Drug Utilisation Pattern for Diabetic Foot

Introduction: Diabetic mellitus is a chronic disorder which is rapidly raising, major public health problem. Having DM are more prone to multifarious complication like diabetic foot ulcer, which is highly susceptible to infection. Prevalence of bacterial flora in foot ulcer of this study population indicate current medical scenario of increased multidrug resistant diabetic foot infection, appropriate selection of antibiotic plays important role in DFU management increasing prevalence of antibiotic resistance is a major factor for morbidity or mortality in DFU. The main objective of this study was to asses microbial sensitive resistance to antibiotic and also to know the drug utilisation of antibiotics in DFU. Method: A prospective observational study was carried out in 123 inpatients, after taking written informed consent from those met the study criteria. The study was done from October 2017 to march 2018 in surgery department. Patient case sheet were reviewed and assessed on daily basis. Culture report form and all other relevant data were collected to assess the utilisation of antibiotic, it’s sensitivity and resistant interaction, drug interactions and ADR were assessed by using Micromedex and other resources available in the department Result: In this study population, about 87(70.3%) patients were male and 36(29.27%) female. Mainly patients of age range 41-50 is 47(38.21%)followed by 51-60 is 33(26.83%)then 61-70 is 23(18.70%).Hospital Conclusion: Diabetic foot infections are real public health problem and early diagnosis along with appropriate treatments are essential. Different bacterial profiles and antibiotic sensitivity were found in different DFU. Clinician should try to stay updated in antibiotic sensitivity and resistant pattern of common pathogen in their area for better therapeutic outcome and to minimize medication errors.


Introduction
Diabetes mellitus (DM) is one of the most prevalent pathology of endocrine that leads to a number of complications. According to the International Diabetes Federation (IDF) 2017, estimation of, epidemic proportion shows 425 million people in the world has diabetes and is gradually increase to 629 million in the year2045(younis2018). The major causes of DM involves impaired insulin secretion or inadequate sensitivity to secreted insulin. 1 DM is provoked mainly by metabolic complications, Such as due to improper storage and mobilization of metabolic fuels, including the catabolism (breakdown) and anabolism (buildup) of carbohydrates, lipids and proteins arise from defective insulin secretion, its action, or both that can gradually lead to immature death . 2 The global prevalence of Diabetic foot ulcer (DFU) was 6.3% and it was more common in people with type 2 diabetes (younis2018). Frequently occurring complication normally affect lower extremities among which DFU is the recognised one. 3 It remains prevalent and faces many challenges to treat and may results to hospital admissions and even amputations.It contributes the economic drain on the health care system which may tends to morbidity and even s The prevalence of causative organisms in DFI may vary from area to area. The organisms that occur on foot infections are mainly Staphylococcus aureus and Streptococcus pyrogens obtained from the patients' own skin and Enterococci from bowel. Among the Gram positive aerobes Staphylococci are more universal. Empirical antibiotic therapy should be optimized for local clinical microbiology,Many of these microorganisms are developing resistance to regularly used antibiotics largely due to their indiscriminate use. 5, 6 The standard guidelines encircle with a combination of diabetes education, daily self foot checks, custom padded insoles, specialized diabetic shoes and routine physician follow-ups for foot inspections. 7 In this present study we used to found out the most commonly found causative organism, prescription pattern of drugs used in diabetic foot along with its bacterial resistance and sensitivity.

Methodology
Materials Medical records of patients with diabetic foot ulcers, who were admitted at the Sri Adichunchanagiri Hospital And Research Center (AHRC) between October 2017 to March 2018, were reviewed. At the first visit a complete medical history was obtained. For analysis of the demographic and clinical characteristics, variables such as age, gender, smoking history, family history, HbA1C, wound duration, diabetes medications used, previous infection history and previous use of antibiotics were investigated , only the first admission period was included in this study. This study protocol was approved by the Institutional Review Board, AH&RC, B G. Nagara.
(AHRC No: AIMS/IEC/1637/2017-18) Culture specimens were collected using sterile cotton swabs. Swabbing was done on inflammmed tissue as bacteria tend to present in greater number in these areas After rinsing the wound area with saline and debriding the wound, swab/ tissue samples were collected and taken to the microbiology laboratory.
The study data was analysed by using suitable descriptive statistics like mean, frequency, percentage etc, through Microsoft excels  Figure 1. Among 123 study population, 87(70.73%) patients were males and 36(29.27%) patients were females as shown in Figure 2.       6 were taking Cefaperazone sodium and tazobactum, 6 were taking Cefaperazone sodium and sulbactum,6 were taking Gentamycin,6 were taking Levofloxacin,4 were taking Glanocef X,4 were taking Piperacillin and tazobactum,3 were taking Feropenem and 2 were taking Tinidizole as shown in figure 3. In the present study the most commonly used antibiotics was found to be ceftriaxone 52(26.26%) followed by metronidazole 27 (13.64%) and then amikacin 19 (9.60%)which shows similar resulted by the study concluded by Elhami E,Nagaraju K.

Conclusion
This study had provided base line data regarding the prescription pattern (utilisation) of antibiotic drugs in diabetic foot patients. Total 65 culture were isolated. Among these, gram positive methicillin resistant staphylococcus 28 (68.29%) and gram negative klebsiella 12 (50%) spatients were prescribed with three drug combination due to their severity.