporins ; Diabetic Foot ; microbiology ; Drug Resistance, Multiple, Bacterial ; Gram-Negative Bacteria ; classification ; isolation & purification ; Gram-Positive Bacteria ; classification ; isolation & purification ; Humans ; Osteomyelitis ; microbiology ; Risk Factors ; Wound Infection ; microbiology

No abstract available.
Asian Continental Ancestry Group ; Bacteremia/complications/*diagnosis/microbiology ; Base Sequence ; Diabetes Mellitus, Type 2/*complications ; Diabetic Foot/microbiology ; Gram-Positive Cocci/genetics/*isolation & purification ; Humans ; Male ; Middle Aged ; RNA, Ribosomal, 16S/chemistry/genetics ; Republic of Korea

INTRODUCTIONThe prevalence of diabetes mellitus is high in Singapore. Infections of the lower limb are significant causes of morbidity in this population. Although the aerobic bacteriology of these infections is well-documented, there is less data available on the anaerobic pathogens involved. This study sets out to describe the anaerobic bacteria associated with diabetic foot infections, and evaluates the susceptibility to 3 antimicrobials with anaerobic activity.

MATERIALS AND METHODSAnaerobic culture was performed on operative samples taken from diabetic foot infections. Organisms were identified through standard microbiological methods and commercial identification kits. Antimicrobial susceptibility testing to clindamycin, metronidazole and imipenem was performed by agar dilution.

RESULTSOne hundred and two strains of strict anaerobic bacteria were isolated from 30 unique specimens. The predominant anaerobic isolates were Peptostreptococcus spp. (46%) and Bacteroides fragilis group (19%). Antibiotic resistance was detected for clindamycin (18%), metronidazole (1%) and imipenem (2%).

CONCLUSIONMultiple anaerobic species can be isolated from diabetic foot infections. A significant proportion of isolates are resistant to clindamycin, while resistance to imipenem and metronidazole remains low.

Anti-Bacterial Agents ; therapeutic use ; Bacteria, Aerobic ; drug effects ; genetics ; isolation & purification ; DNA, Bacterial ; analysis ; Diabetic Foot ; surgery ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Humans ; Nucleic Acid Amplification Techniques ; Retrospective Studies ; Surgical Wound Infection ; drug therapy ; microbiology