Each year the IBMS awards a number of research grants to members.
Here Fearghal Tucker, Service Delivery Manager for Viapath LLP, describes his successful project.
PROJECT TITLE: Carriage of toxigenic and non-toxigenic Clostridium difficile in patients with diabetic foot ulcers with and without antibiotics.
BACKGROUND: Patients with longstanding diabetes often have reduced pain sensation, especially if the blood sugar is not well controlled. This predisposes them to wounds in the feet that can get infected. Often these infections involve the underlying bone as well. As a result, patients are given many courses of antibiotics over long periods of time.
SCIENTIFIC JUSTIFICATION: Antibiotics may lead to Clostridium difficile (CD) infection, resulting in a disease of the large
intestine, which presents as diarrhoea, frequent recurrences and severe complications, including severe colitis, colonic perforation and sometimes death.
Even in its mild form it causes significant discomfort to the patient, long hospital stays and increased cost to the healthcare system. Toxigenic CD isolates can lead to the development of clinical CD, whilenon-toxigenic isolates may prevent the overgrowth of toxigenic isolates and have a protective effect.
Risk groups for CD infection include the elderly and those with co-morbidities, antibiotic therapy and immune deficiency.
Patients with chronic diabetic ulcers are at high risk, as they often have the above characteristics, but CD infection has not been studied in detail in this group.
CD exists in toxin and non-toxin producing forms, the former with disease causing potential and the latter thought to have a protective effect against the former. However, both can be found in the human gut without causing symptoms.
AIM: This study aims to identify the proportion of patients who carry these organisms, to understand the ongoing risks of using antibiotics in this group. Recent research suggests that changes in diabetic patients’ intestines may protect them from developing CD. Normally, the healthy gut bacteria keep overgrowth of CD in check.
This study hypothesises that antibiotics reduce normal gut bacteria, which may cause CD bacteria (which are resistant to antibiotics) to overgrow. Since diabetic patients often receive many courses of antibiotics, for long durations, it is important to assess this risk.
This IBMS Research Grant-supported work aims to determine the carriage rates of toxigenic and non-toxigenic CD in the diabetic foot population and estimate whether there is a difference between those on different types and duration of antibiotics.
DESIGN AND METHOD: The design is a crosssectional analysis of all eligible patients who are seen in the diabetic foot clinic. This will enable a better understanding of the implications of antibiotic use in this population. The use of antibiotics is considered one of the most important risk factors for development of CD and for the alteration of normal gut bacteria.
This would potentially be useful to make a risk assessment of continued antibiotics.
The broad timetable for the stages of the research, including preparation, convening meetings and conducting interviews, interpreting and analysing findings, and preparing the fi nal report, is estimated to be approximately 12 months.