Fungal Diabetic Foot Infections

Abstract

Background: Fungal infections play important role in pathogenesis of diabetic foot infections. Objective: to investigate the prevalence of fungi among patient with diabetic foot infections. Methodology: one hundred and twenty diabetic patients hospitalized due to foot infections were enlisted in this study. Deep tissue specimens from depth of the wound and nail samples were collected from the infected sites using the standard protocol. Laboratory identification of samples was done and pathogens were identified to the species level by morpho-physiological methods. Polymerase chain reaction was used to assess the presence of fungi in samples from infected sites. Results: Fungi were found in 51.7% of the patients. Candida albicans were the most predominant isolated organism (40.1%). Amphotericin B had 100% sensitivity against all Candida isolates. The most susceptible Candida species to fluconazole were C. dubliniensis and C. albicans. The most susceptible Candida species to voriconazole were C. dubliniensis. The most susceptible Candida species to itraconazole were C. dubliniensis. Of the study population, 70.0% had bacterial infection. The predominant isolates were Klebsiella spp. (32.7%). Mixed fungal and bacterial infections were seen in 20.3% of patients. Sensitivity of Pan fungal PCR was 97.4%, specificity was 92.4%. Conclusion: Fungal infections were more in patients with poor glycemic control. The role of antifungal agents in management of diabetic foot infections needs to be evaluated further.