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Abstract
Diabetes is rapidly becoming a major public health problem worldwide. Diabetic foot is one of the serious complications of DM and may be the initial presentation of undiagnosed diabetes. Foot problems are associated with significant morbidity, disability and impairement in the diabetic patient’s quality of life. They cause extensive economic burden on the patient, family and society. Unfortunately, these disorders such as ulceration, infections, gangrene and their sequelae are the leading causes of hospitalization in patients with DM, and may lead in severe cases to amputation of a toe, foot or leg. Infection is a common sequelae of diabetic foot ulceration, and once established becomes progressively severe and more difficult to treat. Foot infections in diabetic patients can be caused by a variety of bacterial species, both singly and in combination, including Gram positive and negative aerobes and anaerobes. This work aimed at studying the bacterial profile in diabetic foot lesions with reference to the role of Interleukin-1. It included the identification of the most commonly encountered aerobic and anaerobic bacteria in diabetic foot lesions, the determination of their antimicrobial susceptibility patterns, and studying the relationship between Interleukin 1 and diabetic foot lesions. This study was carried out on 100 diabetic patients with foot lesions, (48) males and (52) females; who were admitted to the Alexandria Main University Hospital during the period from June 2001 to May 2002.Their ages ranged from 21 to 83 years. Diabetic patients without foot lesions and healthy individuals were included as control groups. An interview questionnaire sheet was filled for every diabetic patient with foot lesion in this study including all the relevant information. Samples from lesions with scanty amount of pus or exudate were collected using sterile disposable cotton wool swabs. Four swabs were taken from every patient, one of which was inserted immediately into a screw-capped tube of cooked meat medium, the second into a tube of thioglycollate broth, the third was immersed into a tube of Amies charcoal transport medium that was used for culture and the last one was spread over a clean glass slide for smear preparation. While those with profuse amount of pus or exudate were aspirated using sterile disposable syringes. Each sample was divided into 3 portions, one of which was inoculated directly into a screw-capped tube of cooked meat medium, the second into a thioglycollate broth tube and the last portion was transferred to the laboratory in the sterile syringe and used for culture and direct smear. The collected pus or exudate samples were subjected to all bacteriological procedures for the isolation and identification of aerobic and anaerobic bacterial agents. Further identification of anaerobic bacteria was done by inoculating a pure inoculum from each type of colony onto API 20 A system. All aerobic and anaerobic isolates were tested for their antimicrobial susceptibility using standardized single disc diffusion method described by Bauer and Kirby. In addition five ml of venous blood were collected from all the diabetic patients with foot lesions and the control groups. The separated sera were collected into clean disposable eppendorf tubes, labelled and kept at – 20?C until they were examined.