Antimicrobial Susceptibility of Bacteria Isolated from Diabetic Foot Infections in Dhamar Governorate, Yemen

Background: Diabetic foot infections (DFIs) are a major complication of diabetes, particularly in resource-limited settings like Yemen, where antimicrobial resistance (AMR) and fragmented healthcare exacerbate outcomes. Dhamar Governorate faces unique challenges, including limited diagnostics, inappropriate antibiotic use, and sparse local data on DFI etiology and resistance patterns, necessitating context-specific insights. Aim: This study aimed to identify predominant bacterial pathogens in DFIs, characterize their antibiotic susceptibility, and evaluate sociodemographic and clinical risk factors to inform tailored management in Dhamar, Yemen. Methods: A cross-sectional study was conducted at two hospitals in Dhamar (April–November 2021). Thirty hospitalized DFI patients were enrolled. Wound samples were collected via swab/aspiration, cultured, and tested for antibiotic susceptibility using disc diffusion (EUCAST guidelines). Sociodemographic, clinical, and microbiological data were analyzed using SPSS. Results: Bacterial infections were detected in 70% (21/30) of patients, predominantly Gram-positive organisms (85.7%). Key risk factors included illiteracy (infected: 84.2% vs. non-infected: 45.5%, p=0.042), urban residence (100% vs. 59.1% rural, p=0.067), and amputation (100% infected vs. 60.9% non-amputated, p=0.048). Type-II diabetes showed borderline association with infection (83.3% vs. 50.0% Type-I, p=0.051). Alarmingly, 100% resistance to amoxicillin and 90.5% to cefuroxime were observed. Vancomycin (94.4% sensitivity in Gram-positive isolates) and amikacin (100% sensitivity in Gram-negative isolates) were most effective. Conclusion: The high prevalence of DFIs and widespread AMR in Dhamar underscore urgent needs for improved antibiotic stewardship and localized guidelines. Empiric use of vancomycin (Gram-positive coverage) and amikacin (Gram-negative) may be warranted, but susceptibility testing remains critical. Addressing socioeconomic risk factors, such as patient education and glycemic control, is essential to reduce DFI morbidity. This study highlights the imperative for enhanced AMR surveillance in low-resource settings.