FREQUENCY OF COMMON BACTERIA AND THEIR ANTIBIOTIC SENSITIVITY PATTERN IN DIABETICS PRESENTING WITH FOOT ULCER

Authors

  • Fawad Rahim Department of Medicine, *Department of Surgery, Khyber Teaching Hospital, Peshawar
  • Fahim Ullah Department of Medicine, *Department of Surgery, Khyber Teaching Hospital, Peshawar
  • Muhammad Ishfaq Department of Medicine, *Department of Surgery, Khyber Teaching Hospital, Peshawar
  • Ayesha Khan Afridi Department of Medicine, *Department of Surgery, Khyber Teaching Hospital, Peshawar
  • Sadiq ur Rahman Khyber Teaching Hospital, Peshawar
  • Hassan Rahman Khyber Teaching Hospital, Peshawar

Abstract

Background: Foot ulcers are one of the most important complications of diabetes mellitus and often lead to lower limb amputation. Diabetic foot ulcers are susceptible to infection. The objective of this study was to determine the frequency of common bacteria infecting these ulcers and their antibiotic sensitivity pattern. Methods: This descriptive cross-sectional study was performed in the Departments of Medicine and Surgery, Khyber Teaching Hospital, Peshawar from April, 2011 to February, 2012. Specimens collected from ulcers of 131 patients were inoculated on Blood Agar and MacConkey Agar, and antibiotic sensitivity was tested using standard disc diffusion method. Results: Out of 131, specimens from 120 patients yielded 176 bacteria. Sixty-six patients had monomicrobial infection while polymicrobial growth was obtained in 54 patients. Overall, Staphylococcus aureus (38.6%) was the most common isolate followed by Pseudomonas aeruginosa (27.3%). Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid while it showed varying sensitivity to Penicillins and Cephalosporins. 47.1% isolates of Staphylococcus aureus were resistant to Methicillin. Most of the gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate. Majority of gram negative bacteria were found resistant to Cephalosporins and Moxifloxacin except Pseudomonas which showed variable sensitivity to Ceftriaxone, Ceftazidime and Moxifloxacin. Conclusions: Majority of isolates were found resistant to the commonly used antibiotics. Most commonly isolated bacterium, Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid, while majority isolated gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate.Keywords: Diabetes mellitus, foot ulcers, infection, antibiotic sensitivity

References

The International Diabetes Federation. Diabetes epidemic out of control [online]. [cited 2006 Dec 4]. Available from: http://www.idf.org/node/1354?unode=7F22F450-B1ED-43BB-A57C-B975D16A812D.

Powers AC. Diabetes mellitus. In: Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL, et al, editors. Harrison's Principles of Internal Medicine. 17th ed. New York: The McGraw-Hill; 2008. p.2276–92.

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87(1):4–14.

Frier BM, Fisher M. Diabetes Mellitus. In: Colledge NR, Walker BR, Ralston SH, Davidson S, editors. Davidson’s principles and practice of medicine. 21st ed., repr. Edinburgh New York: Churchill Livingstone/Elsevier; 2011. p. 795–834.

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Fosse S, Hartemann-Heurtier A, Jacqueminet S, Ha Van G, Grinaldi G, Fagot-Compagna A. Incidence and characteristics of lower limb amputations in people with diabetes. Diabet Med 2009;26(4):391–6.

Raja NS. Microbiology in diabetic foot infections in a teaching hospital in Malaysia: a retrospective study of 194 cases. J Microbiol immunol Infect 2007;40(1):39–44.

Alavi SM, Khosravi AD, Sarami A, Dashtebozorg A, Montazeri EA. Bacteriologic study of diabetic foot ulcers. Pak J Med Sci 2007;23(5):681–4.

Khoharo HK, Ansari S, Qureshi F. Diabetic foot ulcers. Professional Med J 2009;16(1):53–60.

Aragon-Sanchez J, Lazaro-Martinez JL, Quintana-Marrero Y, Hernandez-Herroro MJ, Garcia-Morales E, Cabrera-Galvan JJ, et al. Are diabetic foot ulcers complicated by MRSA osteomyelitis associated with worse prognosis? Outcomes of a surgical series. Diabet Med 2009;26(5):552–5.

Shorr AF. Epidemiology and economic impact of Methicillin-resistant Staphylococcus aureus: Review and analysis of literature. Pharmacoeconomics 2007;25(9):751–68.

Shorrt R, Thoma A. Empirical antibiotic use in soft tissue infections. Can J Plast Surg 2008;16(4):201–4.

Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S, et al. Diabetic foot disorders: A clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg 2000;39(5):51–60.

Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004;39(7):885–910.

Senneville E, Melliez H, Beltrand E, Legout L, Valette M, Cazaubiel M, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis 2006;42(1):57–62.

Pellizzer G, Strazzabosco M, Presi S, Furlan F, Lora L, Benedetti P, et al. Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb threatening diabetic foot infection. Diabet Med 2001;18(10):822–7.

Carvalho CB, Neto RM, Aragão LP, Oliveira MM, Nogueira MB, Forti AC. Diabetic foot infection. Bacteriologic analysis of 141 patients. Arq Bras Endocrinol Metabol 2004;48(3):398–405.

Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an indian tertiary care hospital. Diabetes care 2006;29:1727–32.

McLigeyo, Otieno LS. Diabetic ulcers--a clinical and bacteriological study. East Afr Med J 1991;68(3):204–10.

Umadevi S, Kumar S, Joseph NM, Easow JM, Kandhakumari G, Srirangaraj S, et al. Microbiological study of diabetic foot infections. Indian J Med Spec 2011;2(1):12–7.

Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, et al. Bacteriology of diabetic foot lesions. Indian J Med Microbiol 2004;22(3):175–8.

Chincholikar DA, Pal RB. Study of fungal and bacterial infections of the diabetic foot. Indian J Pathol Microbiol 2002;45(1):15–22.

Mantey I, Hill RL, Foster AV, Wilson S, Wade JJ, Edmonds ME. Infection of foot ulcers with Staphylococcus aureus associated with increased mortality in diabetic patients. Commun Dis Public Health 2000;3(4):288–90.

Dang CN, Prasad YD, Boulton AJ, Jude EB. Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 2003;20(2):159–61.

Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes Complications 2005;19(3):138–41.

Sharma VK, Khadka PB, Joshi A, Sharma R. Common pathogens isolated in diabetic foot infection in Bir Hospital. Kathmandu Univ Med J 2006;4(3):295–301.

Goldstein EJ, Citron DM, Nesbit CA. Diabetic foot infections. Bacteriology and activity of 10 oral antimicrobial agents against bacteria isolated from consecutive cases. Diabetes Care 1996;19(6):638–41.

El-Tahawy AT. Bacteriology of diabetic foot. Saudi Med J 2000;21(4):344–7.

Bansal E, Garg A, Bhatia S, Attri AK, Chander J. Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol 2008;51(2):204–8.

Yoga R, Khairul A, Sunita K, Suresh C. Bacteriology of diabetic foot lesions. Med J Malaysia 2006;61:14–6.

Hartemann-Heurtier A, Robert J, Jacqueminet S, HaVan G, Goldmard JL, Jarlier V, et al. Diabetic foot ulcer and multidrug resistant organisms: risk factors and impact. Diabet Med 2004;21(7):710–5.

Published

2016-08-28

Most read articles by the same author(s)