Diabetic Foot Ulcer Infections and Pseudomonas aeruginosa Biofilm Production During the COVID-19 Pandemic

Abstract

During the different waves of the coronavirus (COVID-19) pandemic, there has been an increased incidence of diabetes mellitus and diabetic foot infections. Among gram-negative bacteria, Pseudomonas aeruginosa is the predominant causative agent for diabetic foot ulcer infections in low-resource countries. P. aeruginosa possesses a variety of virulence factors, including biofilm formation. Biofilm formation is an important benchmark characteristic in the pathophysiology of diabetic foot ulceration. The main objective of the current study was to identify the most commonly isolated organisms and their antibiotic susceptibility patterns in diabetic foot patients during the COVID-19 pandemic. We also determined the genes associated with bacterial persistence and biofilm formation in the predominantly isolated organism. Accordingly, 100 wound swab samples were collected from diabetic foot patients from different hospitals in Alexandria, Egypt. Through phenotypic detection of biofilm formation, 93% (40) of the 43 P. aeruginosa isolates examined were categorized as biofilm producers. Molecular detection of the biofilm-encoding genes among the 43 P. aeruginosa isolates was as follows: algD (100%), pelF (88%) and pslD (49.7%), and this highlights a need for biofilm formation inhibitors to prevent the persistence of bacterial pathogens, and thus achieve better clinical outcomes in diabetic foot ulcer infections.

Resistance Profile of Bacteria Isolated from Diabetic Wounds: Phytochemicals and Antibacterial Studies of Eriosema robustum Leaf Extracts

“…However, isolate S.au 10 was susceptible to gentamicin, ciprofloxacin, and vancomycin with inhibition diameters of 20, 28, and 24 mm, respectively. This result is similar to [34], who reported that 96 % of S. aureus strains were resistant to tetracycline and methicillin, with varying degrees of resistance to other antibiotics. Regarding P. aeruginosa, P.ae1 and P.ae4 were sensitive to all antibiotics tested, while P.ae2 was resistant to 3 antibiotics, namely amoxicillin, gentamicin, and erythromycin, with inhibition diameters of 06, 10, and 08 mm, respectively.…”

“…Among the remaining 42.86 % of gram-negative bacteria, P. aeruginosa was the most frequently detected (24 %). These findings are supported by [33,34], who also identified P. aeruginosa as the primary gram-negative bacterium responsible for diabetic wound infections. The high prevalence of S. aureus and P. aeruginosa in diabetic wounds can be attributed to their ability to utilize sugar as an energy source and also their resistance to various antibiotic classes.…”

Phenotypic and molecular detection of biofilm production by P. aeruginosa isolated from different clinical cases

“…The results showed that the presence of algD gene was in a rate of 65% of the total isolates, fig (3).This is compatible with Garallah, et al (29) who got a percentage of 65.38%, but not compatible with Yang, et al (30), as the presence of this gene was 98.49% in the mentioned study. The results also showed the presence of pslD gene in a percentage of 70% , fig ( 4), this is agreed with Ghadaksaz, et al (31), as the percentage of this gene of that study was 83.7%, but didn't agree with Abdelwahab and Yakout (32) whose detected this gene in just 49.7% of their total isolates. Finally, the results showed the presence of pelF gene in 70% of the total isolates, fig (5), this is close related to the percentage of Pournajaf, et al (33), whose detected this gene in about 57.3% , but far from the results of Yanget al (30), as the gene is found in most of the bacterial isolates of that study 96.48%.…”

Whole-Genome Sequencing-Based Resistome Analysis of Nosocomial Multidrug-Resistant Non-Fermenting Gram-Negative Pathogens from the Balkans

“…The most common and severe NFGNB is P. aeruginosa , which is frequently found to be involved in a wide variety of nosocomial infections, particularly infecting patients with predisposing factors, such as burn victims, immunocompromised hosts, or those with metabolic disorders [ 15 , 16 , 17 ]. It is also recognized as a predominant cause of pulmonary disease and mortality in patients with cystic fibrosis [ 18 ].…”