Microbial Infection and Antibiotic Susceptibility of Diabetic Foot Ulcer in China: Literature Review

Abstract

ObjectiveTo investigate the microbial spectrum isolated from foot ulcers among diabetic patients in China, which was conducted to help clinicians choose optimal antibiotics empirically.MethodThe PubMed, MEDLINE, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases were searched for studies published between 2015 to 2019, that report primary data on diabetic foot infection (DFI) and antibiotic susceptibility in China.ResultA total of 63 articles about DFI and antibiotic susceptibility tests among diabetic patients in China were included. There were 11,483 patients with an average age of 60.2 ± 10.1 years and a mean course of 10.6 ± 5.0 years between 2010 and 2019, covering most geographical regions of China. The prevalence of Gram-positive (GP) bacteria (43.4%) was lower than that of Gram-negative (GN) (52.4%). The most prevalent pathogens isolated were Staphylococcus aureus (17.7%), Escherichia coli (10.9%), Pseudomonas aeruginosa (10.5%), Klebsiella pneumoniae (6.2%), Staphylococcus epidermidis (5.3%), Enterococcus faecalis (4.9%), and fungus (3.7%). The prevalence of polymicrobial infection was 22.8%. GP bacteria were sensitive to linezolid, vancomycin, and teicoplanin. More than 50% of GN bacteria were resistant to third-generation cephalosporins, while the resistance rates of piperacillin/tazobactam, amikacin, meropenem, and imipenem were relatively low. Among the 6017 strains of the isolated organisms, 20% had multi-drug resistance (MDR). Staphylococcus aureus (30.4%) was the most predominant MDR bacteria, followed by extended-spectrum β-lactamase (ESBL) (19.1%).ConclusionThe microbial infection of foot ulcers among diabetic patients in China is diverse. The microbial spectrum is different in different geographic regions and Staphylococcus aureus is the predominant bacteria. Polymicrobial and MDR bacterial infections on the foot ulcers are common. This study could be valuable in guiding the empirical use of antibiotics for diabetic foot infections.

Diabetic foot ulcers: Classification, risk factors and management

“…In the early stage, DFU usually shows monomicrobial infections, while polymicrobial infections are observed in the middle-to-late stages[ 141 ]. Polymicrobial infections and their interactions in the DFU can delay or even stop wound healing[ 142 ]. Current clinical guidelines recommend systemic antimicrobial therapy for patients with DFI[ 85 , 139 ], and the formulation of a specific medication regimen is important in this regard.…”

Bacteriological profile of diabetic foot infections and their antibiotic treatment of choice

“…En cuanto a la proporción de los grupos Gram positivos y Gram negativos, en la presente revisión se determinó que las bacterias Gram negativas constituyeron el grupo de mayor predomino en el 67 % de los artículos revisados, por ejemplo Saltoglu et al (17) realizaron un estudio que incluyó 791 pacientes y se aislaron un total de 536 microorganismos, donde las bacterias Gram negativas constituyeron el mayor porcentaje (56,1 %) y los agentes bacterianos más frecuentes fueron Staphylococcus aureus (20 %), Pseudomona aeruginosa (18 %), Escherichia coli (12,3 %), Enterococcus spp (11,9 %) y Proteus spp (5,9 %). Esto coincide con el trabajo de revisión de la literatura de Fang Du, et al (20) que reportaron un predomino de organismo Gram negativos (52,4 %) de un global de 12292 cepas de bacterias aisladas tras la recopilación de 63 artículos revisados.…”

Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil

“…In a recent study conducted at China, more than 50% of Gram-negative bacteria were resistant to third-generation cephalosporins, while the resistance rates of piperacillin/tazobactam, amikacin, meropenem, and imipenem were relatively low [ 30 ].…”