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Analysis of Diabetic Foot Ulcers in a Tertiary Care hospital-a clinico-microbiological Perspective

Objective: To assess potential risk factors for diabetic foot ulcers infected with multidrug-resistant-organisms (MDROs) and to investigate antibiotic susceptibility patterns and extended spectrum-β-lactamase (ESBL) -production in bacteria isolated from these ulcers. Methods: Seventy-seven diabetic foot ulcer-patients were studied in a consecutive series. Forty-four study factors were recorded for each patient. Specimens were obtained by scraping the ulcer base or the deep portion of the wound edge with a sterile curette. The soft tissue specimens were quickly sent to the laboratory and processed for microbial pathogens. Gram-negative bacterial isolates were tested for ESBL production by double-disc diffusion method. The association of study variables with MDRO and non-MDRO infection status of ulcers was tested by Student's t test or Fisher's exact test using SPSS (version 11.5, Chicago). Results: An alarming number of patients were MDRO-positive (72.7%). ESBL-positive strains constituted 19.8% of total isolates. Staphylococcal isolates identified as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Staphylococcus aureus (VRSA), were 3.7% (n=8) and 0.5% (n=1) respectively. Twenty-two study factors were found to be significantly associated with MDRO infection status of ulcers in the univariate analysis. Multiple logistic regressions proved that MDRO status was the only significant, independent predictor of glycemic control (Odds ratio=4.22, P＜0.01). Conclusion: It is concluded that MDRO infected patients have poor glycemic control. Imipenem and linezolid can be suggested as the drugs of choice in the described setting.