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Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes

Publication Type : Journal Article

Publisher : Journal of Clinical Microbiology

Source : Journal of Clinical Microbiology, Volume 48, Number 6, p.2097-2102 (2010)

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Keywords : adult, aged, amphotericin B, antibiotic resistance, antifungal agent, Antifungal Agents, article, Aspergillus, Bacteria, Bacteria (microorganisms), bacterial infection, Bacterial Infections, Candida albicans, Candida parapsilosis, Candida tropicalis, comorbidity, controlled study, deep tissue infection, diabetes mellitus, diabetic lower limb wound, diabetic patient, Drug Resistance, Enterococcus faecalis, Escherichia coli, female, fluconazole, flucytosine, Fungal, Fungi, fungus, fungus culture, fungus isolation, glycosylated hemoglobin, hospital patient, human, human tissue, Humans, infection, itraconazole, Klebsiella pneumoniae, leg amputation, Lower Extremity, major clinical study, male, middle aged, mixed infection, Mycoses, mycosis, non insulin dependent diabetes mellitus, pathogenicity, prevalence, priority journal, Pseudomonas aeruginosa, seroprevalence, Staphylococcus aureus, Trichosporon asahii, Type 2, voriconazole, wound, Wound healing, wound infection

Campus : Kochi

School : Center for Nanosciences

Department : Nanosciences and Molecular Medicine

Year : 2010

Abstract : The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5- x 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further. Copyright © 2010, American Society for Microbiology. All Rights Reserved.

Cite this Research Publication : Ga Chellan, Shivaprakash, Sb, Ramaiyar, S. Kc, Varma, A. Ka, Varma, Na, Sukumaran, M. Ta, Vasukutty, J. Ra, Bal, Aa, and Kumar, Ha, “Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes”, Journal of Clinical Microbiology, vol. 48, pp. 2097-2102, 2010.

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