Microbiological Profile and Antibiotic Sensitivity Pattern of Bacteria in Diabetic Foot Ulcers in a Tertiary Care Hospital
Keywords:
Diabetic Foot, Gram-Negative, E. coli, S. aureus
Abstract
Introduction: Diabetic foot is any foot pathology due to diabetes or sequelae of diabetes mellitus. This study was conducted to identify the common microorganisms isolated from diabetic foot and to analyse the antibiotic susceptibility pattern of bacteria isolated from diabetic foot. Materials and Method: The study was a hospital based cross-sectional study where 146 foot ulcer samples (who had type 2 diabetes) were analysed. Swabs were collected from the edge and margins of ulcers, and organisms were identified by gram staining culture and biochemical reactions. Result: Out of 146 patients, 69 specimens showed growth of organisms. Total 84 aerobic organisms were isolated and out of them, 64 cases showed bacterial growth, in which 84 bacteria were isolated, which represented an average of 1.28 organisms per case. Among these organisms, 62 gram-negative and 22 gram-positive organisms were isolated. E. coli was the most common gram-negative isolate (23.81%), followed by Pseudomonas aeruginosa (21.4%), and Klebsiella pneumonia (8.33%), while among gram-positive bacteria, S. aureus was the most common isolate (22.6%). Conclusion: Incidence of growth was 47.2% in which E. coli (23.8%) was the most common isolate. Gram-negative bacteria were more common than gram-positive bacteria. Diabetic foot infections are polymicrobial in nature.
How to cite this article:
Roy PG, Kumar K, Singh NP, Rnga GS, Giri S. Microbiological Profile and Antibiotic Sensitivity Pattern of Bacteria in Diabetic Foot Ulcers in a Tertiary Care Hospital. J Adv Res Med. 2021; 8(1): 1-8.
DOI: https://doi.org/10.24321/2349.7181.202101
References
1. WHO [Internet]. Global report on diabetes. 2017 [cited 2019 Feb 17]. Available from: https://www.who.int/ diabetes/global-report/en/
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5): 1047-1053. [PubMed] [Google Scholar].
3. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017 Mar;49(2):106-16. [PubMed] [Google Scholar].
4. Sargen MR, Hoffstad O, Margolis DJ. Geographic variation in Medicare spending and mortality for diabetic patients with foot ulcers and amputations. J Diabetes Complications. 2013 Mar-Apr;27(2):128. [PubMed] [Google Scholar].
5. Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke G-T et al. Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care. 2012 Oct;35(10):2021-7. [PubMed] [Google Scholar]
6. Collee JG, Mackie TJ, McCartney JE. Mackie & McCartney practical medical microbiology. [Internet]. 14th ed. New York: Churchill Livingstone; c1996. [cited 2019 May 11]. 978 p. Available from: https://www.worldcat.org/title/ mackie-mccartney-practical-medical-microbiology/ oclc/35714221
7. CLSI. [Internet]. Performance Standards for Antimicrobial Susceptibility Testing An informational supplement for global application developed through the Clinical and Laboratory Standards Institute consensus process. 26th ed. [cited 2019 May 11]. Available from: https://clsi. org/media/3481/m100ed30_sample.pdf
8. Jain M, Patel MH, Sood NK, Modi DJ, Vegad MM. Spectrum of Microbial Flora in Diabetic Foot Ulcer and Its Antibiotic Sensitivity Pattern in Tertiary Care Hospital in Ahmedabad, Gujarat. Natl J Med Res. 2012;2(3):3547. [Google Scholar].
9. Sekhar MS, Unnikrishnan MK, Rodrigues GS, Vyas N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot (Edinb). 2018 Dec;37:95100. [PubMed] [Google Scholar].
10. Benwan KA, Mulla AA, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health. 2012 Mar;5(1):1-8. [PubMed] [Google Scholar].
11. Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer. Diabetes Metab Syndr. 2018 May;12(3):417-21. [PubMed] [Google Scholar].
12. Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007 Jan;50(1):18-25. [PubMed] [Google Scholar].
13. Bansal E, Garg A, Bhatia S, Attri AK, Chander J. Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol. 2008 Apr-Jun;51(2):204-8. [PubMed] [Google Scholar]
14. Murali TS, Kavitha S, Spoorthi J, Bhat DV, Prasad ASB, Upton Z, et al. Characteristics of microbial drug resistance and its correlates in chronic diabetic foot ulcer infections. J Med Microbiol. 2014 Oct;63(Pt 10):1377-85. [PubMed] [Google Scholar].
15. Ramakant P, Verma AK, Misra R, Prasad KN, Chand G, Mishra A, et al. Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia. 2011 Jan;54(1):58-64. [PubMed] [Google Scholar].
16. Zubair M, Malik A, Ahmad J. Clinico-microbiological study and antimicrobial drug resistance profile of diabetic foot infections in North India. Foot (Edinb). 2011 Mar;21(1):6-14. [PubMed] [Google Scholar].
17. Chavan SK, Karande GS, Chavan KB. Bacterial Profile and Pattern of Antimicrobial Drug Resistance in Diabetic Foot Ulcers at Tertiary Care Hospital. Int J Med Res Rev. 2015 Jan-Feb;3(1):97-105.
18. Citron DM, Goldstein EJC, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-tosevere diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007 Sep;45(9):2819-28. [PubMed] [Google Scholar].
19. Endimiani A, Blackford M, Dasenbrook EC, Reed MD, Bajaksouszian S, Hujer AM, et al. Emergence of linezolidresistant Staphylococcus aureus after prolonged treatment of cystic fibrosis patients in Cleveland, Ohio. Antimicrob Agents Chemother. 2011 Apr;55(4):168492. [PubMed] [Google Scholar].
20. Hartemann-Heurtier A, Robert J, Jacqueminet S, Ha Van G, Golmard JL, Jarlier V, et al. Diabetic foot ulcer
and multidrug-resistant organisms: risk factors and impact. Diabet Med. 2004 Jul;21(7):710-5. [PubMed] [Google Scholar].
21. Shettigar K, Bhat DV, Satyamoorthy K, Murali TS. Severity of drug resistance and co-existence of Enterococcus faecalis in diabetic foot ulcer infections. Folia Microbiol (Praha). 2018 Jan;63(1):115-22. [PubMed] [Google Scholar].
22. Tiwari S, Pratyush DD, Dwivedi A, Gupta SK, Rai M, Singh SK. Microbiological and clinical characteristics of diabetic foot infections in northern India. J Infect Dev Ctries. 2012 Apr;6(4):329-32. [PubMed] [Google Scholar].
23. Shahi SK, Singh VK, Kumar A. Detection of Escherichia coli and associated β-lactamases genes from diabetic foot ulcers by multiplex PCR and molecular modeling and docking of SHV-1, TEM-1, and OXA-1 β-lactamases with clindamycin and piperacillin-tazobactam. PLoS One. 2013 Jul;8(7):e68234. [PubMed] [Google Scholar].
24. Lee J, Oh CE, Choi EH, Lee HJ. The impact of the increased use of piperacillin/tazobactam on the selection of antibiotic resistance among invasive Escherichia coli and Klebsiella pneumoniae isolates. Int J Infect Dis. 2013 Aug;17(8):e638-43. [PubMed] [Google Scholar].
25. Anvarinejad M, Pouladfar G, Japoni A, Bolandparvaz S, Satiary Z, Abbasi P, et al. Isolation and Antibiotic Susceptibility of the Microorganisms Isolated from Diabetic Foot Infections in Nemazee Hospital, Southern Iran. J Pathog. 2015;2015:1-7. [PubMed] [Google Scholar].
26. Nair S, Peter S, Sasidharan A, Sistla S, Kodakara A, Unni K. Incidence of Mycotic Infections in Diabetic Foot Tissue. J Culture Collections. 2006;5(1):85-9. [Google Scholar].
27. Eckhard M, Lengler A, Liersch J, Bretzel RG, Mayser P. Fungal foot infections in patients with diabetes mellitus --results of two independent investigations. Mycoses. 2007;50 Suppl 2:14-9. [PubMed] [Google Scholar].
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5): 1047-1053. [PubMed] [Google Scholar].
3. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017 Mar;49(2):106-16. [PubMed] [Google Scholar].
4. Sargen MR, Hoffstad O, Margolis DJ. Geographic variation in Medicare spending and mortality for diabetic patients with foot ulcers and amputations. J Diabetes Complications. 2013 Mar-Apr;27(2):128. [PubMed] [Google Scholar].
5. Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke G-T et al. Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care. 2012 Oct;35(10):2021-7. [PubMed] [Google Scholar]
6. Collee JG, Mackie TJ, McCartney JE. Mackie & McCartney practical medical microbiology. [Internet]. 14th ed. New York: Churchill Livingstone; c1996. [cited 2019 May 11]. 978 p. Available from: https://www.worldcat.org/title/ mackie-mccartney-practical-medical-microbiology/ oclc/35714221
7. CLSI. [Internet]. Performance Standards for Antimicrobial Susceptibility Testing An informational supplement for global application developed through the Clinical and Laboratory Standards Institute consensus process. 26th ed. [cited 2019 May 11]. Available from: https://clsi. org/media/3481/m100ed30_sample.pdf
8. Jain M, Patel MH, Sood NK, Modi DJ, Vegad MM. Spectrum of Microbial Flora in Diabetic Foot Ulcer and Its Antibiotic Sensitivity Pattern in Tertiary Care Hospital in Ahmedabad, Gujarat. Natl J Med Res. 2012;2(3):3547. [Google Scholar].
9. Sekhar MS, Unnikrishnan MK, Rodrigues GS, Vyas N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot (Edinb). 2018 Dec;37:95100. [PubMed] [Google Scholar].
10. Benwan KA, Mulla AA, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health. 2012 Mar;5(1):1-8. [PubMed] [Google Scholar].
11. Noor S, Raghav A, Parwez I, Ozair M, Ahmad J. Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer. Diabetes Metab Syndr. 2018 May;12(3):417-21. [PubMed] [Google Scholar].
12. Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007 Jan;50(1):18-25. [PubMed] [Google Scholar].
13. Bansal E, Garg A, Bhatia S, Attri AK, Chander J. Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol. 2008 Apr-Jun;51(2):204-8. [PubMed] [Google Scholar]
14. Murali TS, Kavitha S, Spoorthi J, Bhat DV, Prasad ASB, Upton Z, et al. Characteristics of microbial drug resistance and its correlates in chronic diabetic foot ulcer infections. J Med Microbiol. 2014 Oct;63(Pt 10):1377-85. [PubMed] [Google Scholar].
15. Ramakant P, Verma AK, Misra R, Prasad KN, Chand G, Mishra A, et al. Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia. 2011 Jan;54(1):58-64. [PubMed] [Google Scholar].
16. Zubair M, Malik A, Ahmad J. Clinico-microbiological study and antimicrobial drug resistance profile of diabetic foot infections in North India. Foot (Edinb). 2011 Mar;21(1):6-14. [PubMed] [Google Scholar].
17. Chavan SK, Karande GS, Chavan KB. Bacterial Profile and Pattern of Antimicrobial Drug Resistance in Diabetic Foot Ulcers at Tertiary Care Hospital. Int J Med Res Rev. 2015 Jan-Feb;3(1):97-105.
18. Citron DM, Goldstein EJC, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-tosevere diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007 Sep;45(9):2819-28. [PubMed] [Google Scholar].
19. Endimiani A, Blackford M, Dasenbrook EC, Reed MD, Bajaksouszian S, Hujer AM, et al. Emergence of linezolidresistant Staphylococcus aureus after prolonged treatment of cystic fibrosis patients in Cleveland, Ohio. Antimicrob Agents Chemother. 2011 Apr;55(4):168492. [PubMed] [Google Scholar].
20. Hartemann-Heurtier A, Robert J, Jacqueminet S, Ha Van G, Golmard JL, Jarlier V, et al. Diabetic foot ulcer
and multidrug-resistant organisms: risk factors and impact. Diabet Med. 2004 Jul;21(7):710-5. [PubMed] [Google Scholar].
21. Shettigar K, Bhat DV, Satyamoorthy K, Murali TS. Severity of drug resistance and co-existence of Enterococcus faecalis in diabetic foot ulcer infections. Folia Microbiol (Praha). 2018 Jan;63(1):115-22. [PubMed] [Google Scholar].
22. Tiwari S, Pratyush DD, Dwivedi A, Gupta SK, Rai M, Singh SK. Microbiological and clinical characteristics of diabetic foot infections in northern India. J Infect Dev Ctries. 2012 Apr;6(4):329-32. [PubMed] [Google Scholar].
23. Shahi SK, Singh VK, Kumar A. Detection of Escherichia coli and associated β-lactamases genes from diabetic foot ulcers by multiplex PCR and molecular modeling and docking of SHV-1, TEM-1, and OXA-1 β-lactamases with clindamycin and piperacillin-tazobactam. PLoS One. 2013 Jul;8(7):e68234. [PubMed] [Google Scholar].
24. Lee J, Oh CE, Choi EH, Lee HJ. The impact of the increased use of piperacillin/tazobactam on the selection of antibiotic resistance among invasive Escherichia coli and Klebsiella pneumoniae isolates. Int J Infect Dis. 2013 Aug;17(8):e638-43. [PubMed] [Google Scholar].
25. Anvarinejad M, Pouladfar G, Japoni A, Bolandparvaz S, Satiary Z, Abbasi P, et al. Isolation and Antibiotic Susceptibility of the Microorganisms Isolated from Diabetic Foot Infections in Nemazee Hospital, Southern Iran. J Pathog. 2015;2015:1-7. [PubMed] [Google Scholar].
26. Nair S, Peter S, Sasidharan A, Sistla S, Kodakara A, Unni K. Incidence of Mycotic Infections in Diabetic Foot Tissue. J Culture Collections. 2006;5(1):85-9. [Google Scholar].
27. Eckhard M, Lengler A, Liersch J, Bretzel RG, Mayser P. Fungal foot infections in patients with diabetes mellitus --results of two independent investigations. Mycoses. 2007;50 Suppl 2:14-9. [PubMed] [Google Scholar].
Published
2021-03-31
Section
Research Article
