Diversity of microbiological pathogens in diabetic foot ulcers in an African population
DOI:
https://doi.org/10.18203/2320-6012.ijrms20232770Keywords:
Diabetes mellitus, Diabetic foot ulcer, Microbiology, NigeriaAbstract
Background: Diabetic foot ulcer is a devastating complication of diabetes and the commonest cause of non-traumatic amputation worldwide. It constitutes a huge socioeconomic burden to the patient and health care system. The aim of this study was to determine the spectrum of bacterial isolates cultured from diabetic foot ulcers and assess their in vitro susceptibility to commonly used antibacterial agents.
Methods: The study was a retrospective descriptive study where records of all diabetic foot ulcer samples sent to the microbiology department for microscopy, culture and sensitivity between January 2020 to December 2021 were extracted. The bacteriological isolation and antimicrobial sensitivity tests of the isolates was carried out by standard microbiological methods.
Results: A total of sixty-one patients results were retrieved and included in this study. The commonest organism isolated was Staphylococcus aureus which constituted almost half 40 (46.0%) of the organisms isolated, followed by Escherichia coli and Proteus mirabilis which accounted for 23.0% and 18.4% respectively of the organisms. Pseudomonas aeruginosa was the least common organism and was seen in only 3 (3.4%) samples. Concerning antibiotic sensitivity, 55.0% of S. aureus, 50.0% of K. pneumoniae, 60.0% of E coli and P. mirabilis were sensitive to cefpodoxime whereas 50.0% of S. aureus and K. pneumoniae, 90% of E coli and 68.8% of P. mirabilis were sensitive to cefuroxime.
Conclusions: Diabetic foot ulcers are infected with polymicrobial organisms and S. aureus was the predominant organism isolated. However, there is an emerging pattern in the spectrum of antibiotic sensitivity which is an important consideration in management.
References
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(1):37-53.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28.
Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13(1)16.
Macdonald KE, Boeckh S, Stacey HJ, Jones JD. The microbiology of diabetic foot infections: a meta-analysis. BMC Infect Dis. 2021;21(1)770.
Unachukwu CN, Obunge OK, Odia OJ. The bacteriology of diabetic foot ulcers in Port Harcourt. Niger J Med. 2005;14(2):173-6.
Anyim O, Okafor C, Young E, Obumneme-Anyim I, Nwatu C. Pattern and microbiological characteristics of diabetic foot ulcers in a Nigerian tertiary hospital. Afr Health Sci. 2019;19(1):1617-27.
Hena JV, Growther L. Studies on bacterial infections of diabetic foot ulcer. Afr J Cln Exp Microbiol. 2010;11(3):146-9.
Otu AA, Umoh VA, Essien OE, Enang OE, Okpa HO, Mbu PN, et al. Profile, bacteriology, and risk factors for foot ulcers among diabetics in a tertiary hospital in Calabar, Nigeria. Ulcers. 2013;2013:820468.
Gerstein AC, Rosenberg A, Hecht I, Berman J. diskImageR: quantification of resistance and tolerance to antimicrobial drugs using disk diffusion assays. Microbiology. 2016 l;162(7):1059.
Amaefule KE, Dahiru IL, Okpe IO, Aliyu S, Aruna A. A clinico-microbial profile of diabetic foot infections in Zaria, North-West Nigeria. Sahel Med J. 2019;22(1):28-32.
Fatima HK, Suhad HM. Microbiological profile, antibiogram, and risk factors of patients with diabetic foot infections: A systemic metaanalysis. Biomed Biotechnol Res J. 2021;5(3):235-44.
Tong T, Yang C, Tian W, Liu Z, Liu B, Cheng J, et al. Phenotypes and outcomes in middle-aged patients with diabetic foot ulcers: a retrospective cohort study. J Foot Ankle Res. 2020;13(1):1-8.
Dinh T, Veves A. The influence of gender as a risk factor in diabetic foot ulceration. Wounds. 2008;20(5):127-31.
Otu AA, Umoh VA, Essien OE, Enang OE, Okpa HO, Mbu PN. Profile, bacteriology, and risk factors for foot ulcers among diabetics in a tertiary hospital in Calabar, Nigeria. Ulcers. 2013;2013.
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;54:58-64.
Hitam SAS, Hassan SA, Maning N. The significant association between polymicrobial diabetic foot infection and its severity and outcomes. Malay J Med Sci. 2019;26(1):107-14.
Miyan Z, Fawwad A, Sabir R, Basit A. Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country. J Pak Med Assoc. 2017;67(5):665-9.
Atlaw A, Kebede HB, Abdela AA, Woldeamanuel Y. Bacterial isolates from diabetic foot ulcers and their antimicrobial resistance profile from selected hospitals in Addis Ababa, Ethiopia. Front Endocrinol. 2022;13:987487.
Dwedar R, Ismail DK, Abdulbaky A. Diabetic foot infection: microbiological causes with special reference to their antibiotic resistance pattern. Egypt J Med Microbiol. 2015;24:95-102.
Amogne W, Reja A, Amare A. Diabetic foot disease in Ethiopian patients: a hospital based study. Ethiop J Health Develop. 2011;25(1):17-21.
Shanmugam P, Jeya M. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Dign Res. 2013;7(3):441.
Nwankwo EO, Nasiru MS. Antibiotic sensitivity pattern of Staphylococcus aureus from clinical isolates in a tertiary health institution in Kano, Northwestern Nigeria. Pan Afr Med J. 2011;8:4.
Macdonald KE, Jordan CY, Crichton E, Barnes JE, Harkin GE, Hall LM, et al. A retrospective analysis of the microbiology of diabetic foot infections at a Scottish tertiary hospital. BMC Infect Dis. 2020;20:1-7.
Edo AE, Eregie A. Bacteriology of diabetic foot ulcers in Benin City, Nigeria. Diabetes Int. 2007:21-3.
Ikeh EI, Peupet F, Nwadiaro C. Studies on diabetic foot ulcers in patients at Jos University Teaching Hospital, Nigeria. Afr J Clin Exp Microbiol. 2003;4(2):52-61.
Yefou MD, Jingi AM, Etoga MC, Mekobe FM, Agoons BB, Ngassam E, et al. Bacterial profile of diabetic foot infections and antibiotic susceptibility in a specialized diabetes centre in Cameroon. Pan Afr Med J. 2022;42.
Al Benwan K, Al Mulla A, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health. 2012;5(1):1-8.
Goh TC, Bajuri MY, C Nadarajah S, Abdul Rashid AH, Baharuddin S, Zamri KS. Clinical and bacteriological profile of diabetic foot infections in a tertiary care. J Foot Ankle Res. 2020;13(1):1-8.
Ramani A, Ramani R, Shivananda PG, Kundaje GN. Bacteriology of diabetic foot ulcers. Indian J Pathol Microbiol. 1991;34(2):81-7.
