To Identify Aerobic Bacteria Found

in Diabetic Foot Ulcer Patients

Yasothai Rajendran1, Imam Budi Putra2

1
University Sumatera Utara, Students of the Faculty of Medicine class of 2012:
yasothairajendran@gmail.com
2
Lecturer Department of Dermatovenereology, Faculty of Medicine of University Sumatera Utara

ABSTRACT

Diabetic foot is one of the complications of diabetes mellitus(DM) which is characterized by

coupled vascular complications with peripheral neuropathy and infection causing diabetic ulcers.
Most amputations in diabetic foot ulcers starts from theulcers in skin. DM ulcer patients obtained
Staphylococcus aureus, Streptococcus, and the rest are Enterobacter bacteria as well as anaerobic
bacteria. The aim of this study is to identify the aerobic bacteria in diabetic foot ulcers in DM
patients at Astri Wound Care Centre. Next aim, is to determine the characteristics of DM patients
at Astri Wound Care Centre such as age, sex, type of work, periode of DM, periode of diabetic
ulcers, grade of diabetic foot and glucose level of DM patients. This is a descriptive observational
study with a cross-sectional design which is done by taking samples from diabetic patients foot
ulcer in Astri Wound Care Centre and then samples was taken to Laboratory of Microbiology,
Fakultas Kedokteran Universitas Sumatera Utara. This study was conducted by using total sampling.
The details were analyzed manually. The type of bacteria found from gram stain examination in the
samples of DM foot ulcer patients are gram negative rod bacteria as many as 16 samples (100,0%)
with Enterobacteriaceaea and Pseudomonas auroginosa. The most bacteria found in DM patientsleg
ulcer was Klebsiella sp. as many as 7 samples (44,0%).

KEYWORDS: Diabetes mellitus patient, diabetic foot ulcer, aerobic bacteria.

1
University Sumatera Utara, Students of
Faculty of Medicine class of 2012
Phone:+6283199059077 /
+60195909527
E-mail: yasothairajendran@gmail.com
Corresponding author:

Yasothai Rajendran
 INTRODUCTION osteomyelitis in diabetic foot patients, mostly
Diabetic foot is one of the complications of elderly patients with decreased pulsation. In
diabetes mellitus which characterized by the addition, it was found 7 patients with positive
presence of vascular complications which are blood cultures and on tissue cultures obtained
coupled with peripheral neuropathy and anaerobes, in deep tissue cultures of
infection causing diabetic ulcers.3 different bacterias were obtained by bacteria
in the superficial tissue.2
The medical records in hospital Prof. dr.
Margono Soekarjo Purwokerto showed cases MATERIALS AND METHODS
of diabetes mellitus patients with diabetic This is a descriptive observational study with
ulcers reached 592 (63 cases of a cross-sectional design. Respondents in this
hospitalization and 529 cases of outpatients) study were patients with diabetes mellitus
in 2010. In 2011 diabetes mellitus patients who have foot ulcers based on the Wages
with diabetic ulcers are 772 cases (562 cases classification, whom for the first time visited
of hospitalization and 205 cases of the Astri Wound Care Centre, from October
outpatients). Meanwhile, diabetic ulcers and to November 2015. Sampling was done by
diabetes mellitus tipe 2 patients in January using total sampling technique and taken in
2013 to October 2013 reached 149 cases (10 all diabetes mellitus patients whom visited
cases of hospitalization and 139 cases of Astri wound care Centre, by considering the
outpatients).1 inclusion and exclusion criterias. Data
collected by interviewing the patients and
Diabetic foot complications are the most sampling was done at the foot ulcers patients
common cause of amputations based on the with diabetes mellitus by taking swab from
non-traumatic events. Complications due to the foot ulcers.The samples were examined
diabetic foot causes the periode of diabetes in Microbiology Labotorium of University of
mellitus to become longer. More than 25% of North Sumatra by inspection, culture
patients with diabetes mellitus were being examination, and chemical reactions
caused by diabetic foot. Most amputations in examination as well as gram examination.
diabetic foot ulcers stems from the skin.4 Data were tabulated to be easily processed
and analysed. The data was analyzed
Gold Stain (1996) reported a study towards 25 descriptively.
diabetic ulcer patients obtained a result that,
76.0% are Staphylococcus aureus,
Streptococcus 10.0%, and the rest consisting
of Enterobacterea and anaerobic bacterias.2

Minneapolist Veterans Administration Hospital

Medical Center conducted a study about
factors influencing the prognosis and the role
of antimicrobials against 51 patients with
 Table 1. Characteristics of Diabetic Foot Ulcer Patients
Characteristics No. of Diabetic Foot Ulcer Patients
n (%)
Age
40-49 4 (25.0)
50-59 3 (19.0)
60-69 6 (37.5)
70-79 2 (12.5)
80-89 1 (6.0)
Gender
Male 6 (37.5)
Female 10 (62.5)
Periode of Diabetes Mellitus
< 1 year 3 (19.0)
1 year-10 years 6 (37.0)
11 years-20 years 7 (44.0)
Periode of Diabetic Foot Ulcer
< 1 month 2 (12.5)
1 month-11 months 10 (62.5)
1 year-5 years 2 (12.5)
6 years-10 years 2 (12.5)
Grade Diabetic Foot Ulcer
III 2 (12.5)
IV 12 (75.0)
V 2 (12.5)
Blood Glucose Level mg/dL
< 200 3 (19.0)
200-400 8 (50.0)
400-600 5 (31.0)

RESULTS and Pseudomonas auroginosa (6.0%). The

In this study, groups of aerobic bacterias were Enterobacteriaceaes that found in diabetic food
indentified in diabetic foot ulcer patients. The ulcer patients were Klebsiella sp. (44.0%),
type of bacteria found from gram stain proteus sp. (19.0%) and E.coli (31.0%). The
examination in the samples of diabetic foot bacteria found mostly in diabetic foot ulcer
ulcer patients are gram negative rod bacteria patients was Klebsiella sp. (44,0%).
(100.0%) only with Enterobacteriaceaea (94.0%)
Tabel 2 Demographics of Sampel of Diabetic Foot Ulcer

Tabel 2.1 Distribution of Chemical Reaction Experiment Results on Gram Negative Rod Bacteria
No. Gram Negative Rod Bacteria n Percentage(%)
1. Enterobacteriaceae
Proteus sp. 3 19.0
Klebsiella sp. 7 44.0
E.coli 5 31.0
2. Pseudomonas aeruginosa 1 6.0
Total 16 100.0

Tabel 2.2 Distribution of Comparison Between Aerobic Bacteria and Periode of Diabetes
Mellitus in Diabetic Patients.
Periode of Gram Negative Rod Bacteria in Aerobic Bacteria TOTAL
Diabetes
Mellitus Enterobacteriaceaae Pseudomonas aeruginosa
N % N % n %
< 10 years 8 50.0 1 6.0 9 56.0
> 10 years 7 44.0 0 0.0 7 44.0
Total 15 94.0 1 6.0 16 100.0

Tabel 2.3 Distribution of Comparison Between Aerobic Bacteria and Periode of Diabetic Foot
Ulcer in Diabetic Patients.
Periode of Gram Negative Rod Bacteria in Aerobic Bacteria TOTAL
Diabetic Foot
Ulcer Enterobacteriaceaae Pseudomonas aeruginosa
N % N % n %
< 1 year 12 75.5 0 0.0 12 75.5
> 1 year 3 18.5 1 6.0 4 24.5
Total 15 94.0 1 6.0 16 100.0

DISCUSSION old (37.5%). This study also shows that females

As the study was conducted towards 16
diabetic patients, whom visited Astri Wound
Care Centre for the first time with diabetic foor
ulcer according to Wages classification whom
were ready to participate in this study. The
most frequently affected age group in this study
were the patients among the age 60 to 69 years
were found the most compared to males with a
ratio (5:3), where females were found 10
patients (62.5%) and males were 6 patients
(37.5%). The patients whom were mostly found
with diabetic foot were housewifes around 9
patients (57.0%). This study also shows that 7
patients (44.0%) with diabetic foot ulcer were
suffering from diabetes mellitus for for 11 to 20
years and 10 patients (62.5%) were suffering
with diabetic foot for 11 months. The patients
were also having diabetic foot ulcer with grade
IV the most with 12 patients (75.0%) as well as 8
patients (50.0%) were having blood glucose level
around 200mg/dL to 400mg/dL. In addition,
swab from the diabetic foot ulcer patients were
giving negative rod bacteria as a result 16
samples (100.0 %) with 15 samples (94.0 %)
giving result Enterobacteriaceae and one sample
(6.0%) as Pseudomonas aeruginosa.

CONFLICT OF INTEREST
The authors declare that they have no conflict
of interest.

ACKNOWLEDGEMENT
Astri Wound Care Centre and Faculty of
Medicine of University of North Sumatra Utara
as well as Microbiology Laboratorium of
University of North Sumatra.

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Terhadap Kejadian Amputasi pada Kaki
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3. Supriyanto, 2001. Hubungan antara

Derajat Kaki Diabetik dengan Neuropati
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4. Tri Sunaryo, S., 2014. Diabetic Exercise,

Diabetic Foot Ulcers. Pengaruh Senam
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