Study of Risk factors and bacteria that cause infections in chronic renal failure on hemodialysis patients with diabetic foot ulcers

Studies indicate a prevalence of 39.2% diabetes mellitus (DM) as the most common underlying cause in patients with dialysis. Statistics showed that the rates of morbidity and mortality were higher in hemodialysis patients with diabetes compared with hemodialysis patients without diabetes. The aim of this study was to evaluate the risk factors responsible for infections in patient’s chronic renal failure on hemodialysis patients having diabetic foot ulcers.
In this cross-sectional study, data were collected from 30 randomly selected hemodialysis patients who were referred to Imam Reza hospital, Tabriz from April 2016 to April 2017. The patient's records were taken according to inclusion and exclusion criteria and data were collected in designed questionnaires for further analysis.
63.3% of patients were males and 36.7% were females. The average age of study population was 51.23±12.74. Duration of dialysis was 5.15±3.58 years. The average HBA1C was 9.08±1.48. Bacterial cause of feet ulcer was isolated only in 56.7% of cases. Isolated bacteria were anaerobic (47.05%), gram-positive (35.29%) and gram negative (17.64%). Amputation was performed in 26.7% of cases. Mortality was reported in 13.3% of patients. Low personal hygiene, presence of vasculopathy, mortality and amputation was higher in anaerobic infections. Most infections were seen in patients with inadequate dialysis. Low dialysis adequacy, amputation, vasculopathy, increased duration of dialysis, poor hygiene was seen in patients with higher HbA1C.
These results indicate the importance of diabetic foot ulcers caused by anaerobic infections, because of the outcome of amputation and higher mortality rates in these patients, the prognosis is worse than other cases. Also, due to the direct relationship between personal hygiene and the development of anaerobic infections, it is possible to prevent these infections significantly by following these considerations. Most infections were found to be inappropriate in dialysis adequately. Therefore, accurate monitoring of patient's diabetes in the long run and the importance of this can control the complications of diabetes, including vasculopathy, followed by the need for amputation for fighting against diabetic foot ulcers.