Antibiotic profiles of Microbial Infection in Diabetic Foot Ulcers

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Introduction and aim: Diabetic foot ulcers are a serious medical and economic worry. It is the most common reason for diabetic patients to be admitted to hospital. If not treated appropriately, the infection might lead to amputation of the infected foot. The current research aims to recognise the frequencies of isolated aerobic bacterial pathogens associated with diabetic foot ulcers and detect their antibiotic susceptibility and resistance patterns to reduce the risk of complications.
 Methodology: This cohort study included 140 swab samples from diabetic foot ulcers from patients referred to the surgery department at Al-Azhar University Hospital in New Damietta, Egypt, in the period between January and December 2018. All samples were processed for the identification of aerobic bacterial strains were identified using routine bacteriological culture methods and antimicrobial susceptibility by the Kirby-Bauer disc diffusion method.
 Results: Out of 140 pus and tissue samples obtained of diabetic foot ulcers, 120 (85.7%) exhibited aerobic organism growth, yielding a total of 132 isolates with an average of 1.1 isolates per specimen. Polymicrobial infection was 10%. Gram-negative isolates were prominent (62.88%), with Pseudomonas aeruginosa (26.5%) being the most common strain causing diabetic foot infections, followed by E. coli (20.5%). Staph aureus was the most common Gram-positive bacteria (8.9%). Out of 83 Gram-negative bacteria, 54 (65%) produced extended-spectrum lactamase (ESBL). The majority of Gram-negative isolates were resistant to levofloxacin, gentamicin, ampicillin-sulbactam, and gatifloxacin. All Gram-negative bacteria were sensitive to imipenem. Of the 25 Staph aureus, 15 (60%) were Methicillin Resistant Staphylococcus aureus (MRSA) and susceptible to vancomycin and linezolid.
 Conclusion: Pseudomonas sp. was the most prevalent cause of infections. Most isolates were multidrug resistant. In our study, Gram-negative bacteria were the main cause of diabetic foot infections. A significant number of MDR isolates were also observed. The inappropriate use of broad-spectrum antibiotics may be the main cause of the increase in the frequency of MDR isolates.