Bacteriological Profile of Diabetic Foot Ulcers and Detection of Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum β-Lactamase Producers in a Tertiary Care Hospital

Abstract

IntroductionDiabetic foot infection is the most dreaded complication of diabetes mellitus and the commonest cause of hospitalization and limb amputation. Identification of the causative agent responsible for diabetic foot infection and the earliest initiation of appropriate antimicrobial therapy are vital for the control and prevention of the complication of diabetic foot ulcers. Therefore, we conducted this study to determine the bacteriological profile of diabetic foot ulcers and to detect methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) producers in our institute. MethodologyDuring the study period, samples were collected from the foot ulcers of 100 patients at the Diabetic Outpatient Department. The samples were processed according to the standard laboratory protocol, and bacterial isolates were identified. Antibiotic susceptibility testing was performed using the modified Kirby-Bauer disk diffusion technique, and results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (CLSI 2016). A phenotypic test for MRSA detection was performed using cefoxitin (30 μg) disk. ResultsThe highest incidence of diabetic foot ulcers was observed in patients aged 41-50 years. There were 83 men and 17 women, with a male to female ratio of 4.882. Of the 100 collected samples, 73 were positive for microbial growth, and 27 samples showed no growth. Of the 73 positive cultures, monomicrobial infection was found in 48 patients, and polymicrobial infection was found in 25 patients. Gram-positive pathogens were isolated from 34 patients, and gram-negative microbes were isolated from 64 patients. Among all collected isolates (n=100), Staphylococcus aureus was the most predominant organism and Acinetobacter species was the least common (only two isolates). Among the gram-negative bacteria, Pseudomonas aeruginosa was predominant. All the isolated gram-positive bacteria were susceptible to vancomycin. Gramnegative bacteria were highly susceptible to colistin with the exception of Proteus species which is intrinsically resistant to colistin and it is not reported for Proteus species. ESBL producers were primarily found among Klebsiella species isolates (22.22%). Among 29 S. aureus isolates, 8 (27.5%) were found to be MRSA producers. ConclusionBased on the bacteriological profile of diabetic foot ulcers, S. aureus among the gram-positive isolates and P. aeruginosa among the gram-negative isolates were the predominant pathogens. Infections caused by multidrug-resistant bacteria such as MRSA and ESBL producers have been reported with increasing frequency. According to the antibiotic susceptibility pattern, treatment can be initiated, continued, or altered, thereby reducing morbidity in patients with diabetic foot ulcers.

Microbiological Detection of Some Pathogenic Bacteria in Diabetic Foot Ulcers of Type 1 and 2 Diabetic Mellitus Patients

“…S. aureus was the most common gram-positive bacteria and E. coli was the most common gram-negative bacterium responsible for DFUs, according to a similar finding by [22,26]. Additionally, similar outcomes in India and Iraq, respectively, were reported by [27,28].…”

Relative Abundance and Detection of Pseudomonas aeruginosa from Chronic Wound Infections Globally

“…There were 30 studies conducted in Asian countries that discussed the microbiology of wound infections and the prevalence of P. aeruginosa ( Figure 1 ). Countries that were represented in the literature search included China [ 69 , 70 , 71 ], India [ 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ], Indonesia [ 83 , 84 ], Iran [ 85 , 86 ], Kuwait [ 87 ], Lebanon [ 88 ], Malaysia [ 89 , 90 , 91 ], Pakistan [ 92 , 93 , 94 ], Singapore [ 95 ], Turkey [ 96 ], and Iraq [ 97 ]. Most of the included studies focused on diabetic foot infections, and the frequency of P. aeruginosa isolation was therefore comparable when all chronic wound infections were evaluated or if diabetic foot infections specifically were analyzed ( Figure 1 and Figure 2 ).…”

“…Contrary to the rest of the continent, P. aeruginosa was the most abundant pathogen in India and Malaysia. Of the 11 studies that took place in India, five of the investigations found that P. aeruginosa was the most commonly isolated organism, which was followed by S. aureus and members of the order Enterobacterales (mainly Escherichia coli and Klebsiella pneumoniae ), respectively [ 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ]. The reported frequency of P. aeruginosa isolation was also relatively consistent with a range of 16–30% in every Indian study.…”

Pie diabético y resistencia a los antibióticos durante la pandemia de COVID-19

“…La ulceración del pie diabético, pueden complicarse con infecciones, es una de las principales complicaciones, representan entre el 15-34% de las personas con (5,6) diabetes . La infección del pie diabético (IDF) es predominantemente polimicrobianas y (7,8) multirresistentes (MDR) con la capacidad de formar biopelículas . Existen reportes de aislamientos de bacterias resistentes a múltiples fármacos, como los productores de Staphylococcus Aureus resistente a la meticilina (MRSA) y betalactamasa de espectro (8) extendido (BLEE), con una frecuencia cada vez mayor .…”