Prevalence of Diabetic foot ulcer infections associated with Gram negative bacteria with special reference to drug resistant isolates

Abstract

Introduction: Diabetic Mellitus type 2 is most common causes are foot ulcer; Infections include abscess, necrotizing, fasciitis, gangrene, arthritis, tendonitis, cellulitis, osteomyelitis and eventually lead to the development of limb amputation.Aims and Objectives: This study carried out to determine the patterns of infection in diabetic foot ulcers with special reference to the susceptibility and drug resistant isolates.Materials and Methods: Samples were collected from 199 diabetic foot ulcers patients by using pus swab, tissue, and exudates in sterile containers and processed to using standard microbiological techniques.Results: A total of 441 bacterial isolates were obtained from 199 patients with diabetic foot ulcers. A maximum number of patients were in the age group of 45 to 64 years and male predominant compared to female. Most of the isolates recovered according to Wagner classification system in DFU (Diabetic foot ulcer) >4cm2, >7.0 HbA1C and blood urea >30 mg/dl and serum creatinine >1.3mg/dl. 55% isolates of non-lactose fermenting Gram negative bacteria were more prevalent than 45% isolates of lactose fermenting Gram negative bacteria. The most commonly found isolate was Pseudomonas aeruginosa (39.6%), Escherichia coli (17.46%), Acinetobacter species (15.41%), Proteus species (12.47%), and Klebsiella species (9.75%) respectively. Antimicrobial susceptibility of the Gram negative bacteria was also studied. ESBL producing most common bacteria was Klebsiella species and Citrobacter species in this study than Escherichia coli and Enterobacter species.Conclusion: This study shows NLF predominant than LF GNB among the isolates from the diabetic foot ulcers. Antimicrobial susceptibility result of this study suggests that pathogens having susceptible to Imipenem and Piperacillin/ tazobactam were sensitive against LF, NLF-GNB and also ESBL producing bacteria. Colistin is the drug of choice multi-drug resistant (MDR) pathogens. Surveillance and monitoring on the antibiotic susceptibility pattern of the isolates will be helpful in determining the drugs for the empirical treatment of diabetic ulcers.