Analysis of the microbiota in the diabetic foot ulcers: Is research standardization required?

Abstract

Background: Complications of infected wounds in patients with diabetic foot ulcer (DFU) are one of the greatest challenges in modern medicine. Analysis of the microbiological profile of infected ulcers may significantly improve treatment results. The aim of the study was to determine the profile of pathogens isolated in patients with DFU and to compare the results of other centers. Materials and Methods: A retrospective study was carried out on 137 patients with DFU hospitalized at the Department of Diabetology and Internal Diseases, Medical University of Warsaw in 2011-2014. The analysis included the results of 200 microbiological cultures tested for fungi, aerobic and anaerobic bacteria. Statistical analysis was used to test differences in HbA1c values in relation to the strain of the most commonly cultured bacteria and the relationship between glycemic control and most frequently isolated pathogens. Results: Seventy-nine bacterial species were isolated in 183 positive cultures. Gram-negative bacteria predominated with the highest percentage of representatives of Enterobacterales. The most often isolated bacteria were Serratia marcescens, Pseudomonas aeruginosa, Proteus mirabilis and methicillin-susceptible Staphylococcus aureus. The Kruskal-Wallis test revealed that HbA1c concentrations were different in groups infected with different strains of bacteria (p = 0.0087). Isolation of Escherichia coli and Morganella morganii was more often associated with poor control of diabetes. Conclusions: The study revealed statistically significant differences in the frequency of microorganisms isolated from the wounds of patients with DFU. The discrepancies in the results of other studies published in this field indicate the need for standardization of the research design.