Open AccessMulticentre study of the burden of multidrug-resistant bacteria in the aetiology of infected diabetic foot ulcers
Author(s) -
Adekunle Adeyemo,
Babatope Kolawole,
Vincent O. Rotimi,
Aaron O. Aboderin
Publication year - 2021
Publication title -
african journal of laboratory medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 11
eISSN - 2225-2010
pISSN - 2225-2002
DOI - 10.4102/ajlm.v10i1.1261
Subject(s) - microbiology and biotechnology , anaerobic bacteria , citrobacter , multiple drug resistance , klebsiella pneumoniae , pseudomonas aeruginosa , diabetic foot , peptostreptococcus , medicine , staphylococcus aureus , antibiotics , drug resistance , bacteroides , biology , bacteria , escherichia coli , enterobacteriaceae , diabetes mellitus , endocrinology , biochemistry , genetics , gene
Background Infected diabetic foot ulcer (IDFU) is a public health issue and the leading cause of non-traumatic limb amputation. Very few published data on IDFU exist in most West African countries. Objective The study investigated the aetiology and antibacterial drug resistance burden of IDFU in tertiary hospitals in Osun state, Nigeria, between July 2016 and April 2017. Methods Isolates were cultured from tissue biopsies or aspirates collected from patients with IDFU. Bacterial identification, antibiotic susceptibility testing and phenotypic detection of extended-spectrum beta-lactamase and carbapenemase production were done by established protocols. Specific resistance genes were detected by polymerase chain reaction. Results There were 218 microorganisms isolated from 93 IDFUs, comprising 129 (59.2%) Gram-negative bacilli (GNB), 59 (27.1%) Gram-positive cocci and 29 (13.3%) anaerobic bacteria. The top five facultative anaerobic bacteria isolated were: Staphylococcus aureus (34; 15.6%), Escherichia coli (23; 10.6%), Pseudomonas aeruginosa (20; 9.2%), Klebsiella pneumoniae (19; 8.7%) and Citrobacter spp. (19; 8.7%). The most common anaerobes were Bacteroides spp. (7; 3.2%) and Peptostreptococcus anaerobius (6; 2.8%). Seventy-four IDFUs (80%) were infected by multidrug-resistant bacteria, predominantly methicillin-resistant S. aureus and GNB producing extended-spectrum β-lactamases, mainly of the CTX-M variety. Only 4 (3.1%) GNB produced carbapenemases encoded predominantly by bla VIM . Factors associated with presence of multidrug-resistant bacteria were peripheral neuropathy (adjusted odds ratio [AOR] = 4.05, p = 0.04) and duration of foot infection of more than 1 month (AOR = 7.63, p = 0.02). Conclusion Multidrug-resistant facultative anaerobic bacteria are overrepresented as agents of IDFU. A relatively low proportion of the aetiological agents were anaerobic bacteria.