Occurrence and Antimicrobial Resistance of Extended- Access Spectrum Beta-Lactamase Producing Bacteria in Diabetic Foot Infections at Korle-Bu Teaching Hospital

Background: Common complications of diabetes mellitus include foot infections, which lead to increased healthcare cost and delayed wound healing.Diabetic foot infections (DFIs) can be caused by Gram-negative, Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria which are resistant to a wide range of antibiotics used in clinical medicine.This presents a significant challenge to the treatment of DFIs.However, identifying the bacterial species involved can be critical for effective management and targeted therapy. Objective:The study investigated the antimicrobial resistance and molecular characteristics of ESBL-producing bacteria from diabetic foot infections at Korle Bu Teaching Hospital (KBTH) using disk diffusion and Polymerase Chain Reaction (PCR). Methods:From January to September 2018, tissue samples, aspirates, or pus were collected from diabetic patients from the ulcer room at the department of surgery, KBTH.Patients' demographics were gathered using a data collection tool.Bacterial culture, antimicrobial susceptibility testing and PCR detection of ESBL genes were performed. Results:In total, 138 Gram-negative isolates were recovered from the 50 study participants enrolled.Majority of the isolates were resistant to ciprofloxacin (55.79%, n = 77/138) but susceptible to meropenem (97.82%, n = 135/138).Among the isolates, 41 (29.71%) were phenotypically positive for ESBL production using CHROMagar ESBL.The CTX-M gene was predominantly identified in E. coli (9/19) by PCR. Conclusion:ESBL-producing Gram-negative bacteria continue to pose a major challenge in Ghana, with the CTX-M gene identified as the most prevalent among ESBL-positive isolates.Notably, a majority of the isolates remained susceptible to meropenem, suggesting its potential as an effective treatment option.Continued surveillance is crucial to monitor the emergence and dissemination of AMR pathogens in DFIs.