Abstract:

Background: Foot problems are common in people with diabetes due to their increased risk of peripheral neuropathy, peripheral arterial disease, abnormal pressure on the foot, and impaired resistance to infection. These factors usually combine and result in ulceration which in most cases in super infected with bacterial and fungal pathogens leading into gangrene and subsequent lower limb amputation. As the incidence of diabetes mellitus is increasing worldwide, these problems are now on the rise in developing countries and have a high mortality rate.

The aim of this study: Is to determine outcome and predictors of outcome of diabetic foot at Bugando Medical Centre (BMC) and Sekou Toure regional referral Hospital.

Methods: This was a cross sectional analytical study conducted at Bugando Medical Centre (BMC) and Sekou Toure regional referral Hospital involving 176 diabetic patients with diabetic foot who met inclusion criteria. Socio-demographic and clinical information was collected using structured pretested questionnaire. Tissue biopsy was taken from the lesion and was analyzed using standard microbiological procedures for bacterial and fungal species. Data analysis was done using STATA software version 13.0 according to study objectives.

Results: The median age for the study population was 60.5 [51 – 68] years and majority were males 113 (64.20%). The median duration of diabetes since diagnosis was 120 [42 – 180] months. 95 (54.0%) had positive culture with majority of them growing E. coli 27 (25.7%), and Pseudomonas spp 26 (24.8%). Patients who received surgical treatment were 58(32.9%); out of which major amputation was done in 16 (27.5%). On multivariate analysis; only X-ray features of osteomyelitis and Wagner classification were found to be independent predictors of amputation, [OR (95%CI) = 28.01 (3.05-257.46), p value <0.003 and 78.42 (5.30-159.34), p value 0.002 and respectively]. The overall 30 days mortality was 3.4%. Two out of 6 patients who died has Pseudomonas aeruginosa attributable infections.

Conclusion and Recommendations: Approximately one third of patients with diabetic foot attending Bugando Medical Centre (BMC) and Sekou Toure Regional Hospital received surgical treatment; of which 27.5% had major amputation predicted X-ray features of osteomyelitis and Wagner classification. Tissue culture should be taken from all foot lesions regardless of clinical diagnosis to delineate the attributable etiological agents and subsequently guide specific antibacterial or antifungal therapy to avoid misdiagnosis, complications and deaths. A study to assess the role of anaerobes would be of interest in the future to ascertain their roles in diabetic foot patients as well as the diabetic control (Hb1 AC) studies will also be important to ascertain its predictive value in outcome of diabetic foot.