Study of Multidrug Resistant Bacteria Associated With Diabetic Foot Ulcers.

Objective: India has the world's largest number of diabetics. Non-traumatic lower limb amputation is the most common devastating complication of diabetes, primarily due to diabetic foot ulcers (DFU) and diabetic foot infections (DFI). In India, the incidence of foot ulcers ranges from 8-17 per cent. DFIs are predominantly polymicrobial and multidrug-resistant (MDR) with the ability to form biofilm, which is an important virulence factor and results in treatment failure. Aim: The main objectives of the study are to identify the multidrug-resistant bacteria associated with these infections, their antibiotic sensitivity pattern, and to detect the biofilm formation. Materials and Methods: This is a prospective and hospital-based study was conducted in the Department of Microbiology, Shadan Institute of Medical Sciences, Teaching Hospital and Research Center over a period of 1 year (2021-2022). Inclusion Criteria: The study participants were diabetic patients with DFUs presenting to the surgical outpatient clinic and medical wards. Selection criteria were being 18 years of age or older with a diagnosis of diabetes and complication of DFUs. Exclusion Criteria: Other foot ulcers unrelated to diabetic were excluded. Bacteria were isolated and identified using a Microgen kit. Biofilm forming ability and antibiogram of isolates were determined using microtiter plate and disk diffusion methods, respectively. Results: According to age wise distribution of the study subjects, the majority of the patients (30 patients) belonged to the age group 51-60 years. Followed by 29 patients in the age group of 61-70 years. In our study, Biofilm assay of High Congo red agar method showed 12.0% positive cases, tube method showed 24.00%, and Tissue culture plate method showed 22.00%. On the other hand, Weak Congo red agar method 56.00%, tube method 16.00%, Tissue culture plate method showed 22.00%. In our study, among Biofilm formers few strains were sensitive to Clindamycin, Amikacin and Lenizolid, 3, 56, 59 respectively. Number of strain resistance to Penicillin G: 32, Tetracycline 27, Gentamycin 30, Clindamycin 35, Amoxy-clav 38, Cefoxitin 30 and Ciprofloxacin 45. Moreover, among resistant few strains were sensitive to Clindamycin, Amikacin and Lenizolid 35, 10, 4 respectively. Conclusion: This study showed that bacteria isolated from diabetic foot ulcers are polymicrobial, Biofilm producers and showed resistance to commonly used antibiotics. Knowledge on antibiotic sensitivity pattern and biofilm phenotype of the isolates will be helpful in determining the drugs for the treatment of diabetic ulcers. [ABSTRACT FROM AUTHOR]