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Inflammatory markers as risk factors for infection with multidrug-resistant microbes in diabetic foot subjects
Saba Noor1, Abhijit Girish Borse2, Maaz Ozair1
1Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N. Medical College, Aligarh Muslim University, Aligarh, India.
Background:
Diabetic foot ulcers (DFUs), a dreadful microvascular complication of diabetes is responsible for substantial increase in morbidity and mortality. Infection, not a cause, but a consequence in DFUs that accounts for minor or major limb loss. The current study aimed to evaluate the microbial etiology of infected diabetic foot ulcers in northern tertiary care hospital, assessment of risk factors and role of inflammatory markers involved in colonization of multidrug-resistant organisms (MDROs) and their impact on the outcome.
Methods:
Pus aspirates and soft tissue samples from 65 patients with infected DFUs were collected and processed for aerobic culture analysis. Serum concentrations of IL-6 and TNF-α were determined by enzyme linked immuno-sorbent assay.
Results:
Aerobic gram-negative isolates were more commonly present (74.7%), followed by gram-positive aerobes (25.2%). Fifty-seven percent patients were positive for MDROs. IL-6 (pg/mL) was significantly lower in diabetic patients with MDROs infected foot ulcers than without (47.0±17.2 vs. 78.3±22.1 vs. p=<0.001) and TNF-α (pg/mL) was also significantly diminished in MDROs infected subjects than without (144.2±25.8 vs. 168.7±20.9, p<0.001) respectively.
Conclusions:
In this study diabetic foot wounds harbored by MDROs were associated with longer duration of ulcer and increased ulcer size. Poor glycemic control was also a confounding factor in mounting MDROs infected ulcers. The declined levels WBCs and neutrophils as well as of cytokines IL-6 and TNF-alpha explains compromised immune responses of host in multi drug resistant infections.
Insights
Diabetic foot ulcers (DFUs) infected with multidrug-resistant organisms (MDROs) show lower inflammatory markers (IL-6, TNF-α). MDROs in DFUs are linked to larger ulcers and poor glycemic control, indicating compromised host immunity.
Area of Science:
- Microbiology
- Immunology
- Diabetology
Background:
- Diabetic foot ulcers (DFUs) are a severe complication of diabetes, leading to increased morbidity and mortality.
- Infections in DFUs often result in limb loss and are frequently caused by multidrug-resistant organisms (MDROs).
Purpose of the Study:
- To investigate the microbial causes of infected DFUs in a tertiary care hospital.
- To assess risk factors and the role of inflammatory markers in MDRO colonization and outcomes in DFUs.
Main Methods:
- Collected pus and tissue samples from 65 infected DFU patients for aerobic culture.
- Measured serum concentrations of Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) using enzyme-linked immunosorbent assay.
Main Results:
- Gram-negative aerobic bacteria were the most common isolates (74.7%), followed by gram-positive aerobes (25.2%).
- Fifty-seven percent of patients had MDRO infections.
- Lower serum levels of IL-6 and TNF-α were observed in patients with MDRO-infected DFUs compared to those without.
Conclusions:
- MDRO-infected DFUs were associated with longer ulcer duration and larger ulcer size.
- Poor glycemic control was a significant factor in the development of MDRO-infected ulcers.
- Declined levels of white blood cells, neutrophils, IL-6, and TNF-α suggest a compromised host immune response in MDRO infections of DFUs.
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