Bacteriological analysis and antibiotic resistance in patients with diabetic foot ulcers in Dhaka

• Published in: PloS one 2024-05, Vol.19 (5), p.e0301767-e0301767
• Main Authors: Baral, Poulomi, Afnan, Nafisa, Ahmad Zahra, Maftuha, Akter, Baby, Rabia Prapti, Shek, Muazzam Hossan, Mohammed, Haque, Fahim Kabir Monjurul
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ampicillin; Amputation; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotic resistance; Antibiotics; Bacteria; Bangladesh - epidemiology; Biochemical tests; Biology and Life Sciences; Care and treatment; Consent; Data collection; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - microbiology; Diabetic foot; Diabetic Foot - drug therapy; Diabetic Foot - microbiology; Drug resistance; Drug resistance in microorganisms; Drug Resistance, Bacterial; E coli; Escherichia coli; Escherichia coli - drug effects; Escherichia coli - isolation & purification; Ethics; Feet; Female; Foot diseases; Gram-negative bacteria; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - isolation & purification; Gram-positive bacteria; Gram-Positive Bacteria - drug effects; Gram-Positive Bacteria - isolation & purification; Health aspects; Humans; Infections; Klebsiella; Klebsiella pneumoniae; Leg ulcers; Male; Medical research; Medicine and Health Sciences; Medicine, Experimental; Microbial Sensitivity Tests; Middle Aged; Morphology; Mortality; Multidrug resistance; Norfloxacin; Patients; Physiology; Piperacillin-tazobactam; Plantar ulcers; Polymerase chain reaction; Pseudomonas aeruginosa; Public health; Questionnaires; Research and Analysis Methods; Selective media; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Statistical analysis; Tobacco; Type 2 diabetes; Ulcers; Vancomycin
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0301767

The primary objective of this study was to isolate bacteria from diabetic foot ulcers and subsequently assess their antibiotic resistance capabilities. Seventy-five patients diagnosed with diabetic foot ulcers were investigated. A number of these patients (97.33%) had type 2 diabetes, with a significant proportion of them having been diagnosed for 1-5 years (29.33%). Notably, a substantial number of these individuals were on insulin usage (78.66%). Among the patients under examination, 49.33% reported having no use of tobacco products, alcohol, or betel leaf. The ulcers analyzed in this study were classified into grades 1-5 according to the Wagner scale. Wagner grade 2 diabetic foot ulcers had the highest number of culture-positive patients, at 33.33%. Pus samples collected from patients were cultured on selective media, and bacterial identity was confirmed by biochemical tests and polymerase chain reaction. A total of 141 isolates were isolated. Among the isolates, 82.97% gram-negative bacteria and 17.02% gram-positive bacteria were detected. Klebsiella pneumoniae was the most common isolate. Proteus spp., Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were also detected. Approximately 61.33% of the ulcers exhibited were polybacterial. In this study, it was observed that all bacterial isolates, except for Proteus spp., were primarily detected in patients classified under Wagner's grade 2. Moreover, antibiotic susceptibility was also tested on these 141 isolates. Among them, Escherichia coli showed the highest multidrug resistance, 81.81%. Most of the gram-negative bacteria were resistant to ampicillin. All of the gram-negative isolates exhibited high levels of susceptibility to piperacillin-tazobactam, and these levels were Klebsiella pneumoniae (97.56%), Pseudomonas aeruginosa (95.24%), Escherichia coli (81.82%), and Proteus spp. (80%). On the other hand, gram-positive Staphylococcus aureus mostly showed sensitivity towards vancomycin and norfloxacin (79.17%).