Email this article 
Hide
Show all
Original Research
Multicentre study of the burden of multidrug-resistant bacteria in the aetiology of infected diabetic foot ulcers
Submitted: 03 May 2020 | Published: 23 March 2021
About the author(s)
Adeyemi T. Adeyemo, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, NigeriaBabatope Kolawole, Department of Medicine, Faculty of Clinical Science, Obafemi Awolowo University, Ile-Ife, Nigeria
Vincent O. Rotimi, Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
Aaron O. Aboderin, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria; and, Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Science, Obafemi Awolowo University, Ile-Ife, Nigeria
Abstract
Background: Infected diabetic foot ulcer (IDFU) is a public health issue and the leading cause of non-traumatic limb amputation. Very few published data on IDFU exist in most West African countries.
Objective: The study investigated the aetiology and antibacterial drug resistance burden of IDFU in tertiary hospitals in Osun state, Nigeria, between July 2016 and April 2017.
Methods: Isolates were cultured from tissue biopsies or aspirates collected from patients with IDFU. Bacterial identification, antibiotic susceptibility testing and phenotypic detection of extended-spectrum beta-lactamase and carbapenemase production were done by established protocols. Specific resistance genes were detected by polymerase chain reaction.
Results: There were 218 microorganisms isolated from 93 IDFUs, comprising 129 (59.2%) Gram-negative bacilli (GNB), 59 (27.1%) Gram-positive cocci and 29 (13.3%) anaerobic bacteria. The top five facultative anaerobic bacteria isolated were: Staphylococcus aureus (34; 15.6%), Escherichia coli (23; 10.6%), Pseudomonas aeruginosa (20; 9.2%), Klebsiella pneumoniae (19; 8.7%) and Citrobacter spp. (19; 8.7%). The most common anaerobes were Bacteroides spp. (7; 3.2%) and Peptostreptococcus anaerobius (6; 2.8%). Seventy-four IDFUs (80%) were infected by multidrug-resistant bacteria, predominantly methicillin-resistant S. aureus and GNB producing extended-spectrum β-lactamases, mainly of the CTX-M variety. Only 4 (3.1%) GNB produced carbapenemases encoded predominantly by blaVIM. Factors associated with presence of multidrug-resistant bacteria were peripheral neuropathy (adjusted odds ratio [AOR] = 4.05, p = 0.04) and duration of foot infection of more than 1 month (AOR = 7.63, p = 0.02).
Conclusion: Multidrug-resistant facultative anaerobic bacteria are overrepresented as agents of IDFU. A relatively low proportion of the aetiological agents were anaerobic bacteria.
Keywords
Metrics
Total abstract views: 7815Total article views: 10066
Crossref Citations
1. Identifying multidrug-resistant organisms in diabetic foot ulcers: a study of risk factors and antimicrobial resistance genes
Mohd Saleem, Soha Abdallah Moursi, Tahani Nasser Almofeed Altamimi, Alharbi Mohammed Salem, Alwaleed Mohammad Alaskar, Sahar Adly Hassan Hammam, Ehab Rakha, Syed Muhammad Ozair Ilyas, Hamoud Abdulmohsin Al-Malaq, Metab Nasser Alshammari, Azharuddin Sajid Syed Khaja
World Journal of Microbiology and Biotechnology vol: 41 issue: 1 year: 2025
doi: 10.1007/s11274-024-04209-2
2. Investigation of Antimicrobial Potential of Medicinal Plants Against Pseudomonas aeruginosa
Nosheen Bibi, Shazia Perveen, Sumaira Kanwal, Fariha Latif, Rehmana Rashid, Sara Janiad, Iram Qadeer, Fatima Naseem, Abdullah R. Alanzi, Rashed N. Herqash, Imran Haider, Mehraj A. Abbasov, Sadaf Kayani, Mohd Asif Shah
Food Science & Nutrition vol: 13 issue: 11 year: 2025
doi: 10.1002/fsn3.70999
3. High prevalence of multidrug-resistant bacteria in diabetic patients with foot ulcers: A descriptive analysis of patients referred to a tertiary care hospital in Vietnam
Tan Dat Huynh, Manh Nguyen Nguyen, Chi Thanh Tran
Journal of Public Health Research vol: 15 issue: 3 year: 2026
doi: 10.1177/22799036261467465
4. Aerobic pathogen profiles and antibiotic resistance in diabetic foot ulcers: Data from a Specialized Diabetes Center in Jordan
Dana Hyassat, Mohammad Al Gazo, Faris Bakri, Yousef Khader, Laith Baqain, Amro Al-Simadi, Eid Samara, Mohammad Al Masri, Jood Aladwan, Shiraz Mheidat, Dalia Hanash, Jamal Wadi Al Ramahi, Mohammad El-Khateeb, Kamel Ajlouni
Medicine vol: 105 issue: 10 first page: e47908 year: 2026
doi: 10.1097/MD.0000000000047908
5. Antimicrobial Remedies and Emerging Strategies for the Treatment of
Diabetic Foot Ulcers
Muzammil Husain, Yogeeta O. Agrawal
Current Diabetes Reviews vol: 19 issue: 5 year: 2023
doi: 10.2174/1573399818666220228161608
6. Antimicrobial resistance in bacterial wound, skin, soft tissue and surgical site infections in Central, Eastern, Southern and Western Africa: A systematic review and meta-analysis
Edward J. M. Monk, Timothy P. W. Jones, Felix Bongomin, Winnie Kibone, Yakobo Nsubuga, Nelson Ssewante, Innocent Muleya, Lauryn Nsenga, V. Bhargavi Rao, Kevin van Zandvoort, Janelisa Musaya
PLOS Global Public Health vol: 4 issue: 4 first page: e0003077 year: 2024
doi: 10.1371/journal.pgph.0003077
7. Multidrug resistance, biofilm formation, and genetic determinants in diabetic foot infections from Uttar Pradesh, India: a clinical-microbiological insight from a prospective study
Mohd Saleem, Mohd Shahid Khan, Arslan Neyaz, Irfan Ahmad, Malak Yahia Qattan, Nadeem Ahmad
Naunyn-Schmiedeberg's Archives of Pharmacology vol: 398 issue: 11 first page: 15965 year: 2025
doi: 10.1007/s00210-025-04284-8
8. Multidrug resistance and inappropriate empiric therapy as predictors of hospital stay in diabetic foot infections
Lana Zuriegat, Rania Itani, Khawla Abu Hammour, Rana Abu-Farha, Shiv Kumar Sah
PLOS One vol: 21 issue: 6 first page: e0350837 year: 2026
doi: 10.1371/journal.pone.0350837
9. Antibiotic Resistance of Acinetobacter baumannii in Women with Polycystic Ovary Syndrome
Nawal B. Yazea, Dhuha M. Abbas, Rand Moshtaq Talib
International Journal of Innovative Science and Research Technology first page: 2746 year: 2025
doi: 10.38124/ijisrt/25may343
10. Retrospective study on antibiotic resistance profiles of uropathogenic Escherichia coli with emphasis on β-lactamase production in a tertiary hospital in Saudi Arabia
Yasser Alraey, Irfan Ahmad, Mushtaq Ahmad Mir, Mohd Saleem, Saleh Abdullah Amer Alshehri, Nawal Mohammad Elkdshani, Ali Alasmari, Menah Halaway, Abdulaziz Saeed Mohammed Alqahtani, Bandar Abdullah Alyazeedi, Awdhesh Kumar Mishra, Abdulah OS Bawazeer, Mohd Shahid Khan
Frontiers in Microbiology vol: 17 year: 2026
doi: 10.3389/fmicb.2026.1867292
11. Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: a systematic review and meta-analysis
Fiseha Wadilo Wada, Michael Fekadu Mekonnen, Edlawit Desta Sawiso, Sitotaw Kolato, Lideta Woldegiorgis, Gemechu Kebede Kera, Ziad El-Khatib, Akililu Alemu Ashuro, Mulatu Biru, Minyahil Tadesse Boltena
Scientific Reports vol: 13 issue: 1 year: 2023
doi: 10.1038/s41598-023-41882-z
12. Prevalence of multidrug‐resistant bacterial infections in diabetic foot ulcers: A meta‐analysis
Shaoling Yang, Liye Hu, Yue Zhao, Guangzhe Meng, Sijia Xu, Rui Han
International Wound Journal vol: 21 issue: 4 year: 2024
doi: 10.1111/iwj.14864
13. Modification of Zn-Metal Organic Framework with Nano Silver as an Antibacterial Material for Diabetic Ulcers (In vitro)
Tri Ana Mulyati, Juni Ekowati, Yohanes Andy Rias, Binti Mu’ arofah, Fery Eko Pujiono
Research Journal of Pharmacy and Technology first page: 4347 year: 2025
doi: 10.52711/0974-360X.2025.00623
14. An Overview of Diabetic Foot Ulcers and Associated Problems with Special Emphasis on Treatments with Antimicrobials
Mirza Shahed Baig, Ahmadi Banu, Mehrukh Zehravi, Ritesh Rana, Sushil S. Burle, Sharuk L. Khan, Fahadul Islam, Falak A. Siddiqui, Ehab El Sayed Massoud, Md. Habibur Rahman, Simona Cavalu
Life vol: 12 issue: 7 first page: 1054 year: 2022
doi: 10.3390/life12071054
15. Bacterial isolates from diabetic foot ulcers and their antimicrobial resistance profile from selected hospitals in Addis Ababa, Ethiopia
Asegdew Atlaw, Habtamu Biazin Kebede, Abdurezak Ahmed Abdela, Yimtubezinash Woldeamanuel
Frontiers in Endocrinology vol: 13 year: 2022
doi: 10.3389/fendo.2022.987487
16. Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries
Zulfiqarali G. Abbas, Raidah R. Gangji, Ilker Uçkay
Endocrinology, Diabetes & Metabolism vol: 7 issue: 4 year: 2024
doi: 10.1002/edm2.503
17. Modulations of the skin microbiome in skin disorders: A narrative review from a wound care perspective
Antonia Piazzesi, Matteo Scanu, Guido Ciprandi, Lorenza Putignani
International Wound Journal vol: 21 issue: 10 year: 2024
doi: 10.1111/iwj.70087
18. Assessment of the impact of pH of wound fluid on the associated microbial distribution in the cases of infected diabetic foot ulcer
Aradhana Singh, Shailendra Rai, Arvind Pratap, Tuhina Banerjee, Mumtaz Ahmed Ansari, Somprakas Basu, Vijay Kumar Shukla
Journal of Family Medicine and Primary Care vol: 14 issue: 5 first page: 1925 year: 2025
doi: 10.4103/jfmpc.jfmpc_1286_24
19. A Retrospective Study of Infections and Antibiotic Susceptibility in Diabetic Foot Ulcers
Shuai Wang, Zunjiang Zhao, Xiangjian Meng, Hongfei Guo, Yinqiao Sun, Dalun Lv
Diabetes Therapy vol: 17 issue: 9 first page: 1333 year: 2026
doi: 10.1007/s13300-026-01896-y
20. Risk factors and clinical outcomes of multidrug-resistant and biofilm-producing infections in diabetic foot ulcers: a two-year cohort study
Mohd Shahid Khan, Noor Jahan, Razia Khatoon, Faisal Moin Ansari, Siraj Ahmad
World Journal of Microbiology and Biotechnology vol: 41 issue: 10 year: 2025
doi: 10.1007/s11274-025-04546-w
21. Phenotypic Profile and Antibiogram of Biofilm-Producing Bacteria Isolates from Diabetic Foot Ulcers in Zaria, Nigeria
Yahaya Usman, Adamu Girei Bakari, Idris Nasir Abdullahi, Abdurrahman El-Fulaty Ahmad, Fatima Sani-Bello, Atiene Solomon Sagay, Adebola Tolulope Olayinka
Nigerian Postgraduate Medical Journal vol: 28 issue: 4 first page: 233 year: 2021
doi: 10.4103/npmj.npmj_552_21
22. Anaerobes in diabetic foot infections: pathophysiology, epidemiology, virulence, and management
Fanny Villa, Hélène Marchandin, Jean-Philippe Lavigne, Sophie Schuldiner, Nicolas Cellier, Albert Sotto, Paul Loubet, Audrey N. Schuetz, Eric Senneville
Clinical Microbiology Reviews vol: 37 issue: 3 year: 2024
doi: 10.1128/cmr.00143-23
23. Association of Methicillin-Resistant Staphylococcus aureus with Amputation Risk in Diabetic Foot Infections: A Systematic Review and Meta-Analysis
John Ashley Flores, Ian Dave Balanditan, Angela Mae Cuartelon, Sofia Alexis Dayrit, Jan Clarence Salinas, Caleb Tiam-Lee, Raphael Enrique Tiongco
SN Comprehensive Clinical Medicine vol: 8 issue: 1 year: 2026
doi: 10.1007/s42399-026-02484-8
24. Diabetes-related lower limb wounds: Antibiotic susceptibility pattern and biofilm formation
Raha Orfali, Safina Ghaffar, Lateefa AlAjlan, Shagufta Perveen, Eman Al-Turki, Fuad Ameen
Saudi Pharmaceutical Journal vol: 32 issue: 6 first page: 102069 year: 2024
doi: 10.1016/j.jsps.2024.102069
25. Antimicrobial resistance and beta-lactamase gene distribution among clinical isolates: a two-year cohort study
Yasser Alraey, Mohammed Mushabub Assiry, Irfan Ahmad, Abdulaziz Alqahtani, Nada Basheer, Mohammed A. M. AlAsiri, Saleh A. M. Alshehri, Saeed M. S. Alhamhhum, Sultan Mohammed Alhefdi, Mohd Shahid Khan, Mohd Saleem, Abdulah A. S. Bawazeer
Scientific Reports vol: 15 issue: 1 year: 2025
doi: 10.1038/s41598-025-08445-w
26. Risk Factors and Nomogram Model for Multidrug‐Resistant Bacterial Infections in Diabetic Foot Wounds
Guangzhe Meng, Liye Hu, Xuan Gao, Sijia Xu, Xiuhui Wang, Yiwen Yang, Xiaoling Li, Libo Zhang, Shaoling Yang
International Wound Journal vol: 23 issue: 5 year: 2026
doi: 10.1111/iwj.70929
27. Characteristic Correlation between Staphylococcal Isolates from Wounds and Nares of Diabetic Foot Patients Living in Erbil City, Iraq
Samira Fattah Hamid, Fatih Koksal, Tulin Guven Gokmen, Tulay Knademir
Current Diabetes Reviews vol: 22 issue: 9 year: 2026
doi: 10.2174/0115733998413217251206210451
28. An Update on Diabetic Foot Ulcer and Its Management Modalities
Mohd Shahid Khan, Noor Jahan, Razia Khatoon, Faisal Moin Ansari, Siraj Ahmad
Indian Journal of Microbiology vol: 64 issue: 4 first page: 1401 year: 2024
doi: 10.1007/s12088-023-01180-8
29. Diabetic foot ulcer, antimicrobial remedies and emerging strategies for the treatment
Ancha Kishore Babu, M. Pradeep Kumar, B. Krupavaram, Sandhya Rani Mandadi, Lakshmi, R. Manikandhan, M. Akiful Haque, Rokeya Sultana
International journal of health sciences first page: 2835 year: 2022
doi: 10.53730/ijhs.v6nS3.6199
30. Hemolytic Activity, Cytotoxicity, and Antimicrobial Effects of Human Albumin- and Polysorbate-80-Coated Silver Nanoparticles
Dmitry Korolev, Michael Shumilo, Galina Shulmeyster, Alexander Krutikov, Alexey Golovkin, Alexander Mishanin, Andrew Gorshkov, Anna Spiridonova, Anna Domorad, Alexander Krasichkov, Michael Galagudza
Nanomaterials vol: 11 issue: 6 first page: 1484 year: 2021
doi: 10.3390/nano11061484
31. Increase in antibiotic resistance in diabetic foot infections among peruvian patients: a single-center cross-sectional study
Jeel Moya-Salazar, Jackelina M. Chamana, Daniela Porras-Rivera, Eliane A. Goicochea-Palomino, Carmen R. Salazar, Hans Contreras-Pulache
Frontiers in Endocrinology vol: 14 year: 2023
doi: 10.3389/fendo.2023.1267699
32. A narrative review of coagulase-negative staphylococci in diabetic foot infections
Chloé Magnan, Lucile Plumet, Madjid Morsli, Catherine Dunyach-Remy, Cassandra Pouget, Albert Sotto, Virginie Molle, Jean-Philippe Lavigne, Audrey N. Schuetz, Benjamin A. Lipsky
Clinical Microbiology Reviews vol: 38 issue: 4 year: 2025
doi: 10.1128/cmr.00121-25
33. Distribution of multidrug-resistant bacterial infections in diabetic foot ulcers and risk factors for drug resistance: a retrospective analysis
Huihui Guo, Qiwei Song, Siwei Mei, Zhenqiang Xue, Junjie Li, Tao Ning
PeerJ vol: 11 first page: e16162 year: 2023
doi: 10.7717/peerj.16162
34. Antimicrobial Activity of Chromolaena Odorata and Syzygium Aromaticum against multi-drug resistant clinical isolates from diabetic foot ulcer patients: A cross-sectional study
Solomon Wireko, Jacob Amonoo-Neizer, Samuel Nii Boadu, Jessica Neebo, Oumar Ramatu, Jemimah Aggrey Appiah, Elizabeth Akua Baidoo, Ebenezer Senu, Alexander Kwarteng, Mina Ofosu
Scientific African vol: 28 first page: e02764 year: 2025
doi: 10.1016/j.sciaf.2025.e02764
35. Prevalence of Extended-Spectrum β-Lactamase and Carbapenemase Producers of Gram-Negative Bacteria, and Methicillin-Resistant Staphylococcus aureus in Isolates from Diabetic Foot Ulcer Patients in Ethiopia
Asegdew Atlaw Woldeteklie, Habtamu Biazin Kebede, Abdurezak Ahmed Abdela, Yimtubezinash Woldeamanuel
Infection and Drug Resistance vol: Volume 15 first page: 4435 year: 2022
doi: 10.2147/IDR.S371431
36. The diabetic foot ulcer: Biofilm, antimicrobial resistance, and amputation
Mohd Shahid Khan, Noor Jahan, Razia Khatoon, Faisal Moin Ansari, Siraj Ahmad
International Journal of Diabetes in Developing Countries vol: 45 issue: 3 first page: 568 year: 2025
doi: 10.1007/s13410-024-01423-4
37. Antimicrobial resistance profiles and detection of mecA, blaCTX-M-1, and blaSHV genes in bacteria among diabetic foot ulcer patients from selected referral hospitals in Uganda
Alice Namatovu, Bienfait Mumbere Vahwere, Ibrahim Ntulume, Robinson Ssebuufu, Rebecca Nalubega, Theophilus Pius, Franck K. Sikakulya, Gidio Agaba, Emmanuel Seremba, Patrick Kyamanywa, George William Nasinyama
BMC Infectious Diseases vol: 25 issue: 1 year: 2025
doi: 10.1186/s12879-025-11909-z
