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      Lower Limb Stump Infection Management among Rural North Indian Population

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          A bstract

          Introduction

          In India, the most common complication of lower limb amputated stump is infection, and it accounts 53.5% of total amputation. The published studies on prevention and management of such infection are very few.

          Materials and methods

          All the patients presenting with infection of amputated lower limb stump between 2010 and 2015 were included in this descriptive study. Diagnosis was confirmed by clinical, hematological, radiological, and microbiological test, i.e., culture and sensitivity of wound. Based on sensitivity report, treatment was started.

          Result

          There were 62 patients with 80 amputated lower limb stump infections. The most common presentation was sinus tract (54.8%). The most common cultured pathogen was Pseudomonas aeruginosa (39%). The most sensitive antibiotic was Piperacillin + Tazobactam (82.25%), followed by imipenem (75%), and levofloxacin (58.75%).

          Conclusion

          More than 60% of Indian population lives in rural area. The primary mode of healthcare services in India is peripheral health centers. The first choice of drug therapy in management of amputated lower limb stump infection can be levofloxacin.

          How to cite this article

          Mishra S, Kumar DK, Gupta AK, et al. Lower Limb Stump Infection Management among Rural North Indian Population. Indian J Phys Med Rehab 2019;30(3):66–68.

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          Most cited references11

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          Practice guidelines for the diagnosis and management of skin and soft-tissue infections.

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            Systemic antibiotic therapy for chronic osteomyelitis in adults.

            The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for chronic osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4-6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating chronic osteomyelitis are important, unmet needs.
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              Imaging of the painful lower limb stump.

              Several postoperative complications associated with pain may develop in the stump of an amputated lower limb. Clinical findings are often nonspecific; however, radiologic evaluation, especially with magnetic resonance (MR) imaging, is useful in the early diagnosis of these complications, thereby helping minimize physical disability with its psychologic and socioeconomic implications. Conventional radiography can demonstrate evidence of osseous origins of pain (eg, aggressive bone edge, heterotopic ossification, osteomyelitis) and should be the first imaging study performed after clinical examination. Videofluoroscopy can help evaluate improper prosthetic fit by demonstrating abnormal residual limb motion, piston action, rolling of soft tissues, and abnormal angle between the limb axis and the prosthesis during gait. Ultrasonography can demonstrate inflammatory changes in the stump as well as soft-tissue fluid collections. However, MR imaging is the modality of choice when clinical and other imaging findings are indeterminate. Because of its high spatial and contrast resolution, MR imaging can demonstrate subtle inflammatory changes, fluid collections, cancers, neuromas, and subtle traumatic bone lesions. Knowledge of various surgical and rehabilitation techniques is required for accurate diagnosis of complications associated with stump pain. Correct diagnosis allows choice of the most appropriate therapy, which may involve treating the stump, remodeling the prosthesis, or both.
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                Author and article information

                Journal
                IJOPMR
                Indian Journal of Physical Medicine and Rehabilitation
                IJOPMR
                Jaypee Brothers Medical Publishers
                0973-2209
                July-September 2019
                : 30
                : 3
                : 66-68
                Affiliations
                [1–3 ]Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, Uttar Pradesh, India
                [4 ]Department of Community Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
                Author notes
                Sudhir Mishra, Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, Uttar Pradesh, India, Phone: +91 8169802961, e-mail: sudhirpmr10@ 123456gmail.com
                Article
                10.5005/jp-journals-10066-0054
                1bfad765-41bb-4bfa-ab98-0fea977ec3a7
                Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.

                © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Categories
                ORIGINAL ARTICLE
                Custom metadata
                ijopmr-2019-30-66.pdf

                General medicine,Pathology,Surgery,Sports medicine,Anatomy & Physiology,Orthopedics
                First-line drug therapy,Levofloxacin,Lower limb amputated stump infection

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