Prevalence and Antimicrobial Resistance of Bacterial Pathogens in Diabetic Foot Infections: A Clinical Microbiological Study
DOI:
https://doi.org/10.63682/jns.v13i1.9218Keywords:
Diabetic foot infections, antimicrobial resistance, bacterial pathogens, Escherichia coli, Staphylococcus aureus, Klebsiella.Abstract
Background: Diabetic foot infections (DFIs) are a major complication of diabetes mellitus, frequently associated with antimicrobial resistance and poor clinical outcomes.
Objective: To determine the prevalence of bacterial pathogens in diabetic foot infections and assess their antimicrobial susceptibility patterns.
Methodology: This cross-sectional study was conducted at the Medical Unit of Northwest General Hospital and Research Center, Peshawar, from December 2019 to June 2020. A total of 140 adult diabetic patients aged 20–70 years with clinically diagnosed DFIs were included. Specimens were collected from ulcers, processed using standard bacteriological techniques, and antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method according to CLSI guidelines. Data were analyzed with SPSS version 22.0.
Results: The mean age of patients was 60.4 ± 7.8 years, with 70.71% males and 29.29% females. The most frequent ulcer grade was Wagner grade 2 (45.00%). Escherichia coli was the most prevalent isolate (53.57%), followed by Staphylococcus aureus (21.43%), Klebsiella species (18.57%), and Streptococcus species (6.43%). Pathogen distribution varied with age and ulcer severity, with Klebsiella significantly higher in older patients (23.53% vs. 5.26%, p=0.013) and Streptococcus species more common in grade 3 ulcers (11.63%, p=0.000). Patients with a history of toe or foot amputation showed a higher prevalence of Klebsiella (22.77% vs. 7.69%, p=0.039). Antimicrobial susceptibility revealed high resistance among Gram-negative organisms to cephalosporins, whereas carbapenems demonstrated comparatively better activity.
Conclusion: Escherichia coli was the predominant pathogen in DFIs, and high resistance to commonly used antibiotics highlights the need for ongoing surveillance and rational antibiotic prescribing.
Downloads
References
Hurlow JJ, Humphreys GJ, Bowling FL, McBain AJ. Diabetic foot infection: A critical complication. International wound journal. 2018 Oct;15(5):814-21. https://doi.org/10.1111/iwj.12932.
Maity S, Leton N, Nayak N, Jha A, Anand N, Thompson K, Boothe D, Cromer A, Garcia Y, Al-Islam A, Nauhria S. A systematic review of diabetic foot infections: pathogenesis, diagnosis, and management strategies. Frontiers in Clinical Diabetes and Healthcare. 2024 Aug 6;5:1393309. https://doi.org/10.3389/fcdhc.2024.1393309.
Yousif D, Yousif Z, Joseph P. Diabetic foot ulcer neuropathy, impaired vasculature, and immune responses. InDiabetic Foot Ulcers-Pathogenesis, Innovative Treatments and AI Applications 2024 Mar 26. IntechOpen. DOI: 10.5772/intechopen.1003834.
Noor S, Khan RU, Ahmad J. Understanding diabetic foot infection and its management. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017 Apr 1;11(2):149-56. https://doi.org/10.1016/j.dsx.2016.06.023.
Abbas ZG. Managing the diabetic foot in resource-poor settings: challenges and solutions. Chronic Wound Care Management and Research. 2017 Oct 27:135-42. https://doi.org/10.2147/CWCMR.S98762
Hawkins BK, Barnard M, Barber KE, Stover KR, Cretella DA, Wingler MJ, Wagner JL. Diabetic foot infections: A microbiologic review. The Foot. 2022 May 1;51:101877. https://doi.org/10.1016/j.foot.2021.101877
Eleftheriadou I, Tentolouris N, Argiana V, Jude E, Boulton AJ. Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs. 2010 Oct;70(14):1785-97. https://doi.org/10.2165/11538070-000000000-00000
Woldeteklie AA, Kebede HB, Abdela AA, Woldeamanuel Y. Prevalence of extended-spectrum β-lactamase and carbapenemase producers of gram-negative bacteria, and methicillin-resistant Staphylococcus aureus in isolates from diabetic foot ulcer patients in Ethiopia. Infection and Drug Resistance. 2022 Jan 1:4435-41. https://doi.org/10.2147/IDR.S371431
Yan X, Song JF, Zhang L, Li X. Analysis of risk factors for multidrug-resistant organisms in diabetic foot infection. BMC Endocrine Disorders. 2022 Feb 21;22(1):46. https://doi.org/10.1186/s12902-022-00957-0
Lipsky BA. Diabetic foot infections: Current treatment and delaying the ‘post‐antibiotic era’. Diabetes/metabolism research and reviews. 2016 Jan;32:246-53. https://doi.org/10.1002/dmrr.2739
Kaimkhani GM, Siddiqui AA, Rasheed N, Rajput MI, Kumar J, Khan MH, Nisar S, Mustafa S, Yaqoob U, Rajput IM, Khan MH. Pattern of infecting microorganisms and their susceptibility to antimicrobial drugs in patients with diabetic foot infections in a tertiary care hospital in Karachi, Pakistan. Cureus. 2018 Jun 25;10(6). DOI: 10.7759/cureus.2872.
Lienard A, Hosny M, Jneid J, Schuldiner S, Cellier N, Sotto A, La Scola B, Lavigne JP, Pantel A. Escherichia coli isolated from diabetic foot osteomyelitis: clonal diversity, resistance profile, virulence potential, and genome adaptation. Microorganisms. 2021 Feb 13;9(2):380.
Abalkhail A, Elbehiry A. Methicillin-resistant Staphylococcus aureus in diabetic foot infections: protein profiling, virulence determinants, and antimicrobial resistance. Applied Sciences. 2022 Oct 25;12(21):10803. https://doi.org/10.3390/app122110803.
Liu C, Shi J, Guo J. High prevalence of hypervirulent Klebsiella pneumoniae infection in the genetic background of elderly patients in two teaching hospitals in China. Infection and drug resistance. 2018 Jul 7:1031-41. https://doi.org/10.2147/IDR.S161075
Dörr S, Freier F, Schlecht M, Lobmann R. Bacterial diversity and inflammatory response at first-time visit in younger and older individuals with diabetic foot infection (DFI). Acta Diabetologica. 2021 Feb;58(2):181-9. https://doi.org/10.1007/s00592-020-01587-5.
Dharod M. Diabetic foot: microbiology, pathogenesis and glycan studies (Doctoral dissertation, University of Westminster). https://doi.org/10.34737/9057z.
Kandemir Ö, Akbay E, Şahin E, Milcan A, Gen R. Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. Journal of Infection. 2007 May 1;54(5):439-45. https://doi.org/10.1016/j.jinf.2006.08.013.
Eslami M, Safaripour A, Banihashemian SZ, Nikjoo Niaragh S, Hemmati MA, Shojaeian A, Fakhariyan S, Rabbani A, Oksenych V. Innovative antibiotic therapies for carbapenem-resistant gram-negative bacterial infections: clinical efficacy, safety, and comparative studies. Microorganisms. 2025 Jan 29;13(2):295. https://doi.org/10.3390/microorganisms13020295
Zhang F, Yang C, Li M, Peng Y, Xie X, Ji X, Niu S. Characterization of Microbial Profiles and Antimicrobial Resistance in Diabetic Foot Ulcers at a Tertiary Care Facility in Northern China. Diabetes Therapy. 2025 Aug 4:1-7. https://doi.org/10.1007/s13300-025-01778-9.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
