Bacteriology of diabetic foot Infection
Corresponding Author(s) : Dr.Premchandran
drshanthig@yahoo.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 3 No. 1 (2015): 2015 Volume 3- Issue -1
Abstract
Objective
To determine the microbiological profile and antibiotic susceptibility pattern of organisms isolated from diabetic foot ulcer in RMMCH Chidambaram
Methods
This is a retrospective study with a review of the bacteriology results of specimens taken from 100 consecutive patients with diabetic foot infection at RMMCH in Chidambaram during the period of 2010 to 2011. The specimens were cultured using optimal aerobic and anaerobic microbiologic technics. Antimicrobial susceptibility testing to different agents was carried out using the diffusion method.
Result
Staphylococcus aureus was the commonest isolate being recovered from 20% cases , including methicillin resistant staphylococcus aureus in 9 of 27(30) patients wounds. The organism isolated were pseudomonas aeruginosa(16%),proteousmirabilis (18%),klebsiella pneumonia(0.7%), Escherichia coli(13%), and klebsiellaoxytoca(0.6%).The antimicrobial suscepteblity testing , showed thatvancomycin was the most effective against gram positive and amikoscin and ceftazidime was the most effective against gram-negative organism.
Conclusion
Staphylococcus aureus, pseudomonas aeruginosa, proteous mirabilis, klebsieella pneumonia, Escherichia coli and klebsiellaoxytoca were the most common causes of diabetic foot infection. These wounds require use of combined antimicrobial therapy for initial patient.
Keywords
Diabetes mellitus
diabetic foot ulcer
microbiological profile
1.
Dr.Premchandran. Bacteriology of diabetic foot Infection. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Aug. 3 [cited 2025 Nov. 14];3(1):56-60. Available from: https://ijamscr.com/ijamscr/article/view/139
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References
-
[1] Aetiopathogenesis.Boulton AJM,Conner H,Cavanagh PR (eds).2000;The Foot in Diabetes.3rd edition. John Willy and sons Ltd Chichester, West Sussex: pp 19-31.
[2] Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, et al. 2004; Bacteriology of diabetic foot lesions. Indian J Med Res 22:175-8. Boultrom AJM. The pathway to ulceration:
[3] Akova M, Ozcebe O, Gullu I, Unal S, Gur D, Akalin S et al.1996;Efficacy of sulbactam-ampicillin for the treatment of severe diabetic foot infections. J Chemother 8: 284-289.Biomedine, 2000; 20(3): 176-179.
[4] Bybee JD, Rogers DE. 1964; The phagocytic activity of polymorphnuclear leucocytes obtained from patients with diabetes mellitus. J Lab Clin Med 64: 1-13.
[5] Candel G, Alramadan M, Matesanz M, Diaz A, Gonzalez-Romo F,Candel I, Calle A, Picazo JJ (2003). Infections in diabetic foot ulcers.Eur. J. Int. Med., 14: 341– 343.
[6] Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. 1994; Assessment and management of foot disease in patients with diabetes. N Engl J Med 331: 854-860.
[7] Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. (Eds). 1989. Mackie andMc Cartney Practical Medical Microbiology,14th Edn, Singapore: Churchill Livingstone.
[8] Davies, M. R., D. J. McMillan, R. G. Beiko, V. Barroso, R. Geffers, K. S.Sriprakash, and G. S. Chhatwal. 2007. Virulence profiling of Streptococcus dysgalactiae subspecies equisimilis isolated from infected humans reveals 2 distinct genetic lineages that do not segregate with their phenotypes or propensity to cause diseases. Clin. Infect. Dis. 44:1442–1454.
[9] Dhanasekaran G, Sastry G, Viswanathan M (2003). Microbial pattern of softtissue infections in diabetic patients in South India. Asian J.Diabet., 5: 8–10.diabetic foot infections. Indian J Med Sci 2001;55:655-62.
[10] Dipali AC, Pal RB. 2002; “Study of fungal and bacterial infections of the diabetic foot.” Indian J Pathol. Microbiol, 45(1): 15-22.
[11] Ericcson HM, Sharris JC. 1971; Antibiotic Sensitivity testing.Report of an International collaborative study. Acta Pathologica et Microbiologica Scandinavica Section B Supplement, 217:1-90.
[12] Frykberg RG (2003). An evidence-based approach to diabetic foot infections. Am. J. Surg., 186: 44S-54S.
[13] Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R(2006). A Clinico-microbiological Study of Diabetic Foot Ulcers in an Indian Tertiary Care Hospital. Diabetes Care, 29: 1727-1731.
[14] Ge Y, MacDonald D, Hait H, Lipsky B, Zasloff M, Holroyd K (2002).Microbiological profile of infected diabetic foot ulcers. Diabet Med.,19: 1032–1035.
[15] Gibbons GW, Eliopoulos GM. Infection of the diabetic foIn: Kozak GP, Hoar GS, Rowbottam JL, Wheelock FC,Campel D, editors. 1984. Management of diabetic foot problems.Philadelphia (USA): WB Saunders; p. 97-102.
[16] Goldstein EJ, Citron DM, Nesbit CA. 1996; Diabetic foot infections. Bacteriology and activity 10 oral antimicrobial agents against bacteria isolated from consecutive cases. Diabetes Care 19: 638-641.
[17] Grayson ML, Gibbons GW, Habershaw GM. Use of amplicillin/sulbactam versus imipenem cliastatin in the treatment of limb threatening foot infections in diabetic patients. Clin Infect Dis 1994; 18: 683-693.
[18] Greig,J.M., and M.J.Wood. 2003. Staphylococcus lugdunensis vertebral osteomyelitis. Clin. Microbiol. Infect. 9:1139–1141.
[19] Gu, J., H. Li, M. Li, C. Vuong, M. Otto, Y. Wen, and Q. Gao. 2005. Bacterial insertion sequence IS256 as a potential molecular marker to discriminate invasive strains from commensal strains of Staphylococcus epidermidis. J.Hosp. Infect. 61:342–348.
[20] Gupta U: 1973: A study of Bacteroidaceae from clinical material.India J Med Res 61(7):1002-1008,
[21] Hartemann-Heurtier,A., J. Robert, S. Jacqueminet,V.G. Ha, J.L. Golmard,V. Jarlier, and A. Grimaldi. 2004. Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabet. Med. 21:710–715.
[22] Hellbacher,C.,E.Tornqvist, and B.Soderquist.2006. Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates. Clin. Microbiol. Infect. 12:43–49.
[23] Herchline,T.E., and L.W.Ayers. 1991. Occurrence of Staphylococcus lugdunensis in consecutive clinical cultures and relationship of isolation to infection. J. Clin. Microbiol. 29: 419–421.
[24] J S Bajaj. 1984, “ Observations on Diabetic Foot.” Diabetes Mellitus in developing Countries, 43: 243.
[25] Joseph WS. 1991 Treatment of lower extremity infections in diabetics. Drugs; 42: 984-996.
[26] Kandemir Ö, Akbay E, _ahin E, Milcan A, Gen R (2007). Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. J. Infect., 54: 439-445.
[27] Lipsky BA, Pecoraro RE, Wheat LJ. 1990; The diabetic foot: soft tissue and bone infection. Infect Dis Clin North Am 4: 409-432.
[28] Lipsky, B. A., A. R. Berendt, H. G. Deery, J. M. Embil, W. S. Joseph, A. W.Karchmer, J. L. LeFrock, D. P. Lew, J. T. Mader, C. Norden, and J. S. Tan.2004. Diagnosis and treatment of diabetic foot infections. Clin. Infect. Dis.39:885–910.
[29] Louie TJ, Bartlett JG, Tally FP, Gorbach SL. 1976; Aerobic and Anaerobic Bacteria in Diabetic Foot Ulcers. Annals of Internal Medicine, 85: 461-463.
[30] Mitchell AAB1978 :Incidence and isolation of Bacteroides species from clinical material and their sensitivity to antibiotics.
[31] MowatA, BaumJ. 1971; Chemotoxis of polymorphnuclear leucocytes from patients with diabetes mellitus. N Engl J Med 284: 621-627.
[32] Nagamune, H., R. A. Whiley, T. Goto, Y. Inai, T. Maeda, J. M. Hardie, andH. Kourai. 2000. Distribution of the intermedilysin gene among the anginosus group streptococci and correlation between intermedilysin production and deep-seated infection withStreptococcus intermedius. J. Clin. Microbiol.38:220–226.
[33] Ozkara A, Delibas? T, Selcoki Y, Fettah Arikan MF (2008). The major clinical outcomes of diabetic foot infections: One center experience.Cent. Eur. J. Med., 3(4): 464-469.
[34] Pathare NA, Bal A, Tavalkar GV, Antani DU. 1998; “Diabetic foot infections: A study of microorganisms associated with the different Wagner grades.” Indian J. Pathol. Microbiol., 41(4): 437-441.
[35] Ramani A, Ramani R, Shivananda PG, Kundaje GN.Bacteriology1991; of diabetic foot ulcers. Indian J Pathol Microbiol 34: 81-87.
References
[1] Aetiopathogenesis.Boulton AJM,Conner H,Cavanagh PR (eds).2000;The Foot in Diabetes.3rd edition. John Willy and sons Ltd Chichester, West Sussex: pp 19-31.
[2] Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, et al. 2004; Bacteriology of diabetic foot lesions. Indian J Med Res 22:175-8. Boultrom AJM. The pathway to ulceration:
[3] Akova M, Ozcebe O, Gullu I, Unal S, Gur D, Akalin S et al.1996;Efficacy of sulbactam-ampicillin for the treatment of severe diabetic foot infections. J Chemother 8: 284-289.Biomedine, 2000; 20(3): 176-179.
[4] Bybee JD, Rogers DE. 1964; The phagocytic activity of polymorphnuclear leucocytes obtained from patients with diabetes mellitus. J Lab Clin Med 64: 1-13.
[5] Candel G, Alramadan M, Matesanz M, Diaz A, Gonzalez-Romo F,Candel I, Calle A, Picazo JJ (2003). Infections in diabetic foot ulcers.Eur. J. Int. Med., 14: 341– 343.
[6] Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. 1994; Assessment and management of foot disease in patients with diabetes. N Engl J Med 331: 854-860.
[7] Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. (Eds). 1989. Mackie andMc Cartney Practical Medical Microbiology,14th Edn, Singapore: Churchill Livingstone.
[8] Davies, M. R., D. J. McMillan, R. G. Beiko, V. Barroso, R. Geffers, K. S.Sriprakash, and G. S. Chhatwal. 2007. Virulence profiling of Streptococcus dysgalactiae subspecies equisimilis isolated from infected humans reveals 2 distinct genetic lineages that do not segregate with their phenotypes or propensity to cause diseases. Clin. Infect. Dis. 44:1442–1454.
[9] Dhanasekaran G, Sastry G, Viswanathan M (2003). Microbial pattern of softtissue infections in diabetic patients in South India. Asian J.Diabet., 5: 8–10.diabetic foot infections. Indian J Med Sci 2001;55:655-62.
[10] Dipali AC, Pal RB. 2002; “Study of fungal and bacterial infections of the diabetic foot.” Indian J Pathol. Microbiol, 45(1): 15-22.
[11] Ericcson HM, Sharris JC. 1971; Antibiotic Sensitivity testing.Report of an International collaborative study. Acta Pathologica et Microbiologica Scandinavica Section B Supplement, 217:1-90.
[12] Frykberg RG (2003). An evidence-based approach to diabetic foot infections. Am. J. Surg., 186: 44S-54S.
[13] Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R(2006). A Clinico-microbiological Study of Diabetic Foot Ulcers in an Indian Tertiary Care Hospital. Diabetes Care, 29: 1727-1731.
[14] Ge Y, MacDonald D, Hait H, Lipsky B, Zasloff M, Holroyd K (2002).Microbiological profile of infected diabetic foot ulcers. Diabet Med.,19: 1032–1035.
[15] Gibbons GW, Eliopoulos GM. Infection of the diabetic foIn: Kozak GP, Hoar GS, Rowbottam JL, Wheelock FC,Campel D, editors. 1984. Management of diabetic foot problems.Philadelphia (USA): WB Saunders; p. 97-102.
[16] Goldstein EJ, Citron DM, Nesbit CA. 1996; Diabetic foot infections. Bacteriology and activity 10 oral antimicrobial agents against bacteria isolated from consecutive cases. Diabetes Care 19: 638-641.
[17] Grayson ML, Gibbons GW, Habershaw GM. Use of amplicillin/sulbactam versus imipenem cliastatin in the treatment of limb threatening foot infections in diabetic patients. Clin Infect Dis 1994; 18: 683-693.
[18] Greig,J.M., and M.J.Wood. 2003. Staphylococcus lugdunensis vertebral osteomyelitis. Clin. Microbiol. Infect. 9:1139–1141.
[19] Gu, J., H. Li, M. Li, C. Vuong, M. Otto, Y. Wen, and Q. Gao. 2005. Bacterial insertion sequence IS256 as a potential molecular marker to discriminate invasive strains from commensal strains of Staphylococcus epidermidis. J.Hosp. Infect. 61:342–348.
[20] Gupta U: 1973: A study of Bacteroidaceae from clinical material.India J Med Res 61(7):1002-1008,
[21] Hartemann-Heurtier,A., J. Robert, S. Jacqueminet,V.G. Ha, J.L. Golmard,V. Jarlier, and A. Grimaldi. 2004. Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabet. Med. 21:710–715.
[22] Hellbacher,C.,E.Tornqvist, and B.Soderquist.2006. Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates. Clin. Microbiol. Infect. 12:43–49.
[23] Herchline,T.E., and L.W.Ayers. 1991. Occurrence of Staphylococcus lugdunensis in consecutive clinical cultures and relationship of isolation to infection. J. Clin. Microbiol. 29: 419–421.
[24] J S Bajaj. 1984, “ Observations on Diabetic Foot.” Diabetes Mellitus in developing Countries, 43: 243.
[25] Joseph WS. 1991 Treatment of lower extremity infections in diabetics. Drugs; 42: 984-996.
[26] Kandemir Ö, Akbay E, _ahin E, Milcan A, Gen R (2007). Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. J. Infect., 54: 439-445.
[27] Lipsky BA, Pecoraro RE, Wheat LJ. 1990; The diabetic foot: soft tissue and bone infection. Infect Dis Clin North Am 4: 409-432.
[28] Lipsky, B. A., A. R. Berendt, H. G. Deery, J. M. Embil, W. S. Joseph, A. W.Karchmer, J. L. LeFrock, D. P. Lew, J. T. Mader, C. Norden, and J. S. Tan.2004. Diagnosis and treatment of diabetic foot infections. Clin. Infect. Dis.39:885–910.
[29] Louie TJ, Bartlett JG, Tally FP, Gorbach SL. 1976; Aerobic and Anaerobic Bacteria in Diabetic Foot Ulcers. Annals of Internal Medicine, 85: 461-463.
[30] Mitchell AAB1978 :Incidence and isolation of Bacteroides species from clinical material and their sensitivity to antibiotics.
[31] MowatA, BaumJ. 1971; Chemotoxis of polymorphnuclear leucocytes from patients with diabetes mellitus. N Engl J Med 284: 621-627.
[32] Nagamune, H., R. A. Whiley, T. Goto, Y. Inai, T. Maeda, J. M. Hardie, andH. Kourai. 2000. Distribution of the intermedilysin gene among the anginosus group streptococci and correlation between intermedilysin production and deep-seated infection withStreptococcus intermedius. J. Clin. Microbiol.38:220–226.
[33] Ozkara A, Delibas? T, Selcoki Y, Fettah Arikan MF (2008). The major clinical outcomes of diabetic foot infections: One center experience.Cent. Eur. J. Med., 3(4): 464-469.
[34] Pathare NA, Bal A, Tavalkar GV, Antani DU. 1998; “Diabetic foot infections: A study of microorganisms associated with the different Wagner grades.” Indian J. Pathol. Microbiol., 41(4): 437-441.
[35] Ramani A, Ramani R, Shivananda PG, Kundaje GN.Bacteriology1991; of diabetic foot ulcers. Indian J Pathol Microbiol 34: 81-87.
[2] Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, et al. 2004; Bacteriology of diabetic foot lesions. Indian J Med Res 22:175-8. Boultrom AJM. The pathway to ulceration:
[3] Akova M, Ozcebe O, Gullu I, Unal S, Gur D, Akalin S et al.1996;Efficacy of sulbactam-ampicillin for the treatment of severe diabetic foot infections. J Chemother 8: 284-289.Biomedine, 2000; 20(3): 176-179.
[4] Bybee JD, Rogers DE. 1964; The phagocytic activity of polymorphnuclear leucocytes obtained from patients with diabetes mellitus. J Lab Clin Med 64: 1-13.
[5] Candel G, Alramadan M, Matesanz M, Diaz A, Gonzalez-Romo F,Candel I, Calle A, Picazo JJ (2003). Infections in diabetic foot ulcers.Eur. J. Int. Med., 14: 341– 343.
[6] Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. 1994; Assessment and management of foot disease in patients with diabetes. N Engl J Med 331: 854-860.
[7] Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. (Eds). 1989. Mackie andMc Cartney Practical Medical Microbiology,14th Edn, Singapore: Churchill Livingstone.
[8] Davies, M. R., D. J. McMillan, R. G. Beiko, V. Barroso, R. Geffers, K. S.Sriprakash, and G. S. Chhatwal. 2007. Virulence profiling of Streptococcus dysgalactiae subspecies equisimilis isolated from infected humans reveals 2 distinct genetic lineages that do not segregate with their phenotypes or propensity to cause diseases. Clin. Infect. Dis. 44:1442–1454.
[9] Dhanasekaran G, Sastry G, Viswanathan M (2003). Microbial pattern of softtissue infections in diabetic patients in South India. Asian J.Diabet., 5: 8–10.diabetic foot infections. Indian J Med Sci 2001;55:655-62.
[10] Dipali AC, Pal RB. 2002; “Study of fungal and bacterial infections of the diabetic foot.” Indian J Pathol. Microbiol, 45(1): 15-22.
[11] Ericcson HM, Sharris JC. 1971; Antibiotic Sensitivity testing.Report of an International collaborative study. Acta Pathologica et Microbiologica Scandinavica Section B Supplement, 217:1-90.
[12] Frykberg RG (2003). An evidence-based approach to diabetic foot infections. Am. J. Surg., 186: 44S-54S.
[13] Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R(2006). A Clinico-microbiological Study of Diabetic Foot Ulcers in an Indian Tertiary Care Hospital. Diabetes Care, 29: 1727-1731.
[14] Ge Y, MacDonald D, Hait H, Lipsky B, Zasloff M, Holroyd K (2002).Microbiological profile of infected diabetic foot ulcers. Diabet Med.,19: 1032–1035.
[15] Gibbons GW, Eliopoulos GM. Infection of the diabetic foIn: Kozak GP, Hoar GS, Rowbottam JL, Wheelock FC,Campel D, editors. 1984. Management of diabetic foot problems.Philadelphia (USA): WB Saunders; p. 97-102.
[16] Goldstein EJ, Citron DM, Nesbit CA. 1996; Diabetic foot infections. Bacteriology and activity 10 oral antimicrobial agents against bacteria isolated from consecutive cases. Diabetes Care 19: 638-641.
[17] Grayson ML, Gibbons GW, Habershaw GM. Use of amplicillin/sulbactam versus imipenem cliastatin in the treatment of limb threatening foot infections in diabetic patients. Clin Infect Dis 1994; 18: 683-693.
[18] Greig,J.M., and M.J.Wood. 2003. Staphylococcus lugdunensis vertebral osteomyelitis. Clin. Microbiol. Infect. 9:1139–1141.
[19] Gu, J., H. Li, M. Li, C. Vuong, M. Otto, Y. Wen, and Q. Gao. 2005. Bacterial insertion sequence IS256 as a potential molecular marker to discriminate invasive strains from commensal strains of Staphylococcus epidermidis. J.Hosp. Infect. 61:342–348.
[20] Gupta U: 1973: A study of Bacteroidaceae from clinical material.India J Med Res 61(7):1002-1008,
[21] Hartemann-Heurtier,A., J. Robert, S. Jacqueminet,V.G. Ha, J.L. Golmard,V. Jarlier, and A. Grimaldi. 2004. Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabet. Med. 21:710–715.
[22] Hellbacher,C.,E.Tornqvist, and B.Soderquist.2006. Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates. Clin. Microbiol. Infect. 12:43–49.
[23] Herchline,T.E., and L.W.Ayers. 1991. Occurrence of Staphylococcus lugdunensis in consecutive clinical cultures and relationship of isolation to infection. J. Clin. Microbiol. 29: 419–421.
[24] J S Bajaj. 1984, “ Observations on Diabetic Foot.” Diabetes Mellitus in developing Countries, 43: 243.
[25] Joseph WS. 1991 Treatment of lower extremity infections in diabetics. Drugs; 42: 984-996.
[26] Kandemir Ö, Akbay E, _ahin E, Milcan A, Gen R (2007). Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. J. Infect., 54: 439-445.
[27] Lipsky BA, Pecoraro RE, Wheat LJ. 1990; The diabetic foot: soft tissue and bone infection. Infect Dis Clin North Am 4: 409-432.
[28] Lipsky, B. A., A. R. Berendt, H. G. Deery, J. M. Embil, W. S. Joseph, A. W.Karchmer, J. L. LeFrock, D. P. Lew, J. T. Mader, C. Norden, and J. S. Tan.2004. Diagnosis and treatment of diabetic foot infections. Clin. Infect. Dis.39:885–910.
[29] Louie TJ, Bartlett JG, Tally FP, Gorbach SL. 1976; Aerobic and Anaerobic Bacteria in Diabetic Foot Ulcers. Annals of Internal Medicine, 85: 461-463.
[30] Mitchell AAB1978 :Incidence and isolation of Bacteroides species from clinical material and their sensitivity to antibiotics.
[31] MowatA, BaumJ. 1971; Chemotoxis of polymorphnuclear leucocytes from patients with diabetes mellitus. N Engl J Med 284: 621-627.
[32] Nagamune, H., R. A. Whiley, T. Goto, Y. Inai, T. Maeda, J. M. Hardie, andH. Kourai. 2000. Distribution of the intermedilysin gene among the anginosus group streptococci and correlation between intermedilysin production and deep-seated infection withStreptococcus intermedius. J. Clin. Microbiol.38:220–226.
[33] Ozkara A, Delibas? T, Selcoki Y, Fettah Arikan MF (2008). The major clinical outcomes of diabetic foot infections: One center experience.Cent. Eur. J. Med., 3(4): 464-469.
[34] Pathare NA, Bal A, Tavalkar GV, Antani DU. 1998; “Diabetic foot infections: A study of microorganisms associated with the different Wagner grades.” Indian J. Pathol. Microbiol., 41(4): 437-441.
[35] Ramani A, Ramani R, Shivananda PG, Kundaje GN.Bacteriology1991; of diabetic foot ulcers. Indian J Pathol Microbiol 34: 81-87.