title: Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes.
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.
authors.affiliation: Department of Endocrinology, Diabetes and Podiatry, School of Medicine, Amrita Institute of Medical Sciences, Amrita Lane, Kochi-26, Kerala, India. gopic@aims.amrita.edu
authors.forename: Gopi
authors.initials: G
authors.lastname: Chellan
authors.forename: Shashikala
authors.initials: S
authors.lastname: Shivaprakash
authors.forename: Sundaram
authors.initials: S
authors.lastname: Karimassery Ramaiyar
authors.forename: Ajit Kumar
authors.initials: AK
authors.lastname: Varma
authors.forename: Narendra
authors.initials: N
authors.lastname: Varma
authors.forename: Mangalanandan
authors.initials: M
authors.lastname: Thekkeparambil Sukumaran
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Rohinivilasam Vasukutty
authors.forename: Arun
authors.initials: A
authors.lastname: Bal
authors.forename: Harish
authors.initials: H
authors.lastname: Kumar
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D025141:Drug Resistance, Fungal; D005260:Female; D005658:Fungi / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D035002:Lower Extremity / Q000382:microbiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology*; D015995:Prevalence; D014946:Wound Infection / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents
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