Antibacterial Efficacy of Cinnamon Essential Oil Compared to Standard Antibiotics on Diabetic Foot Ulcer Isolates at Tertiary Care Units Karachi, Pakistan: Antibacterial Efficacy of Cinnamon Essential Oil Compared to Standard Antibiotics on Diabetic Foot Ulcer Isolates at Tertiary Care Units Karachi, Pakistan

Ubaid Ullah; Sameen Adib Rahman; Kahkashan Perveen; Benish Zafar; Ayaz Khan; Ashfaq Ahmad

doi:10.54393/pjhs.v6i11.3457

Authors

Ubaid Ullah Department of Medical Technology, Baqai Institute of Medical Technology, Baqai Medical University, Karachi, Pakistan
Sameen Adib Rahman Jinnah Medical and Dental College, Karachi, Pakistan
Kahkashan Perveen Department of Biochemistry, Baqai Medical University, Karachi, Pakistan
Benish Zafar Department of Biochemistry, Baqai Medical University, Karachi, Pakistan
Ayaz Khan Department of Medical Technology, Baqai Institute of Medical Technology, Baqai Medical University, Karachi, Pakistan
Ashfaq Ahmad Department of Hematology, Baqai Medical University, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i11.3457

Keywords:

Diabetes, Diabetic Foot Ulcer, Bacterial Infection, Antibiotics, Cinnamon Essential Oil

Abstract

Lower limb complications associated with Type Ⅱ Diabetes have become a serious public health issue in today's world. Diabetic patients with ulcers commonly experience infection due to Gram-positive, Gram-negative bacteria, as well as some anaerobes. Objectives: To investigate the antibacterial activity of Cinnamon essential oil on microbial isolates from diabetic foot ulcer. Methods: An experimental investigation was carried out on diabetic patients suffering from foot ulcers. A total of 115 pus swab samples from diabetic foot ulcer patients were acquired, who were recruited and processed at Baqai Institute of Diabetology and Endocrinology. Antibiotic sensitivity testing was performed by the Kirby agar Disc diffusion method. Antibacterial activity of cinnamon essential oil was checked by the Kirby agar well diffusion method. Results: Out of 115 samples, 138 bacteria were isolated. 80% of samples were mono-microbial and 20% were poly-microbial. Pseudomonas Aeruginosa was the most frequently encountered bacterium, followed by E. Coli, S. Aureus, Klebsiella Pneumonae, Proteus Mirabilis, Enterococcus species, Coagulase-negative Staphylococcus Species, and Proteus Vulgaris. All the isolated bacteria showed different resistance patterns against commercially available antibiotics. Cinnamon essential oil showed antibacterial activity against all isolated bacteria. Conclusions: The study demonstrated a high bacterial isolation rate from diabetic foot ulcer. Antibiotic resistance varied among bacterial isolates, highlighting the challenge of treating bacterial infections. Cinnamon essential oil exhibited strong antibacterial activity against all isolated bacteria, suggesting its potency of being used as an alternative antimicrobial agent.

References

Mathur P, Leburu S, Kulothungan V. Prevalence, Awareness, Treatment and Control of Diabetes in India from the Countrywide National NCD Monitoring Survey. Frontiers In Public Health. 2022 Mar; 10: 748157. doi: 10.3389/fpubh.2022.748157. DOI: https://doi.org/10.3389/fpubh.2022.748157

Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 Diabetes. The Lancet. 2022 Nov; 400(10365): 1803-20. doi: 10.1016/S0140-6736(22)01655-5. DOI: https://doi.org/10.1016/S0140-6736(22)01655-5

Amin N and Doupis J. Diabetic Foot Disease: From the Evaluation of the “Foot at Risk” to the Novel Diabetic Ulcer Treatment Modalities. World Journal of Diabetes. 2016 Apr; 7(7): 153. doi: 10.4239/wjd.v7.i7.153. DOI: https://doi.org/10.4239/wjd.v7.i7.153

Nirenjen S, Narayanan J, Tamilanban T, Subramaniyan V, Chitra V, Fuloria NK et al. Exploring the Contribution of Pro-Inflammatory Cytokines to Impaired Wound Healing in Diabetes. Frontiers In Immunology. 2023 Jul; 14:1216321. doi: 10.3389/fimmu.2023.1216321. DOI: https://doi.org/10.3389/fimmu.2023.1216321

Boulton AJ, Armstrong DG, Kirsner RS, Attinger CE, Lavery LA, Lipsky BA et al. Diagnosis and Management of Diabetic Foot Complications. American Diabetes Association Clinical Compendia. 2018; 2018(2). doi: 10.2337/db20182-1. DOI: https://doi.org/10.2337/db20182-1

Sloan G, Selvarajah D, Tesfaye S. Pathogenesis, Diagnosis and Clinical Management of Diabetic Sensorimotor Peripheral Neuropathy. Nature Reviews Endocrinology. 2021 Jul; 17(7): 400-20. doi: 10.1038/s41574-021-00496-z. DOI: https://doi.org/10.1038/s41574-021-00496-z

Afonso AC, Oliveira D, Saavedra MJ, Borges A, Simões M. Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies. International Journal of Molecular Sciences. 2021 Jul; 22(15): 8278. doi: 10.3390/ijms22158278. DOI: https://doi.org/10.3390/ijms22158278

Tiwari S, Pratyush DD, Dwivedi A, Gupta SK, Rai M, Singh SK. Microbiological and Clinical Characteristics of Diabetic Foot Infections in Northern India. The Journal of Infection in Developing Countries. 2012 Jan; 6(04): 329-32. doi: 10.3855/jidc.1827. DOI: https://doi.org/10.3855/jidc.1827

Bowers S and Franco E. Chronic Wounds: Evaluation and Management. American Family Physician. 2020 Feb; 101(3): 159-66.

Fu J, Wang Z, Huang L, Zheng S, Wang D, Chen S et al. Review of the Botanical Characteristics, Phytochemistry, and Pharmacology of Astragalus Membranaceus (Huangqi). Phytotherapy Research. 2014 Sep; 28(9): 1275-83. doi: 10.1002/ptr.5188. DOI: https://doi.org/10.1002/ptr.5188

Mieczkowski M, Mrozikiewicz-Rakowska B, Kowara M, Kleibert M, Czupryniak L. The Problem of Wound Healing in Diabetes—from Molecular Pathways to the Design of an Animal Model. International Journal of Molecular Sciences. 2022 Jul; 23(14): 7930. doi: 10.3390/ijms23147930. DOI: https://doi.org/10.3390/ijms23147930

Flynn K, Mahmoud NN, Sharifi S, Gould LJ, Mahmoudi M. Chronic Wound Healing Models. ACS Pharmacology and Translational Science. 2023 Apr; 6(5): 783-801. doi: 10.1021/acsptsci.3c00030. DOI: https://doi.org/10.1021/acsptsci.3c00030

Wang X, Yuan CX, Xu B, Yu Z. Diabetic Foot Ulcers: Classification, Risk Factors and Management. World Journal of Diabetes. 2022 Dec; 13(12): 1049. doi: 10.4239/wjd.v13.i12.1049. DOI: https://doi.org/10.4239/wjd.v13.i12.1049

Okonkwo UA and DiPietro LA. Diabetes and Wound Angiogenesis. International Journal of Molecular Sciences. 2017 Jul; 18(7): 1419. doi: 10.3390/ijms18071419. DOI: https://doi.org/10.3390/ijms18071419

Singh N, Rao AS, Nandal A, Kumar S, Yadav SS, Ganaie SA et al. Phytochemical and Pharmacological Review of Cinnamomum Verum J. Presl-A Versatile Spice Used in Food and Nutrition. Food Chemistry. 2021 Feb; 338: 127773. doi: 10.1016/j.foodchem.2020.127773. DOI: https://doi.org/10.1016/j.foodchem.2020.127773

Nabavi SF, Di Lorenzo A, Izadi M, Sobarzo-Sánchez E, Daglia M, Nabavi SM. Antibacterial Effects of Cinnamon: From Farm to Food, Cosmetic and Pharmaceutical Industries. Nutrients. 2015 Sep; 7(9): 7729-48. doi: 10.3390/nu7095359. DOI: https://doi.org/10.3390/nu7095359

Li X, Du Z, Tang Z, Wen Q, Cheng Q, Cui Y. Distribution and Drug Sensitivity of Pathogenic Bacteria in Diabetic Foot Ulcer Patients with Necrotizing Fasciitis at A Diabetic Foot Center in China. BioMed Central Infectious Diseases. 2022 Apr; 22(1): 396. doi: 10.1186/s12879-022-07382-7. DOI: https://doi.org/10.1186/s12879-022-07382-7

El Atki Y, Aouam I, El Kamari F, Taroq A, Nayme K, Timinouni M et al. Antibacterial Activity of Cinnamon Essential Oils and Their Synergistic Potential with Antibiotics. Journal of Advanced Pharmaceutical Technology and Research. 2019 Apr; 10(2): 63-7. doi: 10.4103/japtr.JAPTR_366_18. DOI: https://doi.org/10.4103/japtr.JAPTR_366_18

Du F, Ma J, Gong H, Bista R, Zha P, Ren Y et al. Microbial Infection and Antibiotic Susceptibility of Diabetic Foot Ulcer in China: Literature Review. Frontiers In Endocrinology. 2022 May; 13: 881659. doi: 10.3389/fendo.2022.881659. DOI: https://doi.org/10.3389/fendo.2022.881659

Atlaw A, Kebede HB, Abdela AA, Woldeamanuel Y. Bacterial Isolates from Diabetic Foot Ulcers and Their Antimicrobial Resistance Profile from Selected Hospitals in Addis Ababa, Ethiopia. Frontiers in Endocrinology. 2022 Aug; 13: 987487. doi: 10.3389/fendo.2022.987487. DOI: https://doi.org/10.3389/fendo.2022.987487

Yang S, Hu L, Zhao Y, Meng G, Xu S, Han R. Prevalence of Multidrug‐Resistant Bacterial Infections in Diabetic Foot Ulcers: A Meta‐Analysis. International Wound Journal. 2024 Apr; 21(4): e14864. doi: 10.1111/iwj.14864. DOI: https://doi.org/10.1111/iwj.14864

Naeem H, Khan S, Siddiqui MA, Ali MM, Siddiqui SN, Ghafoor A et al. Microbial Profile and Antimicrobial Resistance among the Most Common Grades of Diabetic Foot Ulcers (DFUs) at Mayo Hospital, Lahore, Pakistan. Bio-Scientific Review. 2023 Oct; 5(3): 15-25. doi: 10.32350/BSR.53.02. DOI: https://doi.org/10.32350/BSR.53.02

Miyan Z, Fawwad A, Sabir R, Basit A. Microbiological Pattern of Diabetic Foot Infections at A Tertiary Care Center in A Developing Country. Age Years. 2017; 53: 10-20.

Sannathimmappa MB, Nambiar V, Aravindakshan R, Al Khabori MS, Al-Flaiti AH, Al-Azri KN et al. Diabetic Foot Infections: Profile and Antibiotic Susceptibility Patterns of Bacterial Isolates in A Tertiary Care Hospital of Oman. Journal of Education and Health Promotion. 2021 Jul; 10: 254. doi: 10.4103/jehp.jehp_1552_20. DOI: https://doi.org/10.4103/jehp.jehp_1552_20

Shu C, Ge L, Li Z, Chen B, Liao S, Lu L et al. Antibacterial Activity of Cinnamon Essential Oil and Its Main Component of Cinnamaldehyde and the Underlying Mechanism. Frontiers In Pharmacology. 2024 Mar; 15: 1378434. doi: 10.3389/fphar.2024.1378434. DOI: https://doi.org/10.3389/fphar.2024.1378434

Radwan IA, Abed AH, Abd Al-Wanis SA, Abd El-Aziz GG, El-Shemy A. Antibacterial Effect of Cinnamon and Oregano Oils on Multidrug Resistant Escherichia Coli and Salmonellae Isolated from Broiler Chickens. Journal of the Egyptian Veterinary Medical Association. 2016; 76(2): 169-86.