Identification and antibiotic susceptibility of microorganisms isolated from diabetic foot ulcers: A pathological aspect

Shi,Mei-Lian; Quan,Xin-Rong; Tan,Li-Ming; Zhang,Hui-Lan; Yang,An-Qun

doi:10.3892/etm.2022.11752

Identification and antibiotic susceptibility of microorganisms isolated from diabetic foot ulcers: A pathological aspect

Authors:
- Mei-Lian Shi
- Xin-Rong Quan
- Li-Ming Tan
- Hui-Lan Zhang
- An-Qun Yang
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Affiliations: Department of Infection Management, Huaihua Cancer Hospital, Huaihua, Hunan 418000, P.R. China, Department of Medical Quality Management, Huaihua Cancer Hospital, Huaihua, Hunan 418000, P.R. China, Department of Clinical Pharmacy, Huaihua Cancer Hospital, Huaihua, Hunan 418000, P.R. China, Department of Microbiology Laboratory, Huaihua Cancer Hospital, Huaihua, Hunan 418000, P.R. China
Published online on: December 7, 2022 https://doi.org/10.3892/etm.2022.11752
Article Number: 53

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Abstract

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.

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1	Jiang Y, Ran X, Jia L, Yang C, Wang P, Ma J, Chen B, Yu Y, Feng B, Chen L, et al: Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China. Int J Low Extrem Wounds. 14:19–27. 2015.PubMed/NCBI View Article : Google Scholar
2	IDF Diabetes Atlas Group. Update of mortality attributable to diabetes for the IDF diabetes atlas: Estimates for the year 2013. Diabetes Res Clin Pract. 109:461–465. 2015.PubMed/NCBI View Article : Google Scholar
3	Sánchez-Sánchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G and Bocanegra-García V: Bacterial prevalence and antibiotic resistance in clinical isolates of diabetic foot ulcers in the northeast of Tamaulipas, Mexico. Int J Low Extrem Wounds. 16:129–134. 2017.PubMed/NCBI View Article : Google Scholar
4	Noor S, Zubair M and Ahmad J: Diabetic foot ulcer-A review on pathophysiology, classification and microbial etiology. Diabetes Metab Syndr. 9:192–199. 2015.PubMed/NCBI View Article : Google Scholar
5	Zhang P, Lu J, Jing Y, Tang S, Zhu D and Bi Y: Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Ann Med. 49:106–116. 2017.PubMed/NCBI View Article : Google Scholar
6	Markakis K, Bowling FL and Boulton AJ: The diabetic foot in 2015: An overview. Diabetes Metab Res Rev. 32 (Suppl 1):S169–S178. 2016.PubMed/NCBI View Article : Google Scholar
7	van Battum P, Schaper N, Prompers L, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, et al: Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabet Med. 28:199–205. 2011.PubMed/NCBI View Article : Google Scholar
8	Xie X, Bao Y, Ni L, Liu D, Niu S, Lin H, Li H, Duan C, Yan L, Huang S and Luo Z: Bacterial profile and antibiotic resistance in patients with diabetic foot ulcer in Guangzhou, southern China: Focus on the differences among different Wagner's grades, IDSA/IWGDF grades, and ulcer types. Int J Endocrinol. 2017(8694903)2017.PubMed/NCBI View Article : Google Scholar
9	Akhi MT, Ghotaslou R, Asgharzadeh M, Varshochi M, Pirzadeh T, Memar MY, Zahedi Bialvaei A, Seifi Yarijan Sofla H and Alizadeh N: Bacterial etiology and antibiotic susceptibility pattern of diabetic foot infections in Tabriz, Iran. GMS Hyg Infect Control. 10(Doc02)2015.PubMed/NCBI View Article : Google Scholar
10	Mendes JJ, Marques-Costa A, Vilela C, Neves J, Candeias N, Cavaco-Silva P and Melo-Cristino J: Clinical and bacteriological survey of diabetic foot infections in Lisbon. Diabetes Res Clin Pract. 95:153–161. 2012.PubMed/NCBI View Article : Google Scholar
11	Al Wahbi A: Autoamputation of diabetic toe with dry gangrene: A myth or a fact? Diabetes Metab Syndr Obes. 11:255–264. 2018.PubMed/NCBI View Article : Google Scholar
12	Ramakant P, Verma AK, Misra R, Prasad KN, Chand G, Mishra A, Agarwal G, Agarwal A and Mishra SK: Changing microbiological profile of pathogenic bacteria in diabetic foot infections: Time for a rethink on which empirical therapy to choose? Diabetologia. 54:58–64. 2011.PubMed/NCBI View Article : Google Scholar
13	Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 32nd edition. CSLI Supplement M100, Wayne, PA, 2022.
14	Anvarinejad M, Pouladfar G, Japoni A, Bolandparvaz S, Satiary Z, Abbasi P and Mardaneh J: Isolation and antibiotic susceptibility of the microorganisms isolated from diabetic foot infections in Nemazee hospital, Southern Iran. J Pathog. 2015(328796)2015.PubMed/NCBI View Article : Google Scholar
15	Mendes JJ and Neves J: Diabetic foot infections: Current diagnosis and treatment. J Diab Foot Compl. 4:26–45. 2012.
16	Gawey B and Czaja K: Broad-spectrum antibiotic abuse and its connection to obesity. J Nutrition Health Food Sci. 5:1–21. 2017.
17	Shah P, Inturi R, Anne D, Jadhav D, Viswambharan V, Khadilkar R, Dnyanmote A and Shahi S: Wagner's classification as a tool for treating diabetic foot ulcers: Our observations at a suburban teaching hospital. Cureus. 14(e21501)2022.PubMed/NCBI View Article : Google Scholar
18	Thanganadar Appapalam S, Muniyan A, Vasanthi Mohan K and Panchamoorthy R: A study on isolation, characterization, and exploration of multiantibiotic-resistant bacteria in the wound site of diabetic foot ulcer patients. Int J Low Extrem Wounds. 20:6–14. 2021.PubMed/NCBI View Article : Google Scholar
19	Deribe B, Woldemichael K and Nemera G: Prevalence and factors influencing diabetic foot ulcer among diabetic patients attending arbaminch hospital, south Ethiopia. J Diabetes Metab. 5:1–7. 2014.
20	Zubair M: Prevalence and interrelationships of foot ulcer, risk-factors and antibiotic resistance in foot ulcers in diabetic populations: A systematic review and meta-analysis. World J Diabetes. 11:78–89. 2020.PubMed/NCBI View Article : Google Scholar
21	Richard JL, Sotto A and Lavigne JP: New insights in diabetic foot infection. World J Diabetes. 2:24–32. 2011.PubMed/NCBI View Article : Google Scholar
22	Sekhar S, Vyas N, Unnikrishnan M, Rodrigues G and Mukhopadhyay C: Antimicrobial susceptibility pattern in diabetic foot ulcer: A pilot study. Ann Med Health Sci Res. 4:742–745. 2014.PubMed/NCBI View Article : Google Scholar
23	Pontes DG, Silva ITDCE, Fernandes JJ, Monteiro AFG, Gomes PHDS, Ferreira MGM, Lima FG, Correia JO, Santos NJND and Cavalcante LP: Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections. Rev Col Bras Cir. 47(e20202471)2020.PubMed/NCBI View Article : Google Scholar : (In English, Portuguese).
24	Chaudhry WN, Badar R, Jamal M, Jeong J, Zafar J and Andleeb S: Clinico-microbiological study and antibiotic resistance profile of mecA and ESBL gene prevalence in patients with diabetic foot infections. Exp Ther Med. 11:1031–1038. 2016.PubMed/NCBI View Article : Google Scholar
25	Agudelo Higuita NI and Huycke MM: Enterococcal Disease, Epidemiology, and Implications for Treatment. In: Enterococci: From Commensals to Leading Causes of Drug Resistant Infection [Internet]. Gilmore MS, Clewell DB, Ike Y and Shankar N (eds). Massachusetts Eye and Ear Infirmary, Boston, MA, 2014.
26	Sugandhi P and Prasanth DA: Microbiological profile of bacterial pathogens from diabetic foot infections in tertiary care hospitals, Salem. Diabetes Metab Syndr. 8:129–132. 2014.PubMed/NCBI View Article : Google Scholar
27	Dwedar R, Ismail DK and Abdulbaky A: Diabetic foot infection: Microbiological causes with special reference to their antibiotic resistance pattern. Egypt J Med Microb. 24:95–102. 2015.PubMed/NCBI View Article : Google Scholar
28	Amini M, Davati A and Piri M: Determination of the resistance pattern of prevalent aerobic bacterial infections of diabetic foot ulcer. Iran J Pathol. 8:21–26. 2013.