Affiliation:
1. Department of Trauma and Orthopaedics, Wythenshawe Hospital (Manchester University Foundation Trust), Wythenshawe UK
2. The University of New South Wales Sydney Australia
Abstract
AbstractBackground: The microbiological composition of diabetic foot infection (DFI) and its antimicrobial resistance exhibit variations in different parts of the world.Aims: This study aimed to shed light on the microbial load associated with DFI and the patterns of antibiotic resistance in Northwest England.Methods: This was a retrospective descriptive study that included 67 patients (55 male [78.6%]). The mean age at diagnosis was 45.6 years (standard deviation, 15.8). The culture of deep tissue samples was analysed together with antibiotic resistance.Results: A total of 114 causative pathogens were identified. Of note, 40 patients (60.00%) had polymicrobial infections. Moreover, 58.77% of the microbial cohort was composed of gram‐positive bacteria. Staphylococcus spp. were found in 32 patients (47.76%) and were the most prevalent pathogen in our cohort. Anaerobic bacteria were found in 17 patients (25.37%) and were the second most common pathogen in our cohort. Corynebacterium spp., Streptococcus spp. and Enterococcus spp. were identified in 11 (16.42%), 10 (14.93%) and 9 (13.43%) patients, respectively. Among the gram‐negative bacteria, Escherichia spp. were found in 7 patients (10.45%), Enterobacter spp. were found in 6 patients (8.96%), Klebsiella spp. were found in 4 patients (5.97%), Proteus spp. were found in 4 patients (5.97%) and Alcaligenes spp. were found in 2 patients (2.99%). The remaining less common organisms collectively accounted for 1.49% prevalence. Regarding antibiotic therapy, the highest resistance was observed for ciprofloxacin (12 [17.91%]), followed by amoxicillin (11 [16.42%]), penicillin (10 [14.93%]), clarithromycin (7 [10.45%]), trimethoprim (7 [10.45%]), doxycycline (6 [8.96%]) and piperacillin/tazobactam (5 [7.46%]).Conclusions: In contrast to the predominant aerobic gram‐negative bacteria in Asia, the Middle East and Africa, our study found a paradoxically higher prevalence of gram‐positive and anaerobic bacteria in North West England. Moreover, our study found a high incidence of resistance to ciprofloxacin and amoxicillin.