Antimicrobial management of foot infections in patients with diabetes mellitus

A Study on Isolation, Characterization, and Exploration of Multiantibiotic-Resistant Bacteria in the Wound Site of Diabetic Foot Ulcer Patients

This study collected wound swab samples from 50 diabetic patients, especially in Wagner's grade 2 (28) and grade 3 (22) foot ulcers. The samples were processed and subjected to bacterial isolation and characterization. The obtained diabetic foot ulcer (DFU) bacterial isolates were also subjected to antibiotic susceptibility assay. All the collected samples were culture positive and produced a total of 85 isolates. Monomicrobial and polymicrobial infections were observed from the collected grade 2 and 3 samples, respectively. Gram's staining and morphological analyses of the obtained bacterial colony demonstrated the presence of both Gram-positive and Gram-negative bacilli, Gram-positive cocci, and Gram-negative cocco-bacilli in the wounds of diabetic patients. The bacterial profiling of 85 isolates revealed the presence of Gram-negative bacteria such as Pseudomonas aeruginosa, Escherichia coli, Proteus spp, Acinetobacter spp, Enterobacter spp, Klebsiella pneumoniae, Citrobacter spp, K oxytoca, and Stenotrophomonas spp Gram-positive bacteria such as Staphylococcus aureus, Bacillus subtilis, Enterococcus faecalis, Corynebacterium spp, and Streptococcus dysgalactiae were also identified. The predominant microbial flora found in the collected samples were Staphylococcus aureus (38%) and P aeruginosa (23.2%), followed by B subtilis (21%) and Escherichia coli (18%) and other bacteria. Furthermore, the obtained antibiotic susceptibility assay data of DFU isolates have also confirmed the distribution of multiantibiotic-resistant bacteria in the wound site of diabetic patients. The findings of the present study suggest that there is a need for the discovery of novel drug(s) to alleviate antibiotic-resistant bacterial infections in DFU patients.

Antibiotic therapy for diabetic foot infections in a tertiary care hospital in Jakarta, Indonesia

AIMS

The purpose of this study was to determine the microbiology of diabetic foot infections and to assess the antibiotic susceptibility patterns.

MATERIALS AND METHODS

A cross sectional retrospective study of 35 patients with diabetic foot infections hospitalized at the internal medicine clinic of Dr. Mintohardjo Navy Hospital, Jakarta. The data were collected from patient medical records retrospectively. The classification of the diabetic foot infections was evaluated according to Meggit-Wagner's Classification. Identification of causative microorganisms was performed by standard microbiologic methods. Antibiotic susceptibility testing was performed using disk-diffusion method.

RESULTS

During January to December 2012, a total of 288 of diabetic patients were admitted to hospital, and 35 patients had diabetic foot infections. According to Meggit-Wagner's classification the most common disease was grade 3 in 31.4% patients, followed by grade 2 in 25.7%, and grade 4 in 17.3% of patients. Conservative diabetic control care was carried out in 37.1% of patients, and surgical intervention was carried out in 62.9% of patients. A total of 59 pathogens were identified. The most common infecting microorganism isolated on pus cultures was Staphylococcus aureus (47.5%), followed by Pseudomonas spp (16.9%), E. coli (10.2%), Streptococcus spp. (8.5%), Enterobacter spp. (7.0%), Proteus spp. (6.7%), and Acinetobacter spp. (3.2%). Overall, 37.2% of the diabetic foot infection caused by a single microorganism, and 62.8% had polymicrobial infections. The most frequently administrated antibiotic was ceftriaxone (40.0%), followed by ciprofloxacin (11.4%), and meropenem (8.6%).

CONCLUSION

Diabetic foot infections (62.8%) were polymicrobial. S. aureus was most commonly found in the foot infection. Most of the microorganisms isolated from diabetic foot infection were resistant to many types of antibiotics.