Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer

Xinbang Liu,1,2,&ast; Qiuyue Ren,3,&ast; Yangkui Zhai,1,2,&ast; Yihan Kong,1,2 Dong Chen,4 Bai Chang1,2 1NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, People’s Republic of China; 2Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, People’s Republic of China; 3Department of Nephropathy, Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, People’s Republic of China; 4Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bai Chang, Email changbai1972@126.comObjective: The aim of this study is to analyze the microbiological characteristics of diabetic foot ulcer (DFU) and drug resistance of multidrug-resistant organisms (MDROs) and to reveal the potential risk factors for MDROs. This provides a basis for early empiric antibiotic treatment.Methods: This study included 348 patients with diabetic foot ulcer in Chu Hsien-I Memorial Hospital & Metabolic Disease Hospital of Tianjin Medical University between May 2020 and November 2021. A total of 475 strains of bacteria were cultured, among which 240 strains were multidrug-resistant bacteria, accounting for 51%. Binary logistic regression was used to analyze risk factors. First, univariate analysis was used to calculate the p value of variables, and then multivariate analysis was conducted for variables with p < 0.1 to analyze independent risk factors. Risk factors with p < 0.05 in multivariable analysis were considered as independent risk factors. The strength of the association was represented by odds ratio and 95% confidence interval.Results: Univariable logistic regression analysis demonstrated that previous hospitalization, previous antibiotic therapy, ulcer size > 4cm2, surgical therapy, D-dimer, and CRP were associated with MDRO infection in patients with DFU. Multivariate logistic regression analysis demonstrated that previous hospitalization (OR = 1.91; 95% CI = 1.11– 3.28; p = 0.02), ulcer size > 4cm2 (OR = 1.68; 95% CI = 1.03– 2.76; p = 0.04), surgical therapy (OR = 2.14; 95% CI = 1.03– 4.47; p = 0.04), and CRP (OR = 1.01; 95% CI = 1.00– 1.01; p = 0.03) were independent risk factors for MDROs infection in diabetic foot patients. Drug resistance analysis may indicate that the proportion and drug resistance rate of Acinetobacter baumannii in Tianjin, China, have changed.Conclusion: Previous hospitalization, ulcer size > 4cm2, surgical therapy and CRP were independent risk factors for MDROs infection in diabetic foot patients. Identifying these risk factors can help us identify the high-risk patients of diabetic foot with MDRO infection early. More attention to high-risk patients and more aggressive isolation precautions may reduce the incidence of MDRO infection in diabetic foot patients.Keywords: diabetic foot ulcer, multidrug-resistant organisms, infection, risk factors, logistic regression analysis