Bacteriological Profile and their Drug Sensitivity Profile in Diabetic Foot Ulcer, a Report from a Tertiary Care Center

Aim: This study aims to identify different microorganisms involved inDiabetic foot ulcers (DFU), compare their antibiotic sensitivity, and find the best combination of empirical antibiotics to treat patients.

Study Design: This is a Prospective observational study of patients treated at Tertiary Health Care Centre, Pune.

Type of Study: Prospective and observational hospital-based study.

Period of Study: From February 2021 to January 2022.

Sample Size: Tissue culture samples were collected from 100 patients.

Results: 81 male and 19 female patients participated in this research.

In this study, according to Wagner’s grading system, 6 patients have Grade 1 ulcers, 21 patients have grade 2 ulcers, 48 patients have grade 3 ulcers, 21 patients have grade 4, and 4 patients have grade 5 ulcers.

Out of 100 cases, 62 patients had neuropathic conditions, 18 patients had neuropathic cases combined with sepsis, 11 patients had neuro ischemic conditions, and 9 had neuro ischemia plus sepsis.

In our study, there were 31 (31%) polymicrobial cases, 65 (65%) monomicrobial cases, and 4 (4%) cases in which the culture was sterile.

Gram-negative bacterial growths were present in 59 (59%) cases compared to 41 (41%) cases where Gram-positive bacterial growths were present.

aureus (26%) was the most common bacteria isolated, followed by E. coli (20%) and Enterococcus spp (15 percent). Extended-spectrumbeta-lactamase (ESBL) producers made up 53% of the Gram-negative bacteria, Methicillin-resistant staphylococcus aureus (MRSA) made up 41%, and Vancomycin-resistant enterococci (VRE). made up 19%.
Discussion: Most of the patients (63%) in this study were over 45 years old This could be due to a higher incidence of comorbidities.

Higher male prevalence is comparable with a study by Harrison and Lederberg. This might be because men engage in more outdoor physical activity than women, especially in hot, humid environments, with poor foot care.

While GPC was more prevalent in Grades 1 and 2, Gram-negative bacilli and mixed infections were common in Grades 3 and 4, suggesting that Gram-negative infections were associated with severity in DFU and some cases needing limb amputation.

Frequent hospitalization, frequent use of broad-spectrum antibiotics, insufficient surgical source reduction, chronic wounds, irrational use of antibiotics, and the transmission of resistance genes via transport methods are possible causes of MDR. Clinicians should use antibiotics judiciously, on time, and in sufficient amounts, and the relevant organizations should periodically monitor drug intake.

Conclusion: This study demonstrated that among the isolates from the DFUs, multidrug-resistant bacteria predominated. Determining the antibiotics for the empirical therapy of diabetic ulcers will be made easier with knowledge of the pattern of antibiotic resistance among the isolates. Thus, the likelihood of subsequent development of antibiotic resistance as well as the indiscriminate use of antibiotics can be reduced.