Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes.
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.
Chellan
Gopi
G
Department of Endocrinology, Diabetes and Podiatry, School of Medicine, Amrita Institute of Medical Sciences, Amrita Lane, Kochi-26, Kerala, India. gopic@aims.amrita.edu
Shivaprakash
Shashikala
S
Karimassery Ramaiyar
Sundaram
S
Varma
Ajit Kumar
AK
Varma
Narendra
N
Thekkeparambil Sukumaran
Mangalanandan
M
Rohinivilasam Vasukutty
Jayakumar
J
Bal
Arun
A
Kumar
Harish
H
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*
D000935:Antifungal Agents
Indian J Pathol Microbiol. 2008 Apr-Jun;51(2):204-8
18603682
J Clin Microbiol. 2007 Mar;45(3):1005-10
17251396
J Clin Microbiol. 2007 Sep;45(9):2819-28
17609322
J Clin Microbiol. 2009 Aug;47(8):2392-7
19494078
J Am Acad Dermatol. 1993 May;28(5 Pt 1):S7-S11
8496410
Ann Acad Med Singap. 2008 Oct;37(10):835-40
19037517
Antimicrob Agents Chemother. 2008 Oct;52(10):3637-41
18694949
Diabetes Care. 1999 Jul;22(7):1029-35
10388962
J Clin Microbiol. 1996 Jul;34(7):1846-8
8784609
J Clin Microbiol. 2008 Sep;46(9):2902-5
18632907
Diabetes Res Clin Pract. 2006 Dec;74(3):289-94
16730847
Diabetes Care. 2004 May;27(5):1047-53
15111519
Clin Microbiol Infect. 2009 Jul;15(7):662-9
19614718
Clin Microbiol Rev. 2008 Oct;21(4):606-25
18854483
Int J Low Extrem Wounds. 2007 Mar;6(1):34-6
17344200
J Clin Microbiol. 1997 Dec;35(12):3240-3
9399526
J Clin Microbiol. 1998 Nov;36(11):3396-8
9774605
PLoS One. 2008 Oct 03;3(10):e3326
18833331
Int Wound J. 2008 Jun;5 Suppl 2:10-6
18577133
Diabet Med. 2005 Aug;22(8):1124-5
16026387
FEMS Microbiol Lett. 2009 Oct;299(1):1-8
19552706
J Am Acad Dermatol. 1990 Apr;22(4):578-82
2319017
J Clin Microbiol. 2008 Mar;46(3):842-9
18199791
Diabetes Care. 1997 Aug;20(8):1315-8
9250461
Science. 2002 Jun 21;296(5576):2229-32
12077418
Microbiology (Reading). 2007 Jun;153(Pt 6):1677-1692
17526826
Diabetes Care. 2006 Aug;29(8):1727-32
16873771
BMC Microbiol. 2008 Mar 06;8:43
18325110
Clin Microbiol Infect. 2006 Jan;12(1):75-80
16460550
Clin Microbiol Infect. 2004 Mar;10 Suppl 1:11-23
14748799
Diabetes. 1991 Oct;40(10):1305-13
1936593
Diabet Med. 2001 Jul;18(7):567-72
11553187
Diabetes Care. 2007 Aug;30(8):2171-2
17855279
Diagn Microbiol Infect Dis. 2001 Jan;39(1):25-31
11173188
Clin Infect Dis. 2009 Mar 15;48(6):e57-61
19193113
PLoS One. 2009 Jul 31;4(7):e6462
19649281
Adv Skin Wound Care. 2008 Nov;21(11):531-40; quiz 541-2
18981758
Clin Microbiol Infect. 2007 Apr;13(4):351-3
17359317
Diagn Microbiol Infect Dis. 2004 Nov;50(3):219-21
15541609