Development and evaluation of healthy meal plan for public university students in Peninsular Malaysia

Diabetic foot ulcer (DFU) is a dreadful complication of poorly controlled diabetic patients. Diabetic foot ulcer accounts for around 10% of local orthopedic hospital admissions; it causesincreasing public health concerns. Causative microorganisms and prescription trends often differ based on local and regional protocols and guidelines. This study aimed to identify the causative microorganisms, prescription trends, and risk factors for amputation among diabetic foot patients at a tertiary care hospital in central Malaysia. A cross-sectional study using retrospective data of 434 patients admitted for diabetic foot infection (DFI) who underwent amputation in Hospital Ampang was conducted. Data was collected using a proforma. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 29 software. P-value <0.05 was considered statistically significant. Pseudomonas aeruginosa (10.29%), Streptococcus agalactiae (8.7%), Proteus sp. (7.76%), Coagulase-Negative Staphylococcus (4.75%), Enterococcus sp. (4.75%), Staphylococcus aureus (4.59%), Proteus mirabilis (4.11%), Klebsiella sp. (4.11%), Escherichia coli (3.96%) and Methicillin resistance staphylococcus aureus (3.17%) were found to be the most isolated pathogens. The most common empirical antibiotics prescribed were ampicillin/sulbactam (56.9%), followed by ceftazidime (4.8%) and clindamycin/ceftazidime (3.5%), while the therapeutic antibiotics included ampicillin (9.4%), ceftazidime (8.1%) and ciprofloxacin (5.5%). The risk factors for amputation were found to be age 65 years and above (OR = 15.923, p = 0.017), use of both insulin and oral antihyperglycemic agents (OR=2.934, p = 0.055), planter ulcer (OR = 7.807, p < 0.001), white blood cell (OR = 1.104, p < 0.001), nephropathy (OR = 2.98, p = 0.03), history of previous amputation of right 4th toe (OR = 0.006, p = 0.014), Wagner grade 3 (OR = 0.032, p = 0.047), Wagner grade 4 and 5 (OR = 5.836, p = 0.007), midfoot (OR = 90.206, p = 0.009) and hindfoot wound location (OR = 12.61, p = 0.049) respectively. Among the 434 amputated patients, 53.2% healed completely, 36.6% unhealed and 6.7% died, while 3.5% did not come for follow-up. The above findings would assist general practitioners or diabetic clinicians in identifying high- risk patients who may benefit from early referral to specialist centers and be given appropriate early treatment, thereby reducing the rates of amputation.

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