Current status in diabetic foot infectious agents

Objectives: Diabetic foot ulcer which is one of the complications of Diabetes Mellitus that causes prolonged diabetes-releated hospitalization the most and has the highest cost. It is the most common cause of non-traumatic limb amputations. In current study, we aimed to determine the microbiological profile of diabetic foot infectious agents in our center in order to create a guideline for choosing antibiotic and reducing limb loss and cost. Materials and methods: Medical records of 216 patients hospitalized for diabetic foot ulcer in the Endocrinology Clinic of Çukurova University Faculty of Medicine between 2016-2019 were included. The sociodemographic characteristics of the patients; duration, treatment, complications and type of diabetes, history of diabetic foot ulcer and surgery, wound characteristics, Wagner staging, antibiotic use, laboratory and radiological findings, deep tissue and swab cultures and antibiograms were evaluated retrospectively. Results: The mean age of 216 patients was found to be 62,06±11,09 years. 69.4% of whom were male and 97.2% of whom were Type 2 diabetes and the mean duration of diabetes was 16,9±8,41 years. In 172 deep tissue wound cultures, Pseudomonas aeruginosa (16.5%) was the most common bacteria and Staphylococcus aureus (7.5%) was the most common Gram-positive bacteria. In 173 swab wound cultures, Enterococcus (14,5%) was the most common bacteria and Pseudomonas aeruginosa (10.4%) was the most common Gram-negative bacteria. Accuracy rate of the swab culture according to the deep tissue culture was 48.8%. The most effective antibiotics against Gram-negatives were carbapenems, colistin and amikacin, while the most effective antibiotics against Gram-positives were vancomycin, linezolid and daptomycin. Conclusion: Diabetic foot ulcers have high morbidity and mortality therefore early diagnosis and follow-up of diabetic foot ulcers is important. For each center, evaluating its own microorganism surveillance and antibiotic susceptibility profiles and case follow-up with a multidisciplinary approach will be effective in reducing limb loss and cost. In empirical treatment, it seems important to choose antibiotics against Gram-negative bacteria which include Pseudomonas along with Gram-positive cocci. Keywords: Antibiogram, Amputation, Deep tissue culture, Diabetic foot infection, Swab culture.