Predominance of multidrug-resistant bacteria with high resistance to empiric antibiotics in diabetic foot ulcers: a cross-sectional study

Diabetic foot ulcers (DFUs) pose a serious clinical challenge due to their chronic nature and high risk of infection. DFUs present polymicrobial infections frequently involving antibiotic-resistant bacteria, complicating treatment and increasing the risk of amputations. We conducted a cross-sectional study of 153 DFU patients to analyze the bacterial profile of DFUs and prevailing patterns of antibiotic resistance. The pathogenic bacteria isolated from DFUs were predominantly Gram-positive (62%), with Staphylococcus aureus and coagulase-negative staphylococci (CoNS) being the most frequent isolates along with Gram-negative Pseudomonas aeruginosa and Klebsiella pneumoniae. Over 60% of Gram-positive bacteria and 95% of Gram-negative bacteria were multidrug resistant with a median resistance to 9-11 antibiotics, most of which are in the prescribed regimen for diabetic foot infections. Multidrug resistance (MDR) was observed in approximately 95% of Gram-negative and 60-87% of Gram-positive isolates. We categorized the antibiotics following the AWaRe (Access (A), Watch (W), Reserve (R)) classification and have identified the antibiotics that can be prioritized for treatment of DFU leaving out the reserve category only for treating MDR bacteria. The findings underscore the need for prudent use of antibiotics, microbiological profiling of DFU bacteria and periodic updates to the empirical treatment regimen to improve patient outcomes.