Document Type: Original Research

Authors

1 Department of Infectious Diseases and Tropical Medicine, Shahed University, Tehran, Iran

2 Department of Social Medicine, Shahed University, Tehran, Iran

Abstract

Background and Objective: Diabetes mellitus is one of the main problems in health systems in the world. Diabetic Foot infections (DFI) is one of the main complications and the most cause  of non-traumatic lower limb amputation .This study aimed to determine the prevalence of bacteria involved in DFI and their antibiotic resistance in patients with DFI diagnosis.
Patients and Methods: This descriptive-analytical and cross-sectional study was designed in 4 years period from April 2007 to March 2010 on 90 patient in Shahid Mostafa  Khomeini Hospital,Tehran, Iran .For bacteriological analysis, all wound samples culture grown by standard methods bacteriology and Disk diffusion method was used for antibiogram. Patient’s clinical and epidemiologic data were collected from recorded  file. The data were analyzed by using SPSS16 statistical software.
Results: 104 bacteria were isolated from 90 patients. 57.70% were gram-positive and 42.30% were gram-negative. Among gram-positive bacteria Staphylococcus aureus (60%) and enteroccoci spp.(33.3%) and  among gram-negative bacteria E. coli (47.73%), Pseudomonas Aeroginosa  (22.73%) and Proteus spp.(18.18%) were the most common isolates respectively. 75% of isolates were resistant to two antibiotics or more. Previous antibiotic therapy was significant risk factor for multidrug resistant (MDR) infections (P: 0.003). All gram-positive isolates were sensitive to Vancomycin. Imipenem and Amikacin had good activity against gram-negative bacteria.
Conclusion:Infection with MDR bacteria in patients with diabetic foot ulcers is high and have significant association with recent antibiotic therapy. So the proper use of antibiotics in order to prevent the creation of multi-drug resistant bacteria is recommended.
 

Keywords

  1. Shahrad Bejestani H, Motabar AR. Assessment of diabetic foot ulcer's predisposing factors and its outcomes hn patient with diabetic foot syndrome hospitalized in hazrat Rasoul-e-Akram hn Tehran during 1996-2001. Iran Uni Med J 2004; 39(11):77-84.
  1. Armstrong DG, Lipsky BA. Diabetic foot infection:stepwise medical and surgical management. Int wound J 2004;1:123-32.
  1. Lipsky BA, Berendt AR. The Diabetic Foot:Essentials of Managing Infection Complications. London: Current Medicine Group; 2008.
  1. Catherine Amalia SC, Myrna TM, Marissa MA, Concepcion FA. Microbiology and Clinical Profile of Anaerobic Diabetic Foot Infrctions. Phil J Microbial Infect Dis 2002;31(4):151-60.
  1. Taherpor A, Hemati Y, Azizi F. Bactriology of Diabetic foot lesions. Iran J Endocrinol Metabol 2007:1:11-18.
  1. Gaur DS, Varma A, Gupta P. Diabetic foot in Uttaranchal. JK Science 2007;9(1):18-20.
  1. Sharma VK, Khadka PB, Joshi A, Sharma R. Common pathogens isolated in diabetic foot infection in Bir Hospital. Kathmandu Uni Med J 2006;4(3):295-301.
  1. Kruse I, Edelman S. Evaluation and treatment of Diabetic foot ulcers. Clin Diabetes 2006;24(2):91-3.
  1. Lipsky BA, Berendt AR, Gunner DH, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infection. Clin Infect Dis 2004;39(7):885-910.
  1. Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, et al. Bactriology of diabetic foot lesions. Indian J Med Microbiol 2004;22(3):175-78.
  1. Lily SY, Kwang LL, Yeow SC, Tan TY. Anaerobic culture of diabetic foot infection: organisms and antimicrobial susceptibilities. Ann Acad Med Singapore 2008; 37:936-9.
  1. Tahawy A. Bacteriology of diabetic foot infections. Saudi Med J 2000; 21(4):344-7.
  1. Raja NS. Microbiology of diabetic foot infections in a teaching hospital in Malaysia: a retrospective study of 194cases. J Microbiol Immunol Infect 2007; 40:39-44.
  1. Carvalho CB, Neto RM, Aragao LP, Oliveira MM, Nogueira MB, Forti AC. Diabetic foot infections. Bacterial analysis of 141 patients. Arq Bras Endocrinol Metabol 2004; 489(3):398-405.
  2. Benwan KA, Mulla AA, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health 2012; 5(1):1-8.
  3. Citron Diane M, Goldstein EJC, Merriam CV, LipskyBA, Abramson MA. Bacteriology of Moderate-to-Severe diabetic foot infections and in vitro activity of anitimicrobial agent. J Clin Microbiol 2007;45(9):2819-28.
  1. Alavi SM, Sarami A, Khosravi A, Dashtbozorg A, Abasi E, Latifi M. A study of the microbiology of diabetic foot infections in a teaching hospital in Razi Hospital , Ahvaz 2004-2005. Iran J Infect Dis Trop Med 2007;36(12):67-70.
  2. Wheat LJ, Allen SD, Henry M, Kernek CB, Siders JA, Kuebler T, et al. Diabetic foot infections. Bacteriologic analysis. Arch Intern Med 1986;146(10):1935-40.
  3. Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR. Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med 2005;16(8):567-70.
  1. Gadepalli R, Dhawan B, Sreevivas V, Kapil A, Ammini ac, Chaudhry R. A clinic-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care 2006;29:1727-32.
  1. Dang CA, Prasad YD, Boulton AJ, Jude EB. Methicillin resistant Staphylococcus aureus in diabetic foot  clinic:a worsening problem. Diabet Med 2003;20:159-61.
  1. Kandemir O, Akbay E, Sahin E, Milcan A, Gen R. Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. J Infect 2007;54:439-45.