Infective agents in diabetic foot ulcers and their sensitivity patterns

  • Mehmood Nadir
  • Muhammad Qasim Khan
  • Muhammad Anwar Idrees
  • Tehzeeb ul Hassan
  • Maha Nadir
Keywords: Diabetic Foot, Microbial Resistance, Diabetes Mellitus


Background: Diabetic-foot syndrome is a difficult & debilitating complication of inadequately regulated Diabetes Mellitus. Attributed to neural & vascular pathology, the condition is further potentiated by glycemic healing impairment.  A wide array of microorganisms have been implicated & sensitivity-guided antibiotics are essential to save both limb as well as to minimize rampant microbial resistance. Present study aims to determine the culture & sensitivity pattern of bacteria in stated cohort of patients at a Surgical Unit.

Materials & Methods: This prospective cohort study was conducted over a period of 1 year-duration at a tertiary-care-Hospital. All patients presenting with diabetic-foot who had not been subjected to empiric antibiotic-therapy were enrolled. Demographic & lesion-based variables were studied and the Culture & Sensitivity pattern was evaluated and statistically analyzed.

Results:100 patients were included in the study,of which 80 were male (mean-age 60.8±12.7 years) & rest female (mean-age 58.4±11.3-years).35% cultures yielded no growth. Remaining cases showed following pathogens in descending order of incidence. Maximal sensitivity was also reported as mentioned. 1) Staphylococcus-aureus & Klebseilla-Pneumoenae– Piperacillin/Tazobactam,2) Pseudomonas-Aerugionas-Cefotaxime,3)E-coli–Amikacin& Sulbactam,4) Proteus -Gentamicin, 5) Streptococci– Amikacin and 6) Bacteroides – Cefoperazone & Aztreonam. Of 71 cases, 70  had aerobic-organisms isolates & only 1 had anaerobic-isolate.


Conclusions: Six pathogens were identified in present study of which Staphylococcus-Aureus was the most prevalent as well as the most resistant. Streptococci & Gram-negative Organisms were observed in remaining cases. While formulation of an adequate antibiotic regime is rendered difficult by resistance & mixed infections, targeted antibiotic administration is decisively crucial to achieve optimal & timely outcome in diabetic foot.



1. Diagnosis and classification of diabetes mellitus. Diabetes Care, 2014. 37 Suppl 1: p. S81-90.
2. Tsourdi, E., et al., Current Aspects in the Pathophysiology and Treatment of Chronic Wounds in Diabetes Mellitus. BioMed Research International, 2013. 2013: p. 385641.
3. Apelqvist, J., et al., The development of global consensus guidelines on the management of the diabetic foot. Diabetes/Metabolism Research and Reviews, 2008. 24(S1): p. S116-S118.
4. La Fontaine, J., et al., Current concepts in the surgical management of acute diabetic foot infections. The Foot, 2014. 24(3): p. 123-127.
5. Hobizal, K.B. and D.K. Wukich, Diabetic foot infections: current concept review. Diabetic Foot & Ankle, 2012. 3(1): p. 18409.
6. Hena, J. and L. Growther, Studies on bacterial infections of diabetic foot ulcer. African Journal of Clinical and Experimental Microbiology, 2010. 11(3).
7. Otu, A.A., et al., Profile, Bacteriology, and Risk Factors for Foot Ulcers among Diabetics in a Tertiary Hospital in Calabar, Nigeria. Ulcers, 2013. 2013: p. 820468.
8. Ramakant, P., et al., Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia, 2011. 54(1): p. 58-64.
9. Lipsky, B.A., Empirical therapy for diabetic foot infections: are there clinical clues to guide antibiotic selection? Clinical Microbiology and Infection, 2007. 13(4): p. 351-353.
10. Nelson, S.B., Management of diabetic foot infections in an era of increasing microbial resistance. Current Infectious Disease Reports, 2009. 11(5): p. 375-382.
11. Aamir, A.H., et al., Diabetic foot infections and their management in a tertiary care hospital. J Ayub Med Coll Abbottabad, 2011. 23(1): p. 58-62.
12. Durgad, S., et al., Diabetic foot ulcers—where do we stand microbiologically? International Journal of Diabetes in Developing Countries, 2014. 34(3): p. 169-173.
13. Jneid, J., et al., The diabetic foot microbiota: A review. Human Microbiome Journal, 2017. 5-6: p. 1-6.
14. Dowd, S.E., et al., Polymicrobial Nature of Chronic Diabetic Foot Ulcer Biofilm Infections Determined Using Bacterial Tag Encoded FLX Amplicon Pyrosequencing (bTEFAP). PLoS ONE, 2008. 3(10): p. e3326.
15. Eleftheriadou, I., et al., Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs, 2010. 70(14): p. 1785-97.
16. Lipsky, B.A., Evidence-based antibiotic therapy of diabetic foot infections. FEMS Immunology & Medical Microbiology, 1999. 26(3-4): p. 267-276.
17. Morbach, S., et al., Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care, 2012. 35(10): p. 2021-7.
18. Saleem, S., et al. Risk factors associated with poor outcome in diabetic foot ulcer patients. Turkish journal of medical sciences, 2017. 47, 826-831 DOI: 10.3906/sag-1602-119.
19. Cychosz, C.C., et al., Preventive and Therapeutic Strategies for Diabetic Foot Ulcers. Foot & Ankle International, 2015. 37(3): p. 334-343.
20. Armstrong, D.G., A.J.M. Boulton, and S.A. Bus, Diabetic Foot Ulcers and Their Recurrence. New England Journal of Medicine, 2017. 376(24): p. 2367-2375.
How to Cite
Nadir M, Khan M, Ahmed M, Idrees M, Hassan T, Nadir M. Infective agents in diabetic foot ulcers and their sensitivity patterns. JRMC [Internet]. 30Jun.2021 [cited 4Dec.2021];25(2):284-8. Available from: