Cigarette Smoking and Peripheral Vascular Disease are Associated with Increasing Risk of ESKAPE Pathogen Infection in Diabetic Foot Ulcers

Tingting Li,* Zhaoyinqian Li,* Li Huang, Jingyang Tang, Zixuan Ding, Zhangrui Zeng, Yao Liu, Jinbo Liu Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Lu Zhou, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinbo Liu, Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China, Tel +86 08303165730, Email liujb7203@swmu.edu.cnObjective: Diabetic foot ulcers (DFUs) and ESKAPE pathogens have attracted attention globally, but the role of ESKAPE pathogens in diabetic foot infection is not well described. The purpose of this study was to evaluate the clinical features, antimicrobial resistance, and risk factors for ESKAPE infection in patients with DFUs.Methods: A retrospective study was conducted on 180 patients with diabetic foot infection admitted to The Affiliated Hospital of Southwest Medical University (Luzhou, China), from January 2017 to April 2021. Antimicrobial susceptibilities of all isolates were determined. Multivariate logistic regression analysis was performed to analyze the independent risk factors for ESKAPE infection, multidrug-resistant (MDR)-ESKAPE infection, MDR-pathogen infection, and severe group in patients with DFUs.Results: A total of 206 isolates were collected, of which 42.2% were ESKAPE pathogens. The independent risk factors for ESKAPE infection were cigarette smoking (OR = 1.958; 95% CI, 1.015– 3.777) and peripheral vascular disease (OR = 2.096; 95% CI, 1.100– 3.992), while alcohol consumption (OR = 2.172; 95% CI, 1.104– 4.272) was the independent risk factor for MDR-pathogen infection. Additionally, the independent risk factors for severe DFU group were invasive treatment (OR = 326.642; 95% CI, 76.644– 1392.08), the duration of systemic antibiotic treatment (OR = 0.918; 95% CI, 0.849– 0.992), and length of hospital stay (OR = 1.145; 95% CI, 1.043– 1.256). No independent risk factors for MDR-ESKAPE infection were found.Conclusion: Our data established the microbiological features of ESKAPE pathogens and clinical manifestations of diabetic foot infection, and provide support for monitoring and management of ESKAPE infection in patients with DFUs in southwest China.Keywords: diabetic foot ulcers, ESKAPE pathogens, infection, antimicrobial resistance, risk factors