Prevalence and antibiotic susceptibility pattern of bacterial infection in diabetic foot ulcer in different regions of khyber pakhtunkhwa

Muhammad Ismail; Shabir Ahmad; Sarir ud Din; Urooj Ata; Arqam Sheraz; Saleem Ullah Khan Muhammad; Ibrar Ahmad; Yasir Yasir

doi:10.46795/ijhcbs.v6i3.719

Muhammad Ismail Department of Rehabilitation and Allied Health Sciences, Riphah International University Islamabad.
Shabir Ahmad Department of MLT Midwest Institute of Sciences Islamabad Islamabad
Sarir ud Din Department of Pathology Lab Technician at HMC (Hayatabad medical complex) Peshawar
Urooj Ata Department of MLT Mohi ud Din Institute of Nursing and Allied Sciences Mirpur AJ&K
Arqam Sheraz Institute of Allied Health Sciences (IHS) Swabi Khyber Medical University.
Muhammad Saleem Ullah Khan Lecturer Faculty of Allied Health Science in Gomal University Dera Ismail Khan
Ibrar Ahmad Department of MLT Midwest Institute of Sciences Islamabad Islamabad
Yasir Department of MLT Midwest Institute of Sciences Islamabad Islamabad

DOI https://doi.org/10.46795/ijhcbs.v6i3.719

Abstract

Background: Diabetic foot infections (DFIs) represent a significant public health challenge, and understanding the pathogens responsible is essential for effective antibiotic therapy. The microorganisms causing these infections, along with their antibiotic resistance patterns, vary by geographic region, necessitating localized empirical treatment. Objective: This study aims to investigate the incidence of antibiotic sensitivity and resistance patterns of bacterial infections in diabetic foot ulcers in Khyber Pakhtunkhwa. Material and method: A cross-sectional study was conducted at the Diabetes Center, Hayatabad Medical Complex, Peshawar, over four months, involving 500 randomly selected diabetic patients with foot ulcers. Samples were collected aseptically using wound swabs and cultured on various media, including Mueller-Hinton agar, MacConkey agar, and CLED. Bacterial identification was carried out using biochemical assays (catalase, coagulase, TSI), Gram staining, and the use of specific media. Antibiotic susceptibility was evaluated using the Kirby-Bauer disc diffusion method on Mueller-Hinton agar. Data were analyzed using SPSS version 25. Result: Out of 500 samples, 200 (40%) showed positive bacterial growth, with the highest sample contribution from Peshawar (35%), followed by Bannu (25%). Female participants accounted for 58%, with the majority (68%) aged between 41 and 60 years. Staphylococcus aureus and Klebsiella pneumoniae were the principal isolates, confirmed through Gram staining and biochemical assays. Antibiotic susceptibility testing showed high sensitivity to Amikacin (91%) and Gentamicin (89%), while resistance rates for Cotrimoxazole and Imipenem exceeded 90%. Conclusion: This study highlights the significant prevalence of Staphylococcus aureus and Klebsiella pneumoniae in diabetic foot ulcers across Khyber Pakhtunkhwa and the high rates of antibiotic resistance. The results underscore the critical need for localized antibiotic management strategies to reduce resistance and improve patient outcomes.

Keywords: Antibiotic susceptibility, Bacterial infection, diabetic foot ulcer

Downloads

Download data is not yet available.

References

(1) Alam U, Asghar O, Azmi S, Malik RA. General aspects of diabetes mellitus. In U Alam, O Asghar, S Azmi, & R A Malik (Eds), Diabetes: An old disease, a new insight (pp 1–11) Springer International Publishing 2021;126:211-22.
(2) Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice. 2019;157:107843.
(3) Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg (Lond). 2022;79:103901.
(4) Pendsey SP. Understanding diabetic foot. International journal of diabetes in developing countries. 2010;30(2):75.
(5) Pappas P. Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503-35.
(6) Bakker K, Apelqvist J, Lipsky B, Van Netten J, Schaper N, Foot IWGotD. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence‐based global consensus. Diabetes/metabolism research and reviews. 2016;32:2-6.
(7) Macdonald KE, Boeckh S, Stacey HJ, Jones JD. The microbiology of diabetic foot infections: a meta-analysis. BMC infectious diseases. 2021;21:1-10.
(8) Riaz M, Miyan Z, Waris N, Zaidi SI, Tahir B, Fawwad A, et al. Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan. International wound journal. 2019;16(3):768-72.
(9) Yasin M, Zafar S, Rahman H, Khan TA, Nazir S, Shah S, et al. Baseline characteristics of infected foot ulcers in patients with diabetes at a tertiary care hospital in Pakistan. Journal of Wound Care. 2018;27(Sup10):S26-S32.
(10) Adnan SM, Fatima S, Hasan SM. Factors Associated with Diabetic Foot Ulceration among Diabetes Mellitus Type 2 Patients at Dow University Hospital, Karachi: Diabetic Foot Ulceration. Pakistan BioMedical Journal. 2024:02-6.
(11) Alhubail A, Sewify M, Messenger G, Masoetsa R, Hussain I, Nair S, et al. Microbiological profile of diabetic foot ulcers in Kuwait. Plos one. 2020;15(12):e0244306.
(12) Caldwell MD. Bacteria and antibiotics in wound healing. Surgical Clinics. 2020;100(4):757-76.
(13) Qadir AN, Mahmoud BM, Mahwi TO, Al-Attar DMRA, Mahmood SO. Prevalence of microorganisms and antibiotic sensitivity among patients with diabetic foot ulcer in Sulaimani City, Iraq. Hospital Practices and Research. 2020;5(2):56-63.
(14) Burgess JL, Wyant WA, Abdo Abujamra B, Kirsner RS, Jozic I. Diabetic wound-healing science. Medicina. 2021;57(10):1072.
(15) Abbasi AS, Niaz S, Mahjbeen W. Commonly Occurring Bacteria in Diabetic Foot Infections and their Sensitivity to various Antibiotics. Journal of Islamabad Medical & Dental College. 2019;8(1):8-12.
(16) Malik A, Mohammad Z, Ahmad J. The diabetic foot infections: biofilms and antimicrobial resistance. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2013;7(2):101-7.
(17) Ahmadishooli A, Davoodian P, Shoja S, Ahmadishooli B, Dadvand H, Hamadiyan H, et al. Frequency and antimicrobial susceptibility patterns of diabetic foot infection of patients from Bandar Abbas District, Southern Iran. Journal of pathogens. 2020;2020.
(18) Murali TS, Kavitha S, Spoorthi J, Bhat DV, Prasad ASB, Upton Z, et al. Characteristics of microbial drug resistance and its correlates in chronic diabetic foot ulcer infections. Journal of medical microbiology. 2014;63(10):1377-85.
(19) Swoboda L, Held J. Impaired wound healing in diabetes. Journal of Wound Care. 2022;31(10):882-5.
(20) Shah P, Eswarawaka M, Anne D, Shah P, Srivastava N. Bacteriological profile of diabetic foot. International Surgery Journal. 2021;8(2):704-9.
(21) van Netten JJ, Bus SA, Apelqvist J, Lipsky BA, Hinchliffe RJ, Game F, et al. Definitions and criteria for diabetic foot disease. Diabetes/metabolism research and reviews. 2020;36:e3268.
(22) Murshed M. Bacteriological profile of diabetic foot infection and its effect on limb salvation. J Surg Sci. 2020;24(1):21-5.
(23) Khan D, Zeb M, Khattak SK, Shah AA, Abdullah M, Bilal M. Molecular characterization and antibiotic susceptibility pattern of bacterial strains isolated from diabetic foot ulcers. Endocrine and Metabolic Science. 2023;12:100136.
(24) De Lencastre H, Oliveira D, Tomasz A. Antibiotic resistant Staphylococcus aureus: a paradigm of adaptive power. Current opinion in microbiology. 2007;10(5):428-35.
(25) Jain SK, Barman R. Bacteriological profile of diabetic foot ulcer with special reference to drug-resistant strains in a tertiary care center in North-East India. Indian journal of endocrinology and metabolism. 2017;21(5):688-94.