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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.
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