A Retrospective Study of Clinical, Microbiological, and Ulcer Severity Patterns of Diabetic Foot Presenting to a Tertiary Care Hospital.

BACKGROUND

Diabetic foot ulcers (DFUs) are a major complication of diabetes and are frequently associated with infection, antimicrobial resistance, and limb amputation. Regional Indian data on microbiological patterns and antimicrobial resistance remain limited.

METHODS

This retrospective observational study evaluated 40 patients with DFUs presenting to a tertiary care hospital over a 12-month period. Clinical and laboratory parameters, including glycated hemoglobin (HbA1c), C-reactive protein (CRP), total leukocyte count (TLC), and serum albumin, were analyzed. Ulcer severity was graded using the Wagner classification, and wound cultures with antibiotic susceptibility testing were performed.

RESULTS

Most patients were male (70%) and aged 40-60 years. Mean HbA1c was significantly higher in male than in female patients (13.99 ± 1.40 vs 10.45 ± 1.41; p < 0.05). Monomicrobial infections predominated, with Gram-negative organisms accounting for 70.3% of isolates, followed by Gram-positive bacteria (22.2%) and fungi (7.4%). Polymicrobial infections occurred in 12.5% of cases. Gram-negative isolates showed universal sensitivity to colistin, whereas Acinetobacter spp. demonstrated high resistance to other antibiotics. Higher Wagner grades were significantly associated with elevated HbA1c and CRP levels. All amputations occurred in male patients with polymicrobial infections.

CONCLUSION

Gram-negative pathogens predominated in DFUs in this setting, contrasting with the Gram-positive predominance reported in Western literature. Poor glycemic control and elevated inflammatory markers were associated with increasing ulcer severity and amputation risk.