DIABETIC FOOT INFECTIONS;

ROLE OF GRANULOCYTE COLONY STIMULATING FACTOR(G- CSF).

Abstract

Objective: (1) To evaluate the effects of G-CSF in eliminating infection in diabetic foot wound (2) To
compare the effects with conventional diabetic foot management. Design: Prospective, open, randomized comparative
study. Setting: Medical&Surgical Department of Allied, DHQ Hospital & Nawaz Medicare Faisalabad. Period: From
Jan 2000 to Nov 2000 Patients & Methods: Fifty diabetic patients with foot infections were included in this study. The
mean age was 52 years ranging from 27 to 60 years. They were divided into two equal groups(Group A and Group B).
Results: The male patients were 41(82%) and female 9(18%). Forty six percent of patients were on oral hypoglycaemic
drugs, and 54% on insulin. The trauma preceding infection was 20%, Peripheral neuropathy 94% and peripheral
vascular disease 34%. Thirty two percent of patients were smoker. Group A were subjected to G-CSF ( Neupogen )
therapy (n=25) subcutanously daily for 5days in addition to conventional measures. Whereas patients in Group B
received only conventional therapy. Both groups received similar antibiotic and insulin treatment. G-CSF therapy was
associated with earlier eradication of pathogens from the infected ulcer (median 5 [range 2-11] vs11 [6-31] days in the
group B; (p=<O.000I), quicker resolution of cellulitis (6 vs l4 days; p<O.0001), shorter hospital stay (8 vsl6 days;
p<O.000l), and a shorter duration of intravenous antibiotic treatment (7 vs l4 days ;p—0.0001).No G-CSF treated
patient needed surgery, whereas three patients in group B underwent toe amputation and six had extensive
debridement under anaesthesia (p=0.00 1). G-CSF therapy was generally well tolerated. Conclusion: Granulocyte
colony stimulating factor (G-CSF) may be used as a good adjuvant therapy along with conventional measures for the
management of diabetic foot infection, as it promotes the healing of diabetic foot ulcer/cellulitis and consequently
prevents many hazardous complications like amputation of limbs, long hospital stays, extensive and prolonged antibiotic
use and last but not the least the total misery of the patients.