Μικροβιακό προφίλ διαβητικών ελκών και παράγοντες που σχετίζονται με την επούλωση (Master thesis)

Πιζιρτζίδου, Ειρήνη


The purpose of this study is to record the frequency of appearance of microbes that colonize the diabetic foot ulcers and the sensitivity and resistance of them to the antibiotics. Furthermore, the objective is to assess the healing of diabetic foot ulcers and to investigate factors and parameters associated with it. Methodology: The study was conducted at the diabetic center of Papageorgiou general Hospital, in diabetic foot clinic. The recruitment of the patients, which participated in the study, was based on the following criteria: the existence of diabetes, the existence of diabetic foot ulcer in infection and degree classification in accordance with the scale Meggit-Wagner ≥ 2. The evaluation of wound healing was based on qualitative evaluation and the absence points of inflammation, ulceration and infection within the retest (followup) of patients in the clinic. The information about the microbiology of foot ulcers and the sensitivities and resistances to antibiotics were taken retrospectively from the archive of microbiology laboratory through the first cultures and the antibiotic’s susceptibility and resistance graphs of patients on their first visit to the diabetic foot clinic. Cultures were taken with a cotton swab with conservative transport material. All the other information concerning the diabetic foot ulcers and the diabetes were drawn from the patient file of diabetic foot clinic. Results: According to the analysis of the data the most common microbe is staphylococcus aureus by 30%, followed by staphylococcus epidermis 13% and Enterococcus faecalis 12% then follow Enterobacter cloacae 9%, Escherichia coli 8%, MRSA 7%, Acineto baumanii 7% , Pseudomonada aeruginosa, Proteus mirabilis, Serratia marcescens 6%. The most common bacteria were gram positive (68%) while gram negative rate was 50%. As to the growth conditions of microbes the dominant bacteria were aerobic 89%. The majority of infections were monomicrobial (60%) while the majority of the ulcers had duration from 1 to 3 years. The most common lesions are neuroischaemic 50%, 41% neuropathic and 8% ischaemic. The ulcers healed accounted for 53% and 47% showed no healing. The staphylococcus aureus showed 73.3% resistance to penicillin, and 100% sensitivity to linezolid, rifampicin 80% and 76.7% to Oxacillin. The 47% of the ulcers were grade 2 in accordance with the scale Meggit-Wagner. The duration of the ulcers was significantly associated (p = 0,01) with wound healing, as ulcers with duration 1 to 3 years showed healing. The type of ulcer and BMI did not appear to be related to the healing of ulcers. A 4 statistically significant relationship was observed (p = 0,03) between healing and absence of arthropathy Charcot. In addition, there was no statistically significant relationship between the type of infection, the location of ulceration, sex, osteomyelitis, dyslipidemia, grade classification of ulcer in accordance with the scale Meggit-Wagner, growth conditions of microbes, infection by MRSA, the separation of microbes by gram staining and the healing of the ulcers. In additional statistical correlations, a statistically significant trend correlation (p = 0,07) was observed between osteomyelitis and type of infection as the majority of monomicrobial infections characterized by absence of osteomyelitis. Furthermore, a statistically significant trend was observed between the classification by Wagner where ulcers in Wagner grade 2 were 1-3 year duration and ulcers grade 3 lasted 3.5-5 years, and between Charcot arthropathy where the majority of monomicrobial infections characterized by absence of complication. The growth conditions of microbes and classification gram were significantly related to the type of infection with 60% of monomicrobial infections had been transfected by aerobic and 41% of them from gram positive microbes. Conclusions: In the present study the microbial profile of diabetic ulcers observed predominance of gram positive microbes dominated by staphylococcus aureus. Knowledge of sensitivity and resistance of bacteria to antibiotics contribute to the definition of empirical antibiotic treatment granted in time before the completion of the identification of microbes from taking culture. Also the wound healing, which is the main objective of the care of the diabetic foot, is related to the duration of the ulcer and Charcot joint disease but does not appear to be related to the type of infection, the kind of ulcer on the degree by Wagner and with BMI. Key words: diabetic foot infections, microbiology of diabetic foot ulcers, antibiotic susceptibility and resistance.
Institution and School/Department of submitter: Σχολή Επαγγελμάτων Υγείας και Πρόνοιας/ Τμήμα Νοσηλευτικής
Subject classification: Diabetes
Foot--Ulcers--Treatment
Διαβήτης
Πόδι--Έλκη--Θεραπεία
Bacteria
Βακτήρια
Keywords: Μικροβιακό προφίλ;επούλωση;διαβητικά έλκη;Microbial profile;healing;diabetic ulcers
Description: Μεταπτυχιακή εργασία--Σχολή Επαγγελμάτων Υγείας και Πρόνοιας--Τμήμα Νοσηλευτικής,2015--7152
URI: http://195.251.240.227/jspui/handle/123456789/12986
Table of contents: ΠΕΡΙΕΧΟΜΕΝΑ Κατάλογος πινάκων................................................................................................... iii Κατάλογος διαγραμμάτων......................................................................................... iv Κατάλογος γραφημάτων............................................................................................ v Κατάλογος εικόνων ................................................................................................... vi Συντομογραφίες και σύμβολα .................................................................................. vii ΠΕΡΙΛΗΨΗ............................................................................................................... 1 ΑBSTRACT .............................................................................................................. 3 ΠΡΟΛΟΓΟΣ.............................................................................................................. 5 ΕΙΣΑΓΩΓΗ................................................................................................................ 7 ΓΕΝΙΚΟ ΜΕΡΟΣ...................................................................................................... 9 ΚΕΦΑΛΑΙΟ1.Ο ΣΑΚΧΑΡΩΔΗΣ ΔΙΑΒΗΤΗΣ ....................................................... ..……10 1.1 Ορισμός-Επιδημιολογία σακχαρώδη διαβήτη..................................................... 10 1.2 Μορφές και παράγοντες κινδύνου εμφάνισης σακχαρώδη διαβήτη………..12 1.3 Κλινική εικόνα -Διάγνωση σακχαρώδη διαβήτη ................................................ 16 1.4 Επιπλοκές σακχαρώδη διαβήτη........................................................................... 19 1.5Αντιμετώπιση -Θεραπευτικοί στόχοι σακχαρώδη διαβήτη............................ ….24 ΚΕΦΑΛΑΙΟ 2. ΤΟ ΔΙΑΒΗΤΙΚΟ ΠΟΔΙ................................................................. ……..28 2.1 Ορισμός-Επιδημιολογία διαβητικού ποδιού................................................. 28 2.2 Αιτιολογία και παθογένεια διαβητικών ελκών............................................. 29 ii 2.3 Είδη διαβητικών ελκών ....................................................................................... 33 2.4 Ταξινόμηση μέγεθος και έκταση του έλκους...................................................... 35 2.5 Διάγνωση διαβητικών ελκών............................................................................... 38 2.6 Η επούλωση του διαβητικού έλκους................................................................... 46 2.7 Η αντιμετώπιση των διαβητικών ελκών.............................................................. 51 2.8 Αξιολόγηση κύκλου βάδισης .............................................................................. 60 2.9 Εκπαίδευση ασθενών στο διαβητικό πόδι........................................................... 62 ΚΕΦΑΛΑΙΟ 3. ΛΟΙΜΩΞΕΙΣ ΣΤΟ ΔΙΑΒΗΤΙΚΟ ΠΟΔΙ ........................................ ……..64 3.1 Διαβητικό πόδι σε λοίμωξη: διάγνωση και κλινική εικόνα............................ …64 3.2 Μικροβιολογία διαβητικού έλκους σε λοίμωξη.................................................. 67 3.3 Οστεομυελίτιδα ................................................................................................... 70 3.4 Αρθροπάθεια Charcot.......................................................................................... 75 3.5 Αντιμετώπιση διαβητικού ποδιού σε λοίμωξη.................................................... 78 3.6 Ακρωτηριασμοί ................................................................................................... 81 ΕΙΔΙΚΟ ΜΕΡΟΣ ...................................................................................................... 83 ΚΕΦΑΛΑΙΟ 1. ΣΚΟΠΟΣ......................................................................................... 84 ΚΕΦΑΛΑΙΟ 2. ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ ............................................................... 85 ΚΕΦΑΛΑΙΟ 3. ΑΠΟΤΕΛΕΣΜΑΤΑ........................................................................ 87 ΚΕΦΑΛΑΙΟ 4. ΣΥΖΗΤΗΣΗ.................................................................................... 116 ΚΕΦΑΛΑΙΟ 5. ΣΥΜΠΕΡΑΣΜΑΤΑ - ΠΡΟΤΑΣΕΙΣ.............................................. 120 ΒΙΒΛΙΟΓΡΑΦΙΑ....................................................................................................... 122
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