Association of bacteria in diabetic and non-diabetic foot infection – An investigation in patients from Bangladesh

Abstract

The microbial community on a host relies on its immune status and pathophysiological condition. Diabetes mellitus is a metabolic disorder associated with a 25% increased risk of developing foot infection. The pathophysiological differences between diabetic foot infection (DFI) and non-DFI patients may alter the microbial composition in infections. The present study aims to comparatively analyze the microbes colonized in DFI and non-DFI patients in Bangladesh. Pus specimens were collected from 67 DFI and 12 non-DFI patients to investigate the bacteria associated with foot infection. For this investigation, an array of microbiological, molecular biological and immunological approaches were performed. Common bacteria detected in both DFI/non-DFI samples were Pseudomonas spp. (22/29%), Bacillus spp. (12/3%), Enterobacter spp. (22/7%), Staphylococcus spp. (13/13%) and Acinetobacter spp. (10/10%). Enterococcus spp. (9%) and Klebsiella spp. (8%) occurred only in DFI patients, whereas Citrobacter spp. (29%) was only detected in non-DFI samples. The rate of occurrence of three organisms, namely, Enterococcus spp. |Z|=2.2125, Klebsiella spp. |Z|=1.732, Bacillus spp. |Z|=1.9034, were also statistically significant. Most of the isolates from DFI patients were commonly resistant to the cephalosporin (Ceftazidime, Ceftriazone, Cefurozime) and monobactam (Aztreonam) groups of antibiotics. DFI patients had comparatively higher C-reactive protein (CRP) levels than non-DFI patients, and a positive correlation was observed between multi-antibiotic resistance and CRP levels (one of the markers of chronic subclinical inflammation). The present investigation implicated a complex association of the bacterial population in DFI compared with non-DFI with different antimicrobial resistance properties, which was linked with CRP levels.

Diabetic Foot Ulcers: Current Advances in Antimicrobial Therapies and Emerging Treatments

“…(22/7%), and Staphylococcus spp. (13/13%) [32]. Furthermore, in a study performed in India, Gram-negative pathogens were reported to be the most predominant (58.5%) [31], thereby demonstrating the prevalence of Gram-negative bacteria in Eastern countries.…”

“…Openly published evidence suggests that there is no reason to prescribe antibiotic therapy for an uninfected foot wound as either a prophylaxis against infection or in the belief that it accelerates the healing of the wound [36]. In a study performed in Bangladesh, most of the isolates from DFI patients were commonly resistant to cephalosporin (ceftazidime, ceftriaxone, cefuroxime) and carbapenem (aztreonam) [32]. In Mexico, the least effective antibiotics for Gram-positive bacteria identified in DFIs were penicillin and dicloxacillin; for Gram-negative bacteria, cefalotin and penicillin were the least effective.…”

“…Total isolate Cephalosporin (ceftazidime, ceftriaxone, cefuroxime), carbapenem (aztreonam) Not studied Bangladesh [32] Gram-positive Penicillin, dicloxacillin, and vancomycin Levofloxacin, cefalotin Mexico [34] Gram-negative Cefalotin, penicillin, and vancomycin Amikacin Mexico [34] Anaerobes Clindamycin, penicillin, and cefoxitin Imipenem and metronidazole India [31] Gram-negative Not studied Piperacillin/tazobactam India [31] Gram-positive and Gram-negative Not studied Imipenem Brazil [23] Gram-negative Not studied Gentamicin Brazil [23]…”

“…Carbapenems are a mainstay in the treatment of multidrug-resistant Gram-negative bacteria; however, resistance to this group of drugs is increasingly being reported in the clinic [32]. Anaerobic bacteria are preferentially treated with metronidazole, which is also used for the management of chronic DFU infection [31].…”

Emergence of IntI1 associated bla VIM-2 gene cassette-mediated carbapenem resistance in opportunistic pathogen Pseudomonas stutzeri

“…A report is presented here concerning association of multidrug-resistant (MDR) clinical P. stutzeri 40D2 (initially named as 40/D/Mac2) isolated from the pus sample of a diabetic patient with a deep tissue foot infection (cellulitis) in a tertiary care hospital in Dhaka, Bangladesh. 9 Initially, 20 isolates were recovered among which three carbapenem resistant Pseudomonas isolates (40/D/Mac2, 40/D/Swab1, 40/D/CIP+Cefo1) were retrieved belonging to a single genotype, detected through amplified ribosomal DNA restriction analysis. Isolate 40D2 was selected for detailed investigation.…”