Microbiological profile and antimicrobial resistance in diabetic foot infections: a cross-sectional study from a low- to middle-income country

Diabetic foot infections (DFIs) are serious complications of diabetes mellitus, yet little is known about the bacterial profile and antibiotic resistance patterns among patients with diabetic foot ulcers in this region. This study aimed to assess the prevalence and antimicrobial resistance of DFIs in the main referral governmental hospitals in the northern West Bank, Palestine. This descriptive, retrospective cross-sectional study was conducted in the Vascular Surgery Department at Rafidia Surgical Hospital in Nablus, Palestine. The medical records of patients with DFIs in 2022 were reviewed, and the data were analysed via IBM SPSS for Windows v.21.0. Among the 118 patients, 58.5% were male, and 98.3% had type II diabetes mellitus. Gram-negative bacteria were more prevalent, accounting for 58.8% of the cases, whereas gram-positive bacteria accounted for 41.2%. Staphylococcus aureus (25.4%), Escherichia coli (14.0%), and Pseudomonas aeruginosa (11.4%) were the most frequently isolated pathogens. Extended-spectrum β-lactamase (ESBL)-producing strains were detected among E. coli and Klebsiella pneumoniae isolates, and carbapenemase-producing Enterobacterales (CPEs) were also identified. Among gram-positive bacteria, Staphylococcus aureus is methicillin-resistant, and Enterococcus species are vancomycin-resistant. Multidrug-resistant (MDR) isolates, as Acinetobacter baumannii, are present in both gram-positive and gram-negative groups. A longer infection duration and longer hospital stay were significantly associated with increased amputation risk (p = 0.044 and p < 0.001, respectively), highlighting the need of early intervention and targeted antibiotic therapy. This study revealed a high prevalence of multidrug-resistant pathogens among diabetic foot infections in northern Palestine, with Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa as the leading causative organisms. The notable presence of methicillin-resistant S. aureus and extended-spectrum β-lactamase-producing Enterobacterales underscores the urgent need for robust antimicrobial stewardship and regular local surveillance to guide empirical therapy. Early diagnosis, appropriate antibiotic selection, and timely intervention are crucial to improving clinical outcomes and reducing amputation risk in this vulnerable population.