Study on microbiological characteristics of foot ulcers in diabetic patients at the Department of Endocrinology - Diabetes, Bach Mai Hospital in 2021

HANOI NATIONAL UNIVERSITY

UNIVERSITY OF MEDICINE AND PHARMACY

VU LUONG BANG ANH

RESEARCH ON MICROBIOLOGICAL CHARACTERISTICS OF FOOT ULCERS IN DIABETIC PATIENTS AT THE DEPARTMENT OF ENDOCRINE - DIABETES, BACH MAI HOSPITAL IN 2021

UNIVERSITY THESIS: MAJOR: GENERAL PRACTITIONER

HANOI NATIONAL UNIVERSITY

UNIVERSITY OF MEDICINE AND PHARMACY

Performer: VU LUONG BANG ANH

RESEARCH ON MICROBIOLOGICAL CHARACTERISTICS OF FOOT ULCERS IN DIABETIC PATIENTS AT THE DEPARTMENT OF ENDOCRINE - DIABETES, BACH MAI HOSPITAL IN 2021

UNIVERSITY THESIS: MAJOR: GENERAL PRACTITIONER

Course: QH.2016.Y

Instructor: 1. Master, Doctor of Medicine Nguyen Dinh Duc

2. MSc. Dr. Huynh Thi Nhung

ACKNOWLEDGEMENTS

During the process of studying and doing my graduation thesis, I received attention and help from teachers, schools, agencies, hospitals, family and friends.

First of all, I would like to express my deepest gratitude to MSc.BSNT. Nguyen Dinh Duc and MSc.BS. Huynh Thi Nhung for always caring, helping and guiding me so that I can complete this graduation thesis.

I would like to sincerely thank the staff of Bach Mai Hospital for their support and creating favorable conditions for me to carry out this topic.

In addition, I would like to express my deep gratitude to the teachers of the University of Medicine and Pharmacy - Vietnam National University, Hanoi, especially the teachers of the Department of Internal Medicine. The guidance, care, teaching, and dedicated and thoughtful instruction of the teachers during the past 6 years of study have helped me gain more knowledge, courage and enthusiasm to be able to perform well in practical work in the future.

Finally, I would like to express my gratitude to my family and friends who have always been there to encourage, help and give me the best support.

The thesis still has shortcomings, I look forward to receiving guidance and comments from teachers to make the topic more complete.

Thanks a lot!

Hanoi, June 6, 2022

Vu Luong Bang Anh

LIST OF ABBREVIATIONS

ADA

American Diabetes Association
BCTKNV	Peripheral neuropathy
BMI	Body mass index
CFU/g	Colonies/gram
CRP	C-reactive protein
DMNV	Peripheral artery
Mobile	Diabetes
IDF	International Diabetes Federation
IDSA	Infectious Diseases Society of America
IWGDF	International Diabetic Foot Working Group
LBC	Foot ulcers
NFK-B	Nuclear factor kappa B
NO	Nitric oxide
NTBC	Foot infection
PAI-1	Plasminogen activator inhibitor - 1
PKC	Vascular protein kinase C
WBC	White blood cells

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LIST OF TABLES

Table 1.1: Summary of diagnostic criteria for blood glucose disorders 4

Table 1.2: Comparison of characteristics of vascular ulcers and nerve ulcers 13

Table 1.3: Empiric antibiotic regimen for treating NTBC due to diabetes according to IWGDF 2019 21

Table 2.1: Classification of NTBC levels due to diabetes according to IDSA 2012 29

Table 2.2: Patient variables 30

Table 2.3: Bacterial variables 32

Table 3.1: Characteristics of age, gender, time of diabetes detection and BMI 36

Table 3.2: Severity of LBC 37 lesions

Table 3.3: Rate of infection level of LBC 37 lesions

Table 3.4: Characteristics of ulcer duration & treatment status before hospitalization 38

Table 3.5: Characteristics of test indicators 39

Table 3.6: General culture characteristics of all patients 40

Table 3.7: General culture characteristics of patients with positive cultures 40

Table 3.8: Percentage of patients infected with multidrug-resistant bacteria 43

Table 3.9: Resistance rate of gram-positive bacteria 44

Table 3.10: Drug resistance rates of common gram-negative bacteria 45

Table 3.11: Antibiotic resistance of rare gram-negative bacteria 46

LIST OF IMAGES

Figure 1.1: Loss of foot shock absorption function due to peripheral neuropathy. 9 Figure 1.2: Pathogenesis of diabetic foot ulcers 12

Figure 1.3: Vascular ulcers (left), nerve ulcers (middle), infected ulcers (right).. 14 Figure 1.4: Bacteriological characteristics of NTBC due to diabetes 17

Figure 2.1: Research diagram 34

LIST OF CHARTS

Figure 3.1: Ratio of gram-positive cocci and gram-negative bacilli 41

Figure 3.2: Proportion of bacterial species 42

INDEX

ACKNOWLEDGEMENTS

LIST OF ABBREVIATIONS LIST OF TABLES LIST OF FIGURES LIST OF CHARTS

PROBLEM STATEMENT 1

Chapter 1. OVERVIEW 3

1.1. Overview of diabetes 3

1.1.1. Definition: 3

1.1.2. Epidemiology 3

1.1.3. Definitive diagnosis 3

1.1.4. Complications 5

1.1.5. Treatment 6

1.2. Diabetic foot ulcers 7

1.2.1. Definition of foot ulcer 7

1.2.2. Situation of diabetic foot ulcers 7

1.2.3. Pathogenesis 7

1.2.4. Risk factors for LBC 12

1.2.5. Types of diabetic foot ulcers 13

1.2.6. Treatment of diabetic foot ulcers 14

1.3. Diabetic foot infections 16

1.3.1. Mechanisms & bacteria causing foot infections 16

1.3.2. Clinical symptoms 19

1.3.3. Paraclinical 19

1.3.4. Antibiotic treatment 20

1.4. Some studies related to the microbiological characteristics of foot ulcers caused by

diabetes 23

Chapter 2. RESEARCH OBJECTS AND METHODS 26

2.1. Research subjects, locations and time 26

2.1.1. Research subjects 26

2.1.2. Research location and time 26

2.2. Research methods and data collection 26

2.2.1. Research design 26

2.2.2. Sample size and research sampling method 27

2.2.3. Data collection tools 27

2.2.4. Some standards and scales used in research 27

2.2.5. Research variables 30

2.2.6. Information collection techniques 32

2.3. Data processing 33

2.4. Research diagram 34

2.5. Research ethics 35

Chapter 3. RESEARCH RESULTS 36

3.1. General characteristics of research subjects 36

3.1.1. Characteristics of age, gender, time of diabetes detection and BMI 36

3.1.2. Severity of foot ulcer lesions 37

3.1.3. Level of infection of foot ulcer lesions 37

3.1.4. Ulcer duration & treatment status before admission 38

3.1.5. Characteristics of test indicators 39

3.2. Bacterial culture characteristics of LBC lesions in diabetic patients 40

3.2.1. General culture characteristics 40

3.2.2. Proportion of culturable bacterial species 41

3.3. Antibiotic resistance 43

Study on microbiological characteristics of foot ulcers in diabetic patients at the Department of Endocrinology - Diabetes, Bach Mai Hospital in 2021 - 1

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