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Targeted treatment of invasive fungal infections accelerates healing of foot wounds in patients with Type 2 diabetes.
MedLine Citation:
PMID:  22248392     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aim:  To test the hypothesis that fluconazole plus standard care is superior to the standard care for diabetic foot wounds infected with deep-seated fungal infections. Methods:  We carried out a randomized, controlled, open-label, parallel-arm study in 75 patients with both fungal and bacterial infections in deep tissues of diabetic foot wounds. Thirty-seven patients (control group) were given standard care (surgical debridement + culture-specific antibiotics + offloading + glycaemic control) and 38 patients (treatment group) were given fluconazole 150 mg daily plus standard care. Wound surface area was measured every 2 weeks until the endpoints (complete epithelialization or skin grafting) were met. Results:  By week 4, the mean wound surface area reduced to 27.3 from 111.5 cm(2) in the treatment group, as opposed to 67.1 from 87.3 cm(2) in the control group. Subsequently, the mean wound surface areas were remarkably smaller in the treatment group compared with the control group, and statistically significant differences (P ≤ 0.05) in mean wound surface area were observed between the treatment group and the control group at week 6. However, no statistically significant (P = 0.47) difference in complete healing was observed between the treatment group and the control group, 20 vs. 24. The mean wound healing time for the treatment group was 7.3 weeks, whereas for the control group it was 11.3 weeks (P = 0.022). Similarly, the probability of wound healing in the treatment group was 50 vs. 20% in the control group at week 10. Conclusions:  Fluconazole plus standard care was superior to standard care alone in accelerating wound reduction among patients with diabetes with deep-seated fungal infections in diabetic foot wounds. Those in the treatment group who did heal, healed more quickly (P = 0.022), but overall healing was not different. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Authors:
G Chellan; K Neethu; A K Varma; T S Mangalanandan; S Shashikala; K R Dinesh; K R Sundaram; N Varma; R V Jayakumar; A Bal; H Kumar
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-16
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  -     ISSN:  1464-5491     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Affiliation:
Department of Endocrinology, Diabetes and Podiatry Department of Microbiology Department of Biostatistics, School of Medicine, Amrita Institute of Medical Sciences and Research Center, Kerala, India.
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