Bacterial Pathogens and Antimicrobial Susceptibility Trends in Wound Infections among Diabetic Foot Ulcer Patients

International Journal of Medicine and Medical Sciences | Vol. 13, No. 11, November 2023 | pp. 81–88

DOI: 10.46882/2023/IJMMS/130081

Original Research Article

Bacterial Pathogens and Antimicrobial Susceptibility Trends in Wound Infections among Diabetic Foot Ulcer Patients

Elizabeth A. Cole¹, Moses Z. Tarawallie², Victoria N. Okoye¹*

¹Department of Medical Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

²Department of Medicine, Connaught Hospital, Freetown, Sierra Leone.

Abstract:

Diabetic foot ulcers (DFUs) are prone to polymicrobial infections, which can lead to osteomyelitis and lower limb amputation if treated with ineffective antibiotics. This prospective cross-sectional study identified the predominant bacterial pathogens and mapped their antimicrobial resistance trends in patients presenting with infected DFUs. Deep tissue biopsies or wound swabs were collected from 140 diabetic patients presenting with Wagner grade 2 to 4 foot ulcers. Bacterial isolation was achieved using standard microbiological criteria, and antimicrobial susceptibility testing was performed using the disk diffusion technique. A total of 185 bacterial isolates were recovered, showing a polymicrobial infection rate of 32.1%. Gram-negative bacilli predominated at 58.4%, with Pseudomonas aeruginosa (24.3%) and Escherichia coli (18.9%) being the most frequent, while Staphylococcus aureus was the most common Gram-positive isolate (35.1%). Antibiogram mapping revealed alarming resistance rates among S. aureus isolates to erythromycin (75.4%) and clindamycin (41.5%), with 38.5% confirmed as Methicillin-Resistant Staphylococcus aureus (MRSA). Gram-negative bacilli showed high resistance to ciprofloxacin (62.8%) and ceftazidime (58.3%), while remaining highly susceptible to amikacin (91.6%) and imipenem (94.4%). Logistic regression showed that a duration of diabetes > 10 years was strongly associated with MRSA infection (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01). Infected DFUs in this region show high rates of multi-drug resistant pathogens. Treatment should be guided by wound culture results rather than empirical protocols to improve healing outcomes and reduce amputation rates.

Keywords: Diabetic Foot Ulcer, Pseudomonas aeruginosa, Staphylococcus aureus, MRSA, Antimicrobial Resistance, Wound Biopsy

Manuscript Timeline: Received: August 18, 2023; Revised: September 25, 2023; Accepted: October 12, 2023; Published: November 15, 2023.

Citation: Cole EA, Tarawallie MZ, Okoye VN. Bacterial Pathogens and Antimicrobial Susceptibility Trends in Wound Infections among Diabetic Foot Ulcer Patients. International Journal of Medicine and Medical Sciences, 2023, 13(11): 81–88. DOI: 10.46882/2023/IJMMS/130081

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