Study of fungal isolation in diabetic foot ulcers

Patients with diabetes mellitus (DM) and foot ulcers have an increased morbidity and mortality. The aim of this study was to investigate the isolation of fungi in diabetic patients with foot ulcers and furthermore epidemiological and clinical characteristics of these patients. During the period of January 2015 - August 2019, 321 samples of foot ulcers from 185 patients with DM were cultured. Fungi were isolated in 27/321 (8,4%) cultures of examined foot ulcers of 23 patients (18 males, mean age ± stable deviation: 72,1 ± 9,1 years). In only one clinical sample fungi were isolated exclusively, while a polymicrobial growth was observed in the other cases. In total, 30 fungal strains were isolated, 29 of which were yeasts (27 Candida spp. and 2 Trichosporon spp.). Only one culture yielded a mold (Fusariumspp.) along with Candida parapsilosis. C. albicans was isolated in 36,7%, while in a total of 53,3% various species of Candida non-albicanswere developed. Two different (both in genus and species) yeast strains (C. parapsilosis and Trichosporon spp.) were grown in two cultures. C. albicans was the predominant species in this study. Only 4 of the 23 patients received antimicrobial therapy (clindamycin with tetracycline or quinolone) prior to culture. In conclusion, the isolation of fungi in cultures of foot ulcers in patients with DM is not uncommon and it is independent of previous antimicrobial administration. C. albicans was the dominant Candida species, while in total % percentage Candida non-albicans outranked C. albicans. Also, molds should be sought for even if yeasts are already there. Fungal foot infections in diabetic patients are associated with longer duration of DM and a high Hb1Ac, while the main risk factors are peripheral vascular disease and neuropathy.