Bijoy Kumar Panda, Shubha S Chandorkar, Najmussehar Shafaque F, Niraj Bafna


Worldwide, diabetic foot (DF) is one of the most serious complications resulting in long term hospitalization among the diabetic patients. The aim of this prospective observational study of patients with established diagnosis of diabetic foot irrespective of severity type was to explore the current antimicrobial prescribing pattern in diabetic foot. The severity of diabetic foot patients was classified as per IDSA guidelines and enrolled. Microbial culture and sensitivity/resistance reports, antimicrobial treatment received for the study infection was recorded throughout the hospital stay. Out of 72 patients, 67% were males and maximum numbers of patients were in the age group of 51-60 years. MSSA was the predominant gram positive pathogen responsible for diabetic foot and gram negative organisms were very few isolated from pus samples. Parenteral ceftriaxone was empirically preferred in mild DF and amoxicillin-clavulanic acid in moderate to severe cases infected with gram positive pathogens.  Piperacillin-tazobactum was preferred in moderate to severe DF cases infected with gram negative microorganisms. Metronidazole is preferred choice for anaerobic infection in combination with other antimicrobials though the isolation was not evident.


Diabetic foot, antimicrobials, antibiotics, IDSA guidelines

Full Text:

Full text in pdf


Abbas, Z. G., Viswanathan, V. (2007:. The diabetic foot in Africa and India, Int. Diab. Monit., 19, p.8-12.

Abdulrazak, A., Bitar, Z. I., Al- Shamali, A. A., Mobasher, L. A., (2005): Bacteriological study of diabetic foot. J. Diabet. Compli., 19(3), p.138-41.

Ahmed, I., Goldstein, B., (2006):.Diabetes mellitus, Clin Dermatol. 24(4), p.237- 46.

Aherrao, N., Shahi, S. K., Dwivedi, A., Kumar, A., Gupta, S., Singh, S. K., (2012): Detection of anaerobic infection in diabetic foot ulcer using PCR technique and the status of metronidazole therapy on treatment outcome, Wounds; 24(10), p.283-8.

Alcolado, J.C, Pacy, P.J, Beevers, M., Dodson, P.M, (1992): Risk factors for peripheral vascular disease in hypertensive subjects with type 2 diabetes mellitus, Diabet Med., 9, p.904-907.

Ali, N., Rehman, S., Imran, M., Hussain, I., Shebaz, H., Hayat, A., Khan, S. (2009): The In-Practice Prescribing Pattern For Antibiotics In the Management Of Diabetic Foot: Needs Much More To Be Done, J. Young Pharm.1(4), p.375-378.

Arlington Medical Resources (AMR), (2003): The US hospital anti-infective market guide (USA and Europe editions).

Bader, M. S., (2008): Diabetic Foot Infection, Am Farm, Physian. 78(1), p.71-79

Bakker, K., Riley, P. (2005): The year of the diabetic foot. Diabetes Voice. 50, p.11-14.

Bansal, E., Garg, A., Bhatia, S., Attri, A. K., Chander, J. (2008): Spectrum of microbial flora in diabetic foot ulcers, Ind. J. Pathol. Microbiol .51, p.123–126

Beckert, S., Witte, M., Wicke, C., Konigsrainer, A., Coerper, S., (2006):. A new wound-based severity scores for diabetic foot ulcers: A prospective analysis of 1,000 patients. Diabetes Care, 29, p.988–992.

Calvet, H. M., Yoshikawa, T. T., (2001): Infections in diabetes Infect Dis Clin North Am., 15(2), p.407-21.

Dang, C. N., Prasad, Y. D., Boulton, A. J., Jude, E. B., (2003): Methicillin resistant Staphylococcus aureus in the diabetic foot clinic: A worsening problem, Diabet. Med. 20, p.159–161.

Dhanasekaran, G., Sastry, G., Viswanathan, M., (2003): Microbial pattern of soft tissue infections in diabetic patients in South India. Asian J. Diabet., 5, p.8-10.

Fincke, B. G., Miller, D. R., Turpin, R., (2010): A classification of diabetic foot infections using ICD-9-CM codes: application to a large computerized medical database. BMC Health Serv Res. 10, p.192.

Fung, H. B., Chang, J. Y., Kuczynski, S., (2003): A practical guide to the treatment of complicated skin and soft tissue infections, Drugs., 63(14), p.1459-1480.

Gadepalli, R., Dhawan, B., Sreeivas, V., Kapil, A., Ammini, A. C., Chuadhry, R., (2006): A Clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital, Diab. Care, 29, p.1727–1732.

Girish, M., Bengalorkar, T., Kumar, N., (2011): Culture and sensitivity pattern of micro-organism isolated from diabetic foot in a tertiary care hospital, Int. J. Cur. Biomed. Pharm. Res., 1(2), p.34.

Girish, M. B., Kumar, T. N., Srinivas, R., (2010): Pattern of antimicrobials used to treat infected diabetic foot in a tertiary care hospital in kolar. Int. J. Pharm.Biomed. Res., 1 (2), p.48-52.

Goldstein, E. J., Citron, D. M., Nesbit, C. A. (1996): Diabetic foot: bacteriology and activity of 10 oral antimicrobial agents against bacteria isolated from consecutive cases, Diab. Care, 19, p.638–641

Graham L., Nathwani D., et al., (2009): Use of antibiotics in people with diabetic foot disease: A consensus statement, The Diab. Foot J. 12 (2). p.1-10.

Gu, J., Li, H., Li, M., Vuong, C., Otto, M., Wen, Y., Gao, Q., (2005): Bacterial insertion sequence IS256 as a potential molecular marker to discriminate invasive strains from commensal strains of staphylococcus epidermidis, J. Hosp. Infect., 61, p.342-8.

International diabetes federation. International Diabetes Federation Atlas. (2011) 5th ed. Brussels, Belgium: International Diabetes Federation.

International diabetes federation. - statement diabetic foot. Accessed November 10. (2012).

International Working Group on the Diabetic Foot. International consensus on the diabetic foot, 1999. Available at: Accessed 29 May (2006).

Jeffcoate, W. J., Chipchase, S. Y., Ince, P., Game, F. L. (2006): Assessing the outcome of the management of diabetic foot ulcers using ulcer related and person-related measures. Diabet. Care., 29, p.1784–1787.

Joseph, W. S., Lipsky, B. A. (2010): Medical therapy of diabetic foot. J. Vasc. Surg., 52(3). suppl:67S-71S.

Jones, E. W., Edwards, R., Finch, R, Jeffcoate, W. J., (1985): A microbiological study of diabetic foot lesions. Diabet. Med . 2, p.213–215.

Lavery, L. A., Armstrong, D. G., Vela, S. A., Quebedeaux, T. L, Fleischli J.G., (1998): Practical Criteria for Screening Patients at High Risk for Diabetic Foot Ulceration, Arch Intern Med. 158, p.157-162.

Lipsky, B. A., Tabak, Y. P., Johannes, R. S., Hyde, L., Weigelt, J. A., (2010): Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost, Diabetologia. 53(5), p.914-23.

Lipsky, B. A., et al. (2012): A prospective, multicentre, observational study of complicated skin and soft tissue infections in hospitalized patients: clinical characteristics, medical treatment, and outcomes, BMC Infectious Disease. 12 (227), p.2-11.

Lipsky, B. A, Anthony, R. et al (2012): Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic foot. IDSA guidelines. 54(12), p.132-173

Lipsky, B. A., Kamal, I., Norden, C., (2004): Treating foot infections in diabetic patients: A randomized, multicenter, open-label trial of Linezolid versus ampicillin-sulbactam/amoxicillin clavulanate. Clinical Infectious Diseases. 38, p.17-24.

May, A. K., et al. (2009): Surgical Infection Society.Treatment of complicated skin and soft tissue infections.Surg Infect (larchmt).10(5), p. 467-499

Mohammad, Z., Abida, M., Jamal, A. (2010): The clinico-bacteriology and the risk factors for diabetic foot infections with multidrug resistant micro-organisms in north India, Bio. Med., 2(4), p.22–34.

Nelson, E. A., Backhouse, M. R., et al (2013). Concordance in diabetic foot ulcer infection, BMJ Open; 3, p.002370.

Prompers, L., et al (2008): Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The Eurodiale Study. Diabetologia. 51, p.747–755.

Pugazhendhi, S., Durairaj, A. P., (2014): Bacteriological Profile of Diabetic foot. Int. J. Innov.e Res. Sci. Eng. Tech. 3(7), p.14688-14692.

Ramakant, P., et al (2011): Changing microbiological profile of pathogenic bacteria in diabetic foot: time for a rethink on which empirical therapy to choose? Diabetologia, 54(1), p.58-64.

Raya-Cruz, M. (2014): Skin and soft-tissue infections in hospitalized patients: epidemiology, microbiology, clinical and prognostic factors. Enferm. Infec. Microbiol. Clin., 32(3), p.152-159.

Shankar, E. M., Mohan, V., Premlatha, G., Srinivasan, R.S., Usha, A. R., (2006): Bacterial etiology of diabetic foot in South India, Eur. J. Intern. Med. 16, p.567–570.

Sotto, A., Richard, J. L., Combescure, C., Jourdan, N., (2010): Beneficial effects of implementing guidelines on microbiology and costs of infected diabetic foot ulcers. Diabetologia; 53, p.2249–55.

Stevens, D. L., et al., (2005):.Infectious Diseases Society of America. Practice guidelines For the Diagnosis and management of skin and soft tissue infections. Clin. Infect. Dis., 41 (10), p.1373-1406.

Sugandhi, P., Prasanth, D. A., (2014): Microbiological profile of bacterial pathogens from diabetic foot in tertiary care hospitals, Salem. Diabetes Metab Syndr. 8(3), p.129-32.

Tiwari, S., Pratyush, D. D., Dwivedi, A., Gupta, S. K., Rai, M., Singh, S. K., (2012): Microbiological and clinical characteristics of diabetic foot in northern India, J. Infect. Dev.Ctries, 6(4), p.329-32.

Vijay, V., Snehalatha, C., Ramachandran, A., (1997): Socio-cultural practices that may affect the development of the diabetic foot, IDF Bull., 42, p.10-12.

Woolf, S. H, Grol, R., Hutchinson, A., Eccles, M., Grimshaw, J., (1999): Potential benefits, limitations, and harms of clinical guidelines, BMJ. 31(8), p.527-30.


  • There are currently no refbacks.

Copyright © 2015 BIOPHARM JOURNAL  - ISSN 2454-1397 & Powered by Sona Nfinity