Open AccessSpectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes
Author(s) -
Gopi Chellan,
Shashikala Shivaprakash,
Sundaram Karimassery Ramaiyar,
Ajit Varma,
Narendra Varma,
M. Sukumaran,
Jayakumar R. Vasukutty,
Antonin Bal,
Harish Kumar
Publication year - 2010
Publication title -
journal of clinical microbiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.349
H-Index - 255
eISSN - 1070-633X
pISSN - 0095-1137
DOI - 10.1128/jcm.02035-09
Subject(s) - microbiology and biotechnology , biology , candida tropicalis , candida parapsilosis , candida albicans , population , staphylococcus aureus , voriconazole , fluconazole , amphotericin b , bacteria , medicine , antifungal , genetics , environmental health
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- × 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%), andAspergillus 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 wereEnterococcus faecalis (14.1%),Staphylococcus aureus (12.2%), andPseudomonas 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.