Microbiological Profile and Antibiotic Resistance in Diabetic Foot Infections: A Retrospective Study from Marrakech

Introduction: Diabetic foot infection (DFI) is a severe complication of diabetes, often leading to hospitalization and amputation. This study aimed to describe the causative pathogens and their antimicrobial resistance patterns. Methods: We conducted a retrospective study of 146 patients hospitalized for DFI at Avicenne Military Hospital, Marrakech, between 2018 and 2023. Clinical data, microbiological results, and antibiotic susceptibility profiles were collected and analyzed according to CASFM/EUCAST (Comité De l'Antibiogramme de la Société Française de Microbiologie/European Committee on Antimicrobial Susceptibility Testing) 2025 guidelines. Results: The mean age was 63.27 years, with a male predominance (125, 86%) and type 2 diabetes in 90% (131) of cases. A total of 146 bacterial isolates were identified, mainly Gram-negative bacilli (104, 71.2%), with Enterobacterales being the most frequent (87, 60%). The most frequent species were Escherichia coli (26, 17.8%), Klebsiella pneumoniae (21, 14.3%), Pseudomonas aeruginosa (16, 11%), and Staphylococcus aureus (15, 10.3%). Enterobacterales showed high resistance to ampicillin (84%), amoxicillin-clavulanic acid (81%), and ciprofloxacin (57%), while susceptibility to imipenem and amikacin remained high. Pseudomonas aeruginosa was also susceptible to these agents, and Staphylococcus aureus isolates were uniformly susceptible to vancomycin and ciprofloxacin. Conclusion: DFIs in Marrakech are characterized by a predominance of multidrug-resistant Gram-negative bacilli. These findings emphasize the importance of rational antibiotic use, infection control, and continuous microbiological surveillance.