Volume 14, Issue 1 (Winter 2025)                   J Occup Health Epidemiol 2025, 14(1): 16-23 | Back to browse issues page

Ethics code: MESMCH/MES-IRB/Aug-2023


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Rajalakshmy K, Saravana Kumari P, Ahmed S M. Incidence of Multi-Drug-Resistant Bacterial Pathogens from Pus Samples of Diabetic Foot Ulcer Patients Collected at a Tertiary Care Hospital in North Kerala, India. J Occup Health Epidemiol 2025; 14 (1) :16-23
URL: http://johe.rums.ac.ir/article-1-954-en.html

Related article in
Google Scholar

1- Ph.D., Scholar in Microbiology, Dept. of Microbiology, RVS College of Arts and Science, Coimbatore, India.
2- Associate Prof., Dept. of Microbiology, RVS College of Arts and Science, Coimbatore, India. , rajianand2868@gmail.com
3- Professor and Head, Dept. of Microbiology, MES Medical College Hospital, Malappuram, Kerala, India.
Article history
Received: 2024/09/3
Accepted: 2025/01/18
ePublished: 2025/04/30
Subject: Epidemiology
Abstract:   (339 Views)
Background: Diabetes mellitus is a prevalent metabolic disorder, particularly affecting individuals over 45, with 529 million people worldwide impacted. Uncontrolled diabetes can lead to complications, including diabetic foot ulcers (DFU), which are responsible for 20% of morbidity and 25% of mortality in diabetic patients, especially in developing countries. Pathogenic bacteria cause infections in DFUs, and recovery is influenced by bacterial resistance to antibiotics. This study aimed to determine drug resistance rates of pathogens in DFUs and their impact on morbidity in a tertiary care hospital in North Kerala, India.
Materials and Methods: Pus samples from DFU patients were collected between 2018 and 2022, and pathogens were identified through biochemical tests. Antibiotic resistance was assessed using the Kirby-Bauer disc diffusion method.
Results: Of 3008 samples, 2920 showed significant bacterial growth. The majority of samples were from patients aged 51–60 years. Among the positive samples, 85.9% were males, and 14.1% were females. The bacterial distribution was 66.8% Gram-negative and 33.2% Gram-positive. Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most common pathogens. Of 621 Staphylococcus aureus isolates, 48.9% were methicillin-resistant. Among the 1949 Gram-negative isolates, 8.3% were extended-spectrum beta-lactamase (ESBL) resistant, and 5.6% were carbapenem-resistant.
Conclusion: The study concludes that the increasing resistance of DFU pathogens complicates treatment. Culturing and identifying causative organisms and understanding their susceptibility are crucial for effective management of infections in diabetic patients.
Full-Text [PDF 465 kb]   (115 Downloads)    

References
1. Kadhim FH, Mohammed SH. Microbiological profile, antibiogram, and risk factors of patients with diabetic foot infections: A systemic metaanalysis. Biomed Biotechnol Res J. 2021;5(3):235-44. [DOI]
2. Ubeid MH. Prevalence of leukocytes in type 2 diabetic patients in Erbil City. Med J Babylon. 2020;17(1):19-24. [DOI]
3. Saleh RH, Hadi B. Bacterial profile in patients with diabetic foot infections and its association with TNF α. Plant Arch. 2019;19(1):222-8.
4. Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014;70(1):1.e1-8. [DOI] [PMID]
5. Johani K, Fritz BG, Bjarnsholt T, Lipsky BA, Jensen SO, Yang M, et al. Understanding the microbiome of diabetic foot osteomyelitis: Insights from molecular and microscopic approaches. Clin Microbiol Infect. 2019;25(3):332-9. [DOI] [PMID]
6. Anvarinejad M, Pouladfar G, Japoni A, Bolandparvaz S, Satiary Z, Abbasi P, et al. Isolation and antibiotic susceptibility of the microorganisms isolated from diabetic foot infections in Nemazee hospital, Southern Iran. J Pathog. 2015;2015:328796. [DOI] [PMID] [PMCID]
7. Kurup R, Ansari AA, Singh J. A review on diabetic foot challenges in Guyanese perspective. Diabetes Metab Syndr. 2019;13(2):905-12. [DOI] [PMID]
8. Ibrahim AMR, Attia KM, Moawad MM, El-ramah AF, Shahin MM, Al-Molla M, et al. Bacteriological study of diabetic foot infection in Egypt. J Arab Soc Med Res. 2013;8(1):26-32.
9. Khanolkar MP, Bain SC, Stephens JW. The diabetic foot. QJM. 2008;101(9):685-95. [DOI] [PMID]
10. Citron DM, Goldstein EJ, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007;45(9):2819-28. [DOI] [PMID] [PMCID]
11. Won SH, Chung CY, Park MS, Lee T, Sung KH, Lee SY, et al. Risk Factors Associated with Amputation-Free Survival in Patient with Diabetic Foot Ulcers; Yonsei Med J. 2014;55(5):1373-8. [DOI] [PMID] [PMCID]
12. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28. [DOI] [PMID]
13. Ramesh R, Moorthi K, Kunchithapatham S, Mariappan P. Study on drug profile used in diabetic foot ulcer. Int J Basic Clin Pharmacol. 2020;9(7):1095-9. [DOI]
14. Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;3(1):4. [DOI] [PMID] [PMCID]
15. Pillai VA, Bharathi DR, Nataraj GR, Kaimal MR. A study on prevalence and prescription pattern of diabetic foot ulcer. Int J Sci Healthc Res. 2019;4(2):85-92.
16. Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A Clinico-microbiological Study of Diabetic Foot Ulcers in an Indian Tertiary Care hospital. Diabetes Care. 2006;29(8):1727-32. [DOI] [PMID]
17. Hartemann-Heurtier A, Robert J, Jacqueminet S, Ha Van G, Golmard JL, Jarlier V, et al. Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabet Med. 2004;21(7):710-5. [DOI] [PMID]
18. Bentkover JD. Economic evaluation of alternative methods of treatment for diabetic foot ulcers patients: cost-effectiveness of platelet releasate and wound care clinics. Wounds. 1993;5:207-15.
19. Sannathimmappa MB, Nambiar V, Aravindakshan R, Al Khabori MSJ, Al-Flaiti AHS, Al-Azri KNM, et al. Diabetic foot infections: Profile and antibiotic susceptibility patterns of bacterial isolates in a tertiary care hospital of Oman. J Educ Health Promot. 2021;10:254. [DOI] [PMID] [PMCID]
20. Clinical and Laboratory Standards Institute. M100; Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. Wayne, Pennsylvania, United States: Clinical and Laboratory Standards Institute; 2020.
21. Mairghani M, Elmusharaf K, Patton D, Burns J, Eltahir O, Jassim G, et al. The prevalence and incidence of diabetic foot ulcers among five countries in the Arab world: A systematic review. J Wound Care. 2017; 26(Sup9):S27 34. [DOI] [PMID]
22. Banu A, Noorul Hassan MM, Rajkumar J, Srinivasa S. Prospective study of Multidrug Resistant Bacteria causing Diabetic Foot Ulcers in South India. J Sci. 2015;5(8):626-9.
23. Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR. Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med. 2005;16(8):567-70.
24. James GA, Swogger E, Wolcott R, Pulcini Ed, Secor P, Sestrich J, et al. Biofilms in Chronic wounds. Wound Repair Regen. 2008;16(1):37-44. [DOI] [PMID]
25. Banu A, Noorul Hassan MM, Rajkumar J, Srinivasa S. Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: A prospective study. Australas Med J. 2015;8(9):280-5. [DOI] [PMID] [PMCID]
26. Siddiqui M, Unnisa T, Atmakuri SS. Study of Multidrug Resistant Bacteria Associated With Diabetic Foot Ulcers. Eur J Cardiovasc Med. 2022;12(4).
27. Krumperman PH. Multiple antibiotic resistance indexing of Escherichia coli to identify high-risk sources of fecal contamination of foods. Appl Environ Microbiol. 1983;46(1):165-70. [DOI] [PMID] [PMCID]
28. Sandhu R, Dahiya S, Sayal P. Evaluation of multiple antibiotic resistance (MAR) index and Doxycycline susceptibility of Acinetobacter species among inpatients. Indian J Microbiol Res. 2016;3(3):299-304. [Article]
29. Afunwa RA, Ezeanyinka J, Afunwa EC, Udeh AS, Oli NA, Unachukwu M. Multiple Antibiotic Resistant Index of Gram-Negative Bacteria from Bird Droppings in Two Commercial Poultries in Enugu, Nigeria. Open J Med Microbiol. 2020;10(4):171-81. [DOI]
30. Ejiofor SO, Edeh AD, Ezeudu CE, Gugu TH, Oli AN. Multi-Drug Resistant Acute Otitis Media amongst Children Attending Out-Patient Clinic in Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, South-East Nigeria. Adv Microbiol. 2016;6(7):495-501. [DOI]
31. Jude EB, Unsworth PF. Optimal treatment of infected diabetic foot ulcers. Drugs Aging. 2004;21(13):833-50. [DOI] [PMID]
32. Sekhar MS, M K U, Rodrigues GS, Vyas N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot (Edinb). 2018;37:95-100. [DOI] [PMID]
33. Shahrokh S, Aliye T, Yazdi M, Siavash M, Aminorroaya A. Bacterial Profile and Antimicrobial Resistance Patterns of Infected Diabetic Foot Ulcers in Iran: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Int J Low Extrem Wounds. 2022;21(4):364-73. [DOI] [PMID]
34. Nageen A. The Most Prevalent Organism in Diabetic Foot Ulcers and Its Drug Sensitivity and Resistance to Different Standard Antibiotics. J Coll Physicians Surg Pak. 2016;26(4):293-6. [PMID]
35. Miyan Z, Fawwad A, Sabir R, Basit A. Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country. J Pak Med Assoc. 2017;67(5):665-9. [PMID]
36. Ul Hassan F, Qudus MS, Sehgal SA, Ahmed J, Khan M, Ul Haq K, et al. Prevalence of Extended-Spectrum β-Lactamases in Multi-drug Resistant Pseudomonas aeruginosa from Diabetic Foot Patients. Endocr Metab Immune Disord Drug Targets. 2019;19(4):443-8. [DOI] [PMID]
37. Atlaw A, Kebede HB, Abdela AA, Woldeamanuel Y. Bacterial isolates from diabetic foot ulcers and their antimicrobial resistance profile from selected hospitals in Addis Ababa, Ethiopia. Front Endocrinol (Lausanne). 2022;13:987487. [DOI] [PMID] [PMCID]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
This work is licensed under a Creative Commons Attribution 4.0 International License.

2025 CC BY 4.0 | Journal of Occupational Health and Epidemiology

Designed & Developed by : Yektaweb