Rabie Ali Babiker1*, Usama A Elsharief2, Nadia A Mohammed3
1Department of Medical Microbiology, University
of Gadarif, Sudan
2Department
of Pathology, University of Gadarif, Sudan
3Department
of histopathology and Cytology, University of kassala, Sudan
*Corresponding author: Rabie Ali Babiker, Department of Medical Microbiology, University of Gadarif, Sudan. Email: rabie197772@yahoo.com
Received Date: 16 February, 2019; Accepted Date: 22 April, 2019; Published Date: 29 April, 2019
Background:
The infection of Pseudomonas aeruginosa in Diabetic Foot Infection (DFI),
is increasing in Gadarif Diabetic Center, Sudan.
Aims: The
objective of this study is to report on the frequency, antibiotic sensitivity
of P. aeruginosa
in patients with diabetic foot infection.
Methods:
Prospectively, three hundred and fifteen swabs were
obtained from diabetic foot infection wound, collected from diabetic foot
infection patients who attended Gadarif Diabetic Center during the years (2017-2018).
The isolation and identification of P. aeruginosa was done and antimicrobial
susceptibility test of commonly used antibiotics (Piperacillin, Ceftazidime,
Gentamicin, Ciprofloxacin and Doxycycline) against P. aeruginosa was performed.
Results:
The present study included 315 bacterial
wound swabs, there was 96.30% of bacterial isolates were P. aruginosa. The results of antimicrobial
susceptibility test were found to be sensitive to Ciprofloxacin (81.84.4%) and
followed by Ceftazidime (78.81.3%), piperacillin (69.71.9%), Gentamicin (66.
68.8%) and Doxycycline (12.12.5%).
Conclusion:
The study agrees
with previous studies in that, P. aeruginosa was an important causative agents
responsible for diabetic foot infections in Gadarif Diabetic Center. Results
of the antimicrobial sensitivity of P. aeruginosa isolates against commonly used
antibiotics demonstrated the occurrence of resistance to various
antipseudomonal agents (Ciproflopxacin, Piperacillin, Ceftazidime and
Gentamicin).
Abbreviations: ATCC: American Type
Culture Collection; DFI: Diabetic Foot Infection; GDC: Gadarif Diabetic Centre;
MR: Methyl Red; NCCLSs: National Committee for Clinical Laboratory Standards; OF:
Oxidative/Fermentative; VP: Voges-Proskauer
1. Introduction
P. aeruginosa is an important human
opportunistic bacterium in the diabetic foot, it is a Gram-negative aerobic,
rod-shaped non-fermenting bacterium with unipolar motility [1]. P. aeruginosa is
often preliminarily identified by its pearlescent appearance and grape-like [2] or tortilla-like
odour in vitro.
It can be responsible for a spectrum
of presentations from superficial colonization of ulcers to extensive tissue
damage, including osteomyelitis, septic arthritis and bacteraemia [3]. Definitive
clinical identification of P. aeruginosa often includes identifying
the production of pyocyanin and fluorescein, as well as its ability to grow at
42 °C [4,5]. P. aerugenosa is the most commonly isolated
organism from diabetic ulcer [6]. In study from
Malaysia culture of 86 diabetic septic foot patients revealed that P. aeruginosa (17.5%) [7] Dhanasekaran, et
al. reported the prevalence of Pseudomonas species to be 18.79% from a diabetic
centre in Chennai [8]. Fidelis Mbunda,
et al. stated that P. aeruginosa (25.5%)
was the most frequent gram negative bacteria isolated. P. aeruginosa is commonly resistant to
antibiotics, and because of this it is a dangerous and dreaded pathogen. 44%
of P. aerugenosa are multi drug
resistant [6]. In the Mueller
Hinton agar-based antibiogram resistogram pattern study of P. aeruginosa isolated from foot ulcers of diabetes patients, multidrug resistance for about
8 to 11 antibiotics was observed among 55.5% of the strains. No single
antibiotic showed 100% sensitivity to all P. aeruginosa strains. Resistance was least with
cefotaxime (16.6%), followed by an intermediate resistance of 66.7% observed
for ciprofloxacin. Ciprofloxacin and cefotaxime were found to be better choices
for diabetes patients with foot ulcers in this part of the region when compared
to gentamicin, imipenem, piperacillin, and other third-generation
cephalosporins [9].The objective
of this study is to report on the frequency, antibiotic sensitivity, of Pseudomonas aeruginosa
in Diabetic Foot Infection (DFI) in
Gadarif Diabetics Center (GDC).
2. Patients
and methods
This is a prospective observational
analytic hospital based study in which all diabetic foot infections patients
were questioned for personal in information, swabbed aseptically during a 2017-
2018. The study was conducted in Gadarif Diabetic Center (GDC). Three hundred
and fifteen (wound swabs) were collected from diabetic foot infections
patients, transferred immediately to the laboratory for bacteriological
examination.
2.1. Technical
methods
Wound swabs were inoculated on
three plates of Nutrient agar, MacConkey's agar and blood agar were incubated
aerobically at 37 °C for 24-48 hours,
those which did not show visible growth, were discarded. All plates were
examined with the naked eye for colonial morphology, the result of presumptive
colony was recorded. Pure growth was used to identify the causative agents. and
Gram’s stain was done to determine Gram reaction and bacterial morphology. All
the isolated bacteria were examined by biochemical tests such as Catalase, MR,
VP, indole, citrate, urease, oxidase, (OF) Oxidative/Fermentative test for
further identification, the results were recorded.
2.2. Antimicrobial
sensitivity
The bacterial isolates were subjected to a number of antibiotics by disc
diffusion technique (Kirby-Bauer method). And the results were recorded according
to National Committee for Clinical Laboratory Standards (NCCLSs), The same procedure was performed to the control
organisms, American Type Culture Collection of P. aeruginosa (ATCC27853) was used
as a standard control strain.
3. Results
A 315 swabs were obtained from Diabetic
foot infections collected from Gadarif Diabetics Center (GDI) during 2017-2018.
The swabs were cultured, purified by proper streaking on appropriate selective
and differential culture media. The purified cultures of the isolates were then
subjected to identification procedures which were based on the cultural
characteristic, the microscopical examination and the biochemical
characteristics. On the basis of the results of this identification test, it
was found that (96; 30%) out of the total samples (315) were P. aeruginosa. (Figure 1).
The
frequency distribution of Diabetic foot infections patients by P. aeruginosa isolation in relation to age
and gender is shown in (Table 1). The most frequent isolation of the P. aeruginosa was
noted in the age group above 40 years (81.25 %,) followed by those in the age
group of 18 less 40 years (17.71%), less 18 years (1.04%). We found the
relationship between Diabetic foot infections and sex. The prevalence rate was
higher in male (69.8%) patients compared with females (30.2%).
Out of the 96 isolates of P. aeruginosa were
found to be sensitive to Ciprofloxacin, Ceftazidime, Piperacillin, Gentamicin
and Doycycline respectively (Figure 2).
Standard control was tested against P. aeruginosa and the size of the inhibition zones
were recorded so as to be compared with the test organisms (Figure 3).
4. Discussion
The appearance of Diabetic Foot Infection (DFI) in Gadarif
Diabetic Center is a matter of great concern since 96/315 (30%) patients had
developed by P. aeruginosa in the period
during 2017. Another studies of (DFI) showed that P. aeruginosa
is isolated in less than 10% of wounds in studies primarily from developed
northern countries [10]. In a previous study
showed that P. aeruginosa (16%) [11]. Other authors
reported from diabetic ulcers, p. aeruginosa
in 17.5% [12]. Pappu K, et al. who
reported that 76% of the organisms which were isolated from (DFI) were gram
negative bacilli, Pseudomonas being the predominant pathogen (23%) [13]. When factors such as age and sex of the patient
were considered, we found the occurrence of P.
aeruginosa to be higher in males (67, 69.8%) and in patients in the
age group 40 years and above (78, 81.3%). In contrast with other study reported
the presence of P. aeruginosa was not associated with the patient's age [14]. Increasing resistance to different anti-pseudomonal
drugs particularly among hospital strains, has been reported world-wide [15] and this is a serious therapeutic problem in the
management of disease due to these organisms. In this study, antimicrobial
susceptibility patterns of P. aeruginosa
isolates were determined against different antimicrobial agents. The isolates
were found to be sensitive to Ciprofloxacin (81. 84.4%) and followed by
Ceftazidime (78. 81.3%), piperacillin (69.71.9%), Gentamicin (66.68.8%) and
Doxycycline (12.12.5%). Chander and Raza conducted a similar study on the
clinical isolates of P. aeruginosa in Kathmandu,
Nepal, they found that the isolates were sensitive to Ciprofloxacin (70.48.3%),
piperacillin (65.44.8%) [16]). Another
survey and evaluation of the British Society for Antimicrobial Chemotherapy
disc susceptibility test which conducted in UK about Antimicrobial
susceptibility of Pseudomonas aeruginosa:
by Caroline, et al. found that P. aeruginosa was
sensitive to Ciprofloxacin (91.9%), piperacillin (96.1%), ceftazidime (97.7%),
gentamicin (88.9%) [17].
5. Conclusion
The
present study agrees with previous studies in that, P. aeruginosa was an important causative agents
responsible for diabetic foot infection in Gadarif diabetic center. The most
frequent isolation of the P. aeruginosa was noted in the age group above 40 years.
The prevalence rate was higher in male patients compared with females. Results of the antimicrobial sensitivity
of P. aeruginosa
isolates against commonly used antibiotics demonstrated the occurrence of
resistance to various antipseudomonal agents (Ciproflopxacin, Piperacillin,
Ceftazidime and Gentamicin).
Figure
1: Percentage of P. aeruginosa in Diabetic foot infections.
Figure 2: Sensitive & resistant of
P. aeruginosa clinical isolates against
used antibiotics according to the NCCLSS zone diameter standards protocol.
Figure 3: Sensitive & resistant P. aeruginosa (ATCC 27853) standard control strain
against used antibiotics according to the NCCLS zone diameter standards.
Age in years |
M |
F |
Percentage |
Less
than 18 |
1 |
- |
1.04 |
18 and
less than 40 |
4 |
13 |
17.71 |
40 and
above |
62 |
16 |
81.25 |
Percentage |
69.8% |
30.2% |
|
Key: M=
Male, F= Female |
Citation: Babiker RA, Elsharief UA, Mohammed NA (2019) Pseudomonas aeruginosa in
Diabetic Foot Infections, Gadarif Diabetic Center, Sudan (2017-2018). J Trop
Med Health 3: 140. DOI: 10.29011/JTMH-140.000040