Antibiotic Sensitivity and Microbiological Patterns of Diabetic Foot Ulcers

Introduction: Diabetes mellitus, characterized by chronic hyperglycemia due to defects in insulin secretion, action, or both, is a prevalent metabolic disorder with severe long-term complications, including nephropathy, retinopathy, peripheral neuropathy, and vasculopathy. These conditions predispose patients to diabetic foot ulcers (DFUs), chronic non-healing wounds associated with high risks of infection, amputation, and Charcot joint deformities. DFUs represent a significant cause of hospitalization among diabetic individuals. Methods: A cross-sectional descriptive study was conducted involving 138 DFU patients across multiple hospitals in the Malakand Division, Pakistan. Data were collected from patient interviews, clinical observations, and hospital records. Of the 138 patients, 13 underwent amputation, and 3 required re-amputation. Results: The mean age of participants was 45.7 ± 10 years, with a mean diabetes duration of 8.7 ± 3 years and ulceration duration of 4 ± 2 years. The study population comprised 65% males and 45% females. From 150 specimens, 455 aerobic bacteria were isolated (average of 3.03 isolates per specimen), with notable prevalence of multidrug-resistant (MDR) organisms and methicillin-resistant Staphylococcus aureus (MRSA). Among gram-positive aerobes, S. aureus (25.4%) was predominant, while Escherichia coli (16%) led among gram-negative isolates. Gram-positive isolates exhibited resistance to ciprofloxacin (54.5%), erythromycin (53.2%), and clarithromycin (52.56%), but were universally sensitive to vancomycin. Gram-negative isolates showed resistance to ciprofloxacin (75%), cefuroxime (85%), and cefotaxime (54.43%), with imipenem and sulbactam-cefoperazone demonstrating high sensitivity. Conclusion: DFUs predominantly affect individuals around 50 years of age, with ulceration linked to diabetes duration, treatment adherence, and wound care. Males are more affected than females. Vancomycin exhibited 100% efficacy against gram-positive isolates, while linezolid was effective in 92% of cases, aiding recovery in many patients. The presence of MDR isolates underscores the need for tailored antibiotic therapy.