Prevalencia y perfil de resistencia a antibióticos de microorganismos aislados de infecciones en pie diabético

Objective To explore the distribution of pathogens causing infections in the diabetic foot patients and analyze the drug susceptibility so as to provide guidance for reasonable clinical use of antibiotics. Methods A retrospective study was carried out on the clinical materials from 580 patients with diabetic foot infections hospitalized in Nanfang Hospital from January 2000 to December 2014. The patients were grouped according to Wagner grading and type of ulcers. Seasons were classified by pentad mean temperature method, then the distribution characteristics of pathogens in different groups was analyzed. And the data were divided into two phases according to the variation trend of drug resistance as follow: from 2000 to 2010, from 2011 to 2014, then analysis was carried out on the change of drug resistance in recent 15 years. The data among groups were compared by using χ2 test. Results Among 580 cases, there were 347 males(59.8%) and 233 females(40.2%), mean age was 35-87(62±12) years, duration of diabetes was 0-35(8± 6) years. And 349(46.8%) strains of gram-positive bacteria, 354(47.4%) strains of gram-negative bacteria and 43(5.8%) strains of fungi were isolated from ulcers. With rising Wagner grade, bacterial floras transformed from Gram-positive bacteria (62.3% in Wagner grade≤2) to Gram-negative bacteria (61.7% in Wagner grade≥4) while composite infections increased(χ2=24.645,P<0.05). Gram-positive bacteria were the main pathogens of diabetic foot ulcers in neuropathic ulcers(51.7%) while Gram-negative bacteria were the most frequently isolated in ischemic and neuroischemic ulcers(60.9%, 53.0%). There were significant difference in distribution of pathogens among ulcers with different Wagner grades and different types(χ2= 37.383, 13.045,P<0.05). The distribution of pathogens was influenced by seasons in Wagner grade 3 ulcers. Gram-negative bacteria were the most frequently isolated in summer(55.5%) while gram-positive bacteria were the most common in spring or autumn(60.1%) (χ2=17.740,P<0.05). Among Gram-positive bacteria, Staphylococci were dominating floras, they were totally resistant to penicillin and ampicillin while vancomycin and linezolid were the most effective agents(100%). The resistance rate to amoxicillin/clavulanate was increased from 15.0% to 48.1% in 15 years(χ2=7.499, P<0.05). Among gram-negative bacteria,Enterobacteriaceae was dominating floras, they were highly resistant to ampicillin(91.3%) while meropenem was the most effective agents(99.5%). The resistance rate to cefotaxime is obviously increased from 29.2% to 43.7% in 15 years(χ2=3.899,P<0.05). Conclusions We can treat the diabetic foot patients with antibiotics empirically according to the type of ulcers, Wagner grade and seasons. It is essential to pay more attention to pathogen survey and use antibiotics more rationally. Key words: Diabetic foot; Infection; Pathogen; Drug resistance

Objective To investigate the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers. Methods A retrospective study was carried out on the microbiological profile and antibiotic susceptibility in 532 strains of pathogens isolated from 358 patients with diabetic foot ulcers in West China Hospital from January 1996 to December 2009. The data between groups was compared by using χ2 test. Results Foot infection occurred in 507/662 (76.6%) patients with diabetic foot. A total of 532 strains of pathogens were isolated from foot ulcers in 358/510(70.6%) patients. Gram-positive aerobes were most frequently isolated (51.4%, 281 strains), followed by gram-negative aerobes and fungus (38.7% and 8.5%, 206 and 45 strains, respectively). One hundred and thirty-six patients (26.6%) showed polymicrobial involvement. Among the 281 strains Gram-positive bacteria, 89 (16.7%) strains were Staphylococcus aureus, 48(9.0%) strains were Enterococcus, and 43(8.1%) strains were Staphylococcus epidermidis, including three strains of vancomycin resistant Enterococci(VRE) and ten strains of methicillin resistant Staphylococcus aureus(MRSA). Gram-positive bacteria were highly resistant to aztreonam (87.7%), erythromycin (83.5%), ceftriaxone (83.2%) and penicillin (81.0%); vancomycin and norfloxacin were the most effective agents against gram-positive bacteria. Among the 206 strains gram-negative bacteria, 34 strains (6.4%) were Escherichia coli, 23 strains (4.32%) were Enterobacter cloacae, 21 strains(3.9%) were Proteus vulgaris. Gram-negative bacteria were highly resistant to ampicillin(90.2%), ampicillin/sulbactam (75.3%), rifampicin (72.5%), penicillin (66.7%) and erythromycin (60.8%); Imipenem, amikacin sulphate and cefpodoxime were the most effective agents against gram-negative bacteria. The major fungus was Blastomyces albicans (2.4%, 13 strains). Conclusions Gram-positive aerobes are the predominant pathogens isolated from diabetic foot ulcers compared with gram-negative bacteria. Vancomycin and imipenem still keep highly antibacterial activity. It is very important to pay attention to pathogens survey and use antibiotics more rationally. Key words: Diabetic foot; Infection; Drug resistance, microbial

Objective To analyze the pathogen, drug resistance and related factors of diabetic foot infection (DFI) in hospitalized patients. Methods A total of 574 patients with diabetic foot (DF) who were hospitalized in the Department of Endocrinology from January 2014 to December 2018 were studied. The distribution of pathogenic bacteria, drug sensitivity and related factors were collected. Patients were divided into group A or group B based on test result of foot tissue culture, and the related factors were analyzed. SPSS 22.0 software was used for statistics analysis. χ2 test was used for categorical data between groups, t test was used for numerical data, and Logistic regression analysis was used for multivariable analysis. Results 698 strains of pathogenic bacteria were isolated from 574 DF patients. The first three were 166 strains of staphylococcus aureus (23.8%), 54 strains of escherichia coli (7.7%) and 50 strains of enterobacter cloacae (7.2%). Wagner grade 3-5 DFI was dominated by gram-negative bacteria, which accounted for 53.3%, 54.8% and 71.4% of total pathogenic bacteria respectively. Wagner grade 1-2 was dominated by gram-positive bacteria, accounting for 62.7% and 53.8%. Gram negative bacteria (except for Pseudomonas aeruginosa and Acinetobacter baumannii) were more sensitive to meropenem (sensitivity≥98%), imipenem (≥92.6%), piperacillin/tazobactam (≥85.3%); gram positive bacteria were more sensitive to quinolones (sensitivity ≥80%); vancomycin, linezolidine and tegacyclinwere the most sensitive, sensitivity 100%. Logistic regression analysis showed that the length of diabetic foot disease (OR=3.40, 95%CI:1.87-6.20), combined with peripheral vascular lesions (OR=1.42, 95%CI:1.17-1.71), peripheral neuropathy (OR=1.23, 95%CI:2.28-19.69), white blood cells high (OR=4.45, 95%CI: 1.36-13.25), high glycated hemoglobin (OR=5.810,95%CI:2.93-11.54), low density lipoprotein high (OR=1.54, 95%CI: 1.10-2.15) was a major risk factor for DFI. Conclusion The treatment of DFI should be determined based on clinical characteristics of patients and empirical selection of sensitive antibiotics with further adjustment according to drug sensitivity test. Key words: Diabetic foot infection; Pathogen; Drug resistance; Antibacterial

Objective To analyze the pathogenic bacteria distribution and characteristics of the bacterial drug resistance of diabetic foot infection, and provide reference for reasonable selection of antibiotics. Methods A total of 342 strains of positive pathogen bacteria separated patients with diabetic foot infection secretion from January 1st 2011 to December 31st 2014 were retrospectively analyzed. Results Among the 342 strains of pathogenic, 170 strains of gram-negative bacteria (49.7%), 150 strains of gram positive bacteria (43.9%), 22 strains (6.43%) of fungus. Susceptibility results showed that gram negative bacteria e. coli, singular proteus cefepime had low resistance to amikacin, piperacillin/he azole, minocycline, there was no penicillium carbon alkene resistant strains were found, pseudomonas aeruginosa had low resistance to minocycline; Gram-positive bacteria had low resistance to vancomycin. Conclusions The pathogens distribution of diabetic foot infection are wide, the pathogens have high resistance, therefore antimicrobial susceptibility should be chosen according to test results. Key words: Diabetic foot; Bacterial culture; Pathogenic bacteria; Drug sensitive test

Diabetic foot is a chronic complication of diabetes mellitus ,40%-80% of diabetic foot ulcers become infected. Gram-positive aerobic bacteria are the commonest micro-organism isolated, followed by Gram-negative aerobic bacteria ,anaerobes and fungi. Staphylococcus aureus is found most frequently. Pathognomonic features of diabetic foot infection are polypathogens, multi-drug-resistant pathogens, microorganism infection,the type and characters of pathogenic bacterium varied with the ulcer grade and healing stage. The age of patients with diabetic foot infection is older, the wound healing time is longer, combined therapy should be used to treat diabetic foot. It is important to strengthen the earlier precaution and treatment to the diabetic foot infection. Key words: Diabetic foot; Infection; Pathogen; Drug resistance

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.

Objective To investigate the bacterial spectrum and drug resistance of bone infection after multiple hospitalizations. Methods A retrospective case series study was conducted on 95 patients with bone infection due to injuries admitted in the General Hospital of Shenyang Military Area from January 2009 to December 2016. There were 76 males and 34 females, with an average age of 47 years (range, 17-94 years). Bacterial culture and drug sensitivity tests were performed in 246 specimens of the infection secretions and infected tissues. The bacterial species and drug resistance data of all the specimens were statistically analyzed. The numbers and ratios of Gram-positive bacteria and Gram negative bacteria were counted according to the changes of hospitalization frequency, and the changes of drug resistance of Staphylococcus aureus after repeated hospitalizations were also recorded. Results A total of 110 pathogenic bacteria were isolated, and mixed infection was found in 19% of the bacteria. There were 61 Gram-positive bacteria (55.5%), including 35 Staphylococcus aureus [seven methicillin-resistant staphylococcus (MRSA) strains], accounting for 57% of Gram-positive strains. Other Gram positive bacteria were mainly Enterococcus faecalis and Staphylococcus epidermidis. There were 48 Gram-negative bacteria (43.6%), including 12 Pseudomonas aeruginosa strains, accounting for 25% of Gram-negative strains, nine Klebsiella pneumoniae strains, accounting for 19% of the Gram-negative strains. Staphylococcus aureus had a resistance rate to penicillin of 82%, and the major Gram positive bacteria (Staphylococcus aureus, Enterococcus faecalis, Staphylococcus epidermidis) were all highly sensitive to vancomycin and linezolid. The major Gram-negative bacteria (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii) were highly resistant to the second generation of cephalosporins and were sensitive to carbapenem antibiotics. In 95 bone infection patients, the ratio of Gram positive bacteria to Gram negative bacteria increased from 0.98 at the first admission to 3 after repeated hospitalizations, and the ratio change was statistically significant (P<0.05). After multiple hospitalizations, the drug resistance of Staphylococcus aureus to gentamicin, ciprofloxacin, levofloxacin, and tetracycline increased gradually. The resistance rate to penicillin was even up to 100%. Conclusions The mixed infection of bone infection is common, among which Staphylococcus aureus and Staphylococcus epidermidis are the main Gram-positive pathogenic bacteria, Pseudomonas aeruginosa and Klebsiella pneumoniae are the main Gram negative pathogenic bacteria. The proportion of Gram-positive bacteria infection increased after multiple hospitalizations and became the major pathogenic bacteria. Penicillin should be avoided in the treatment of Staphylococcus aureus infection in multiple hospitalizations, and gentamicin and ciprofloxacin should be used with caution. Vancomycin or linezolid which is more sensitive is a better option. Key words: Osteomyelitis; Bacteria; Drug susceptibility test

Objective To investigate the clinical features and risk factors of diabetic foot recurrence infection in diabetes mellitus (DM) patients. Methods A total of 158 patients with diabetic foot infection from January 2014 to December 2017 admitted to the First Affiliated Hospital of Xiamen University were selected in the study.There were 90 patients with diabetic foot recurrence.The clinical data of patients with recurrent infection and non-recurrent infection were compared and analyzed.Multivariate logistic regression was used to analyze the risk factors associated with recurrent infection of diabetic foot. Results Ninety patients with recurrent infection of diabetic foot were cultured with 108 strains of pathogens, of which Gram-positive(G+ ), Gram-negative(G-), and other pathogens accounted for 54.63%(59 strains), 39.81%(43 strains), 5.56%(6 strains), respectively.The differences in disease duration, age, white blood cell count, hs-CRP, hemoglobin, fibrinogen, albumin levels, and Wanger grade 4 to 5 ratio, peripheral vascular lesions of the lower extremities, recent use of antibiotics and the healing time of ulcers in patients of diabetic foot recurrence and non-recurrent infections were statistically significant(t=6.003, 6.132, 3.144, 4.322, 4.513, 11.179, 7.164, χ2=4.269, 8.613, 25.083, 23.298, all P<0.05). Multivariate analysis showed that the independent risk factors for diabetic foot recurrence were peripheral vascular lesions of the lower extremities, recent use of antimicrobial agents, ulcer healing time more than 65 days(χ2=5.134, 4.807, 10.512, all P<0.05). Conclusion The results show that patients with ulcer healing time more than 65 days, vascular lesions around the lower extremities, and diabetic foot who recently used antibiotics have a higher risk of recurrent infections.Close observation should be made to take early precautionary measures based on the patients' own condition. Key words: Diabetic foot; Infections; Risk factors; Peripheral arterial disease; Anti-infective agents; Wound healing

Causative Microorganisms Isolated from Patients with Intra-Abdominal Infections and Their Drug Resistance Profiles: An 11-Year (2011–2021) Single-Center Retrospective Study

La Diabetes Mellitus (DM) tipo 2 es una enfermedad grave y una causa mayor de morbilidad y mortalidad. Es, además, la principal causa de enfermedad renal terminal, amputaciones de las extremidades inferiores no debidas a traumatismo y ceguera en adultos. El pie diabético comprende una combinación de ulceración, infección y gangrena en diferentes grados. Es una de las complicaciones más incapacitantes de la DM tipo 2. Las infecciones en pacientes con pie diabético son frecuentes, complejas de tratar, costosas, y comúnmente llevan a la amputación. La mi- crobiota, presente en la infección en pie diabético, suele ser muy diversa. En infecciones iniciales predominan las bacterias aerobias Gram positivas como S. aureus , incluyendo S. aureus meticilina resistentes (MRSA) y estreptococos beta hemolíticos, incluyendo los grupos A, B, C, y G. En las heridas crónicas se encuentran infecciones principalmente polimicrobianas, donde pueden estar presentes bacterias Gram positivas y Gram negativas aerobias y anaerobias. Debido a que no existen protocolos estandarizados para tratar infecciones en pie diabético, el tratamiento y seguimiento están basados en la opinión de expertos y consensos. En este artículo se revisan los conceptos y consensos actuales.

Diabetic foot ulcers infected with microorganisms increase the risk of amputation. The presence of drug-resistant bacteria in diabetic foot ulcers creates a big challenge during the treatment. The objective of the present study was to determine the bacterial prevalence and antibiotic resistance among bacteria isolated from Chinese patients with diabetic foot ulcers. The present study studied the microbial colonization of diabetic foot ulcers of patients from a single center in China. Wound swabs from 89 patients with diabetic foot ulcers were collected and the presence of microorganisms detected. The isolated microorganisms were subjected to antibiotic susceptibility testing by the disk diffusion method. Of 89 patients, 56 (62.9%) were male and 33 (37.1%) were female, the mean age of patients was 53.2±5.4 years, the mean duration of diabetes was 14.8±2.9 years, the mean random blood sugar was 301±87 mg/dl, mean HbA1c was 7.9±1.4%. Patients with Wanger ulcer grade III (36.0%; P=0.034) and patients within the weight range of 51-75 kg (59.6%; P=0.012) were significantly higher. The prevalence rate of diabetic foot ulcers was 11.3%. Among 153 microorganisms, gram-positive bacteria (52.3%) were more prevalent than gram-negative bacteria (44.4%). Most of the patients with polymicrobial infection were classified to have Wanger III ulcer grade diabetic foot ulcers. Staphylococcus aureus (38.2%) was the most predominant bacteria isolated followed by Staphylococcus epidermidis (29.2%) and Escherichia coli (28.1%). Most of the gram-positive and gram-negative bacteria were resistant to dicloxacillin (73.8%, P=0.021) and cefotaxime (50%), respectively and ~53.4% of the isolates were multi-drug resistance isolates, 61.8% of the Staphylococcus aureus were identified as methicillin-resistant Staphylococcus aureus and 61.8% of the gram-negative bacteria were extended-spectrum β-lactamase producers. Staphylococcus aureus and Escherichia coli were the predominant gram-positive and gram-negative bacteria isolated, respectively. Penicillin resistance was significantly higher among the gram-negative bacteria (P=0.019). Staphylococcus aureus and Escherichia coli were the predominant gram-positive and gram-negative bacteria isolated and levofloxacin and nitrofurantoin were the most effective antibiotics among the gram-positive and gram-negative bacterial isolates, respectively.

IntroductionInfected diabetic foot ulcer (IDFU) is a worldwide problem associated with diabetes mellitus. It could lead from soft tissue infection to bone infection and is a leading cause of lower limb amputation. Gram-negative and Gram-positive bacteria, including anaerobic bacteria and fungi, are considered potential causes of infection. The early diagnosis of DFU infection and appropriate treatment based on the identification of the pathogens and their antimicrobial susceptibility pattern is important for good prognosis. Therefore, the purpose of this study was to isolate the bacteria that infect foot ulcers in selected Hospitals and determine their antimicrobial resistance profile.MethodAn institutional-based multicenter, cross-sectional study was conducted in selected Hospitals in Addis Ababa, Ethiopia, from November 2020 to May 2021. A sterile swab was used to collect samples from the foot ulcer and a sterile needle to collect pus. Isolates were identified by culture, Gram-staining, and a series of biochemical tests. For each bacterial species identified, the antibiotic profiling was determined by the Kirby-Bauer disk diffusion method.Resultsone hundred and twenty-seven pathogenic bacteria were isolated from samples taken from 130 patients with a diabetic foot ulcer. Sixty-eight percent had growth of multiple microorganisms. Two-thirds (66.7%) of the isolates were gram-negative bacteria. The predominant bacterial species were S. aureus 25.19% (32/127), Pseudomonas species 18.89% (24/127), and Escherichia coli 16.53% (21/127). Overall, 92.9% (118/127) of the isolates were identified as multi-drug resistant. Gram-positive isolates were susceptible to chloramphenicol, clindamycin, and amikacin. Gram-negative isolates were also sensitive to chloramphenicol, aztreonam, and amikacin.ConclusionThe majority of bacteria isolated from patients presenting with Diabetic foot ulcer infections were found to be multi-drug resistant in the study sites of the current study. The results demonstrate the importance of timely identification of infection of diabetic foot ulcers, proper sample collection for identification of the pathogens and for determining their antibiotic susceptibility pattern before initiating antimicrobial treatment

Diabetes mellitus (DM) is one of the most chronic and dangerous diseases worldwide and in the Saudi society in particular. Swabs (168) from DM injuries were collected from inpatient and outpatient departments. Analysis of variance revealed the high incidence of diabetic foot infections compared to other injuries by an average of 51 and 33, respectively. Adults’ category was significantly the highest age category in the incidence. Inpatients have recorded the highest incidence than outpatients, while routine cases have recorded the highest rates of infection compared to the urgent and very urgent cases. Etiology was confined in 210 bacterial isolates belonging to gram negative (G-ve), gram-positive (G+ve), aerobic and anaerobic bacteria. The study detected a high incidence in one genus/swab compared to two, three, four genera and polymicrobial/swab, with 67, 14, 1, 0.5 and 1.5% respectively. Aerobic bacteria reached 98.5% compared to anaerobic bacteria (1.5%). G-ve aerobic bacteria were highly significant compared to the G+ve. The dominant bacterial species in diabetic injuries was Pseudomonas aeruginosa followed by Staphylococcus aureus with a rate of 28 and 17%, respectively. It is worth noting that the antibacterial ability was evident in Ps. aeruginosa for the most bacterial isolates tested, and this reinforces the result found in the study of Ps. aeruginosa’s dominance in diabetes compared to the rest of the isolated bacterial genera. Results of the study are considered unique in the epidemic spread of diabetic injuries for inpatients, outpatients, as well as the antagonistic relations of each bacterial etiology of diabetic injuries in Saudi Arabia. Key words: Epidemiology, etiology, bacteria, diabetic injuries, age, in-outpatients, priority, polymicrobial, aerobic, anaerobic, Ps. aeruginosa, S. aureus.

Objective To retrospectively analyze distribution characteristics of pathogenic bacteria and their antimicrobial susceptibility in patients with diabetic foot osteomyelitis(DFO). Methods Sixty cases of suspected DFO were collected from the Endocrinology Department of Henan Provincial People′s Hospital. After admission, bone biopsy was carried out to confirm the pathological diagnosis, and the pathogenic bacteria and drug sensitivity were determined by bone culture. In addition, bacterial culture was carried out in the basal tissue of the wound, and the results of bacterial culture were compared with those of bone culture. Results Sixty patients were diagnosed as DFO after bone biopsy. Among the 60 patients, 45 patients underwent bone culture and basal tissue culture. There are 24 patients of whom the results were consistent, accounting for 53.3%. The positive rate of bone culture was 55.0%, there were 16 strains of gram-positive bacteria and 22 strains of gram-negative bacteria. Staphylococcus aureus(9 strains) occurrence was the most, common finding, followed by Escherichia coli(6 strains). The course of diabetic foot, albumin(ALB), and antibiotic usage rate before admission were lower in bone culture positive group than those in bone culture negative group, while white blood cell(WBC) and C-reactive protein(CRP) were higher in bone culture negative group(P 0.05). The results of bone culture showed that Staphylococcus aureus was the main Gram-positive bacteria, which was more sensitive to vancomycin, tigecyclin, linezolid, etc. Escherichia coli was the main Gram-negative bacteria, which was more sensitive to tigecyclin, carbapenems, amikacin, etc. Conclusion Bone biopsy and bone culture should be carried out in cases for suspected DFO patients to identify the pathogenic bacteria, and the bone tissue should be preserved and obtained according to the operation specification before the application of antibiotics, and the appropriate antibiotics should be selected according to the drug sensitivity results. Key words: Diabetic foot osteomyelitis; Bone biopsy; Bone culture; Basal tissue culture; Pathogen; Antibiotics

Introduction. Long-lasting ulcerative defects in patients with diabetic foot syndrome (DFS) are prone to reinfection, persistence of primary and hospital-acquired infection, and the infectious process is often caused by multidrug-resistant organisms (MDRO).Aim of the study: to compare the prevalence and specific characteristics of the severe diabetic foot infection pathogens during the inpatient and outpatient stages of treatment.Materials and methods. We included 62 type 2 diabetic inpatients (group 1) with severe foot infection and 102 diabetic foot outpatients (group 2) with postoperative wounds, who had been operated on and discharged from the hospital, in to the study.Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.Results and discussion. Severe infection connected with polymicrobe pathogens in both groups of patients. However, the prevalence of Gram-positive and Gram-negative bacilli was different. The most frequently isolated pathogens were Gram-positive bacteria in the wound samples of group 1 of patients with acute infection obtained after surgery interventions immediately. In the wound cultures of group 1 on 14 day of hospitalization and group 2 the prevalence of Gram-positive and Gram-negative bacilli was the same. It should be noted that there is still a high total frequency of isolation of non-fermenting Gram-negative bacilli among Gram-negative pathogens in complicated diabetic foot infection both at the inpatient and outpatient stages of treatment.Conclusion. The great finding of the study is the identification of a parallel of the same prevalence of Gram-positive and Gramnegative pathogens in a prolonged infection at the inpatient and outpatient stages of treatment. The role of Enterobacterales increased with duration of infection. The prevalence of multidrug resistant Enterobacterales makes this group of microorganisms as important as Staphylococcaceae in the complicated course of the infectious process. Polyvalent microbial spectrum of pathogens significantly reduces the effectiveness of treatment.