Abstract
Resistance profile to antibiotics and the occurrence of class-1 integron in 23 bacteria isolated from diabetic foot ulcers (DFUs) were analyzed. Among 23 isolates, 16 elicited resistance to at least two antibiotics and seven were sensitive. Majority of the isolates were resistant to spectinomycin and streptomycin (68.75%) followed by trimethoprim (62.50%) and ampicillin (50%). Among the antibiotics resistant isolates, six exhibited resistance to four different groups of antibiotics and one showed resistance to 11 antibiotics (six antibiotic groups). 17 bacterial strains possessed class-1 integrons with an amplicon size of 0.30 to 2.40 kb which suggested their role in conferring resistance to antibiotics. 2-D gel electrophoresis of proteins extracted from Escherichia coli DF39TA grown with antibiotics revealed significant alteration in total proteome as compared to control culture. Five spots showing four fold up regulation were identified by MALDI TOF MS as OmpX, OmpA, OmpA-OmpF, Omp-tolC and chaperone protein DnaK. Changes in abundance of above proteins following growth with antibiotics may be beneficial for antibiotic resistant bacteria to adapt under adverse environmental conditions. Findings of this study suggest that infection with multiple antibiotic-resistant bacteria is common to DFUs and resistance is mediated by class-1 integrons. Key words: Diabetic foot ulcer, antibiotic resistance, polymerase chain reaction (PCR), class-I integron, 2-D gel electrophoresis, Escherichia coli.
Highlights
Diabetic foot infection is a common and potentially devastating complication that can progress rapidly to irreversible septic gangrene necessitating amputation of the foot
Among the antibiotics resistant isolates, six exhibited resistance to four different groups of antibiotics and one showed resistance to 11 antibiotics. 17 bacterial strains possessed class-1 integrons with an amplicon size of 0.30 to 2.40 kb which suggested their role in conferring resistance to antibiotics. 2D gel electrophoresis of proteins extracted from Escherichia coli DF39TA grown with antibiotics revealed significant alteration in total proteome as compared to control culture
Findings of this study suggest that infection with multiple antibiotic-resistant bacteria is common to diabetic foot ulcers (DFUs) and resistance is mediated by class-1 integrons
Summary
Diabetic foot infection is a common and potentially devastating complication that can progress rapidly to irreversible septic gangrene necessitating amputation of the foot. The specific organisms found in diabetic foot infections differ from patient to patient, and from one part of the country to another (Ozer et al, 2010). Individuals with diabetes have at least a 10-fold greater risk of being hospitalized for soft tissue and bone infections of the foot. Diabetic patients with foot ulcers have several factors that may be associated with a high risk of multidrug resistant micro-organisms (MDRM) carriage, such as inappropriate anti-biotic treatment, chronic course of the wound, reduced antibiotic concentration in the tissue and reduced antimi-crobial effect in the wound environment and frequent hospital admission (Hartemann-Heurtier et al, 2004; Gadepalli et al, 2006; Ozer et al, 2010). Several reports suggest that inadequate selection and abuse of antimicrobials may lead to the development of resistance in various other bacteria and make the treatment of bacterial infections more difficult (Kolar et al, 2001)
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