Bacterial etiology, antibiotic resistance profile and foot ulcer associated amputations in individuals with Type II diabetes mellitus

Objective: In this study, bacterial etiology, antibiotic resistance profile and clinical outcomes of foot ulcer associated amputations in persons with diabetes were analyzed.Methods: A total of 126 persons with Diabetic Foot Ulcer (DFU) admitted in surgical ward from June 2016 to May 2018 were included in this study. Foot ulcers were categorized as per Wagner's classification. Tissue samples obtained from the ulcers were processed for bacterial cultures using conventional techniques. Antibiotic sensitivity of the isolates was done by Kirby-Bauer's Disc Diffusion method.Results: Out of 126 persons with diabetes, 74.6% of them had diabetes for 1-5 years. The minimum and maximum levels of HbA1c were 3% and 10.7%, respectively. Majority (58.7%) of the persons with diabetes had foot ulcers for less than a month. Wagner's grade 3 ulcer was found to be high (38.1%) among the studied patients. Amputation due to foot ulcer was done in 28.6% of patients of which most of them were under insulin therapy. About 75% of amputated patients had DFU which was complicated by Gram -negative bacterial (GNB) infections. Escherichia coli (27.4%) was the predominant bacterium isolated among the GNB where as Staphylococcus aureus (13.4%) was the predominant one among Gram-positive bacteria. S. aureus isolates were highly resistant to penicillin (85%) followed by gentamicin (45.5%) and ciprofloxacin (40.9%). Enterobacteriaceae isolates showed high level of resistance to co-trimoxazole (84.4%). Imipenem was the most sensitive drug (100%) against GNB isolated from DFU.Conclusion: In this study, the Gram-negative bacteria are the major aetiological agents isolated from the amputated patients with diabetes mellitus. Incidence of multi-drug resistant bacteria associated DFU could be the major burden and limit the availability of antibiotic treatment regimens.(c) 2023 The Authors. Published by Elsevier B.V.