Increasing incidence of Gram-negative organisms in bacterial agents isolated from diabetic foot ulcers

Introduction: In the present study, we sought to identify the bacterial organisms associated with diabetic foot infections (DFIs) and their antibiotic sensitivity profiles. Methodology: We retrospectively reviewed the records of wound cultures collected from diabetic patients with foot infections between May 2005 and July 2010. Results: We identified a total of 298 culture specimens (165 [55%] wound swab, 108 [36%] tissue samples, and 25 [9%] bone samples) from 107 patients (74 [69%] males and 33 [31%] females, mean age 62 ± 13 yr) with a DFI. Among all cultures 83.5% (223/267) were monomicrobial and 16.4% (44/267) were polymicrobial. Gram-negative bacterial isolates (n = 191; 61.3%) significantly outnumbered Gram-positive isolates (n = 121; 38.7%). The most frequently isolated bacteria were Pseudomonas species (29.8%), Staphylococcus aureus (16.7%), Enterococcus species (11.5%), Escherichia coli (7.1%), and Enterobacter species (7.1%), respectively. While 13.2% of the Gram-negative isolates were inducible beta-lactamase positive, 44.2% of Staphylococcus aureus isolates were methicillin resistant. Conclusions: Our results support the recent view that Gram-negative organisms, depending on the geographical location, may predominate in DFIs.

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A clinical study of commonly isolated organism and its antibiotic sensitivity in diabetic foot ulcers in Sri Manakula Vinayagar Medical College and Hospital, Pondicherry

International Surgery Journal ◽

10.18203/2349-2902.isj20203032 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2512

Author(s):

Anand Shanmugaiah ◽

Saravanan Pandian ◽

Sudha Selvam

Keyword(s):

Staphylococcus Aureus ◽

Blood Sugar ◽

Diabetic Foot ◽

Foot Ulcer ◽

Antibiotic Sensitivity ◽

Diabetic Foot Ulcer ◽

Empirical Therapy ◽

Gram Negative ◽

Medical College ◽

Diabetic Foot Infections

Background: Diabetic foot ulcer is one of the major surgical problem leading to hospital admission. Diabetic foot ulcer patients with uncontrolled diabetes may end up in forefoot amputation. Early aggressive debridement, control of blood sugar and empirical antibiotic therapy would reduce the morbidities in patients with diabetic foot ulcer. Further the knowledge of commonly isolated microbes and their antibiotic sensitivity pattern would be helpful to start empirical therapy. The purpose of this study was to determine the microbiological proﬁle of diabetic foot infections (DFIs) and assess the antibiotic susceptibility of the causative agents.Methods: This cross-sectional study was conducted in 115 patients admitted with diabetic foot ulcer over a period of 9 months from October 2015 to June 2016 at the department of general surgery, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. Tissue scrapping samples were collected and processed as per standard guidelines.Results: 167 organisms were isolated from 115 patients. 52% of culture showed polymicrobial growth. There was increased prevalence of gram-negative organisms 53% compared to gram positive organisms 47%. When comes to individual isolate, Staphylococcus aureus was the most common organism isolated 24.6% followed by Pseudomonas aeruginosa 21%. All gram-positive aerobes were sensitive to vancomycin and gram-negative isolates were sensitive to amikacin, piperacillin-tazobactum, gentamycin and cefotaxime.Conclusions: Staphylococcus aureus and Pseudomonas were the common pathogens isolated. This study recommends use of vancomycin along with piperacillin-tazobactum as an empirical therapy along with adequate blood sugar control and early debridement of devitalized tissues in patients with diabetic foot infections.

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How Do Preoperative Antibiotics Affect Culture Yield in Diabetic Foot Infections?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx016 ◽

2017 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Heather Young ◽

Whitney Miller ◽

Randy Burnham ◽

Susan Heard ◽

Chrystal Berg ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Gram Negative ◽

Diabetic Foot Infection ◽

Negative Results ◽

Diabetic Foot Infections ◽

Preoperative Antibiotics ◽

The Impact ◽

Culture Negative ◽

Culture Yield

abstractThe impact of preoperative antibiotics on culture of diabetic foot infection samples has not been studied. We found that increasing exposure to preoperative antibiotics was associated with less frequent growth of streptococci and anaerobes and more culture-negative results. In contrast, the yield of Staphylococcus aureus and Gram-negative bacilli was unaffected.

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Clinico-microbial profile in chronic suppurative otitis media and its management in tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185301 ◽

2018 ◽

Vol 5 (1) ◽

pp. 135

Author(s):

Rashmi Ramashesh ◽

Samira Abdul Wajid ◽

Smitha Chandra

Keyword(s):

Staphylococcus Aureus ◽

Otitis Media ◽

Antibiotic Sensitivity ◽

Chronic Suppurative Otitis Media ◽

Health Concern ◽

Research Centre ◽

Suppurative Otitis Media ◽

Gram Negative ◽

Sensitivity Pattern ◽

Pseudomonas Species

Background: Chronic suppurative otitis media (CSOM) is an ever growing concern of preventable hearing loss and is a major health concern especially in tropical countries. Lack of cleanliness, overcrowding, poverty, malnutrition and medical ignorance are few of the contributing factors. The microbiological flora is constantly changing due to indiscriminate use of antibiotics with rapid change in the antibiotic sensitivity patterns. Hence, this study was undertaken to determine the epidemiological profile, bacteriological profile and the antibiotic sensitivity pattern which would help in establishing a protocol in management of CSOM patients in the hospital.Methods: A total of 100 patients of CSOM attending the ENT Outpatient Department of The Oxford medical College, Hospital and Research Centre were included in the study. The samples were immediately sent to the Microbiology laboratory for further processing according to standard procedure. Results: Out of 100 cases, 74 were active mucosal type and 26 were active squamous, with Pseudomonas species (33.6%) being the predominant organism. Staphylococcus aureus was the next common organism with MSSA (16.3%) and MRSA (12.5%), CONS were 6.7%. Among the 28 gram-negative bacilli, Klebsiella pneumoniae (7.7%), was followed by Escherichia coli (5.7%), and Proteus mirabilis (4.8%).Conclusions: Pseudomonas species and Staphylococcus aureus are the commonest organisms of CSOM. Ciprofloxacin can be used as a topical agent for treating gram-negative bacilli. Among systemic antibiotics- Linezolid, Amikacin and Imepenam remains the drug of choice.

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Bacterial Etiology and Antibiotic Sensitivity Pattern of Community Acquired Pneumonia in Diabetic Patients: Experience in a Tertiary Care Hospital in Bangladesh

BIRDEM Medical Journal ◽

10.3329/birdem.v7i2.32445 ◽

2017 ◽

Vol 7 (2) ◽

pp. 101-105

Author(s):

Jamal Uddin Ahmed ◽

Mohammad Delwar Hossain ◽

Muhammad Abdur Rahim ◽

Farhana Afroz ◽

AKM Musa

Keyword(s):

Staphylococcus Aureus ◽

Klebsiella Pneumoniae ◽

Antibiotic Sensitivity ◽

Community Acquired Pneumonia ◽

Sputum Culture ◽

Diabetic Patients ◽

Care Hospital ◽

E Coli ◽

Sensitivity Pattern ◽

Pseudomonas Species

Background: Diabetes mellitus (DM) is an immunosuppressive condition and uncontrolled diabetes is associated with increased susceptibility to various infections like pneumonia. Community acquired pneumonia (CAP) in diabetic patients is often caused by more virulent or atypical organisms and associated with increased resistance to conventional antibiotics. The aims of this study were to identify the bacterial etiology of CAP in patients with DM and to see their antibiotic sensitivity pattern.Methods: This was a cross-sectional, observational study conducted in the Department of Internal Medicine & Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh, from January 2013 to December 2015. A total of 120 hospitalized diabetic patients diagnosed with CAP and with a positive sputum culture growth of any bacteria were included in the study.Results: Majority (67%) of the patients were male. Mean age of the patients was - 55.69 ±10.5 years. Mean duration of diabetes was - 7.35 ±1.3 years. Mean HbA1c was - 8.6 ±1.89%. Sputum for culture showed that out of 120 (100%) patients, Klebsiella pneumoniae was detected in 53 (44.2%) patients, Staphylococcus aureus in 18 (15.0%), Pseudomonas species in 16 (13.3%) patients, Acinetobacter in 10 (8.3%), Escherichia coli in 9 (7.5%) patients and 14 (11.7%) patients had growth of other organisms. Sensitivity pattern of different bacterial growth in sputum to commonly used antibiotics like ceftriaxone, ciprofloxacin, amikacin and imipenem were as follows Klebsiella (19%, 47%, 74%, 96% respectively), Staph aureus (11%, 33%, 78%, 67% respectively), Pseudomonas (19%, 75%, 81%, 88% respectively), Acinetobacter (0%, 0%, 20%, 50% respectively), E. coli (22%, 22%, 100%, 100% respectively). All (100%) of the Pseudomonas and Acinetobacter were sensitive to colistin. Most of the growth of all the bacteria (Klebsiella 94%, Staphylococcus 78%, Pseudomonas 81%, Acinetobacter 100%, E. coli 100%) occurred in patients with poor glycemic control (HbA1c ? 7.0%).Conclusion: This study results suggest that CAP in diabetic patients are more frequently due to Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas species and mostly they are less sensitive to commonly used antibiotics like ceftriaxone and ciprofloxacin. So, whenever possible, treatment of CAP should be guided by sputum culture and sensitivity test and for empirical treatment of CAP in diabetic patients, alternative antibiotics like imipenem and amikacin should be considered.Birdem Med J 2017; 7(2): 101-105

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Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202471 ◽

2020 ◽

Vol 47 ◽

Author(s):

DÊNISSON GUEDES PONTES ◽

IVAN TRAMUJAS DA COSTA E SILVA ◽

JESSICA JANSEN FERNANDES ◽

AMANDA DE FÁTIMA GURGEL MONTEIRO ◽

PEDRO HENRIQUE DA SILVA GOMES ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Resistance ◽

Diabetic Foot ◽

Educational Level ◽

Bacterial Resistance ◽

Positive Culture ◽

Gram Negative ◽

Diabetic Foot Infections ◽

Foot Lesions ◽

Resistance Rates

ABSTRACT Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.

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Effectiveness of Modern Wound Dressing on the Growth of Staphylococcus Aureus Bacteria

Jurnal Keperawatan ◽

10.22219/jk.v9i2.5160 ◽

2018 ◽

Vol 9 (2) ◽

pp. 88

Author(s):

Gito Gito ◽

Erna Rochmawati

Keyword(s):

Staphylococcus Aureus ◽

Wound Dressing ◽

Chronic Wound ◽

Early Stage ◽

Wound Dressings ◽

Inclusion Criteria ◽

Gram Negative ◽

Pseudomonas Species ◽

Bacteria And Fungi ◽

Gram Negative Organisms

Wounds are classified as acute and chronic. The early stage of chronic wound formation are characterized by the emergence of gram-positive and gram-negative organisms. such as Staphylococcus aureus and Escherichia coli. At a later stage, Gram-negative Pseudomonas species tend to attack the inner layers of the wound. Modern wound dressings containing antimicrobials that have been developed since the last twenty years. It is effectively to kill bacteria and fungi in the wounds and to prevent recurrent infections during wound healings. The purpose of this paper is to report the results of a review that focuses on the effect of modern wound dressing on Staphylococcus aureus bacteria. Relevant articles were searched in PubMed and google’s scholar using keywords "modern wound dressing", "antibacterial", "staphylococcus". Ten articles that fit with the inclusion criteria were included in this review. The results show Modern wound dressing with antimicrobial content can inhibit bacterial growth. Interm of time and type of bactreria. Thus, this literatures review can be the basis for further researchs on the effectiveness of modern wound dressings against Staphylococcus aureus.

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Bacterial etiology and antimicrobial susceptibility pattern of neonatal sepsis at a tertiary care hospital in Nepal

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20211671 ◽

2021 ◽

Vol 8 (5) ◽

pp. 830

Author(s):

Kiran Sharma ◽

Love Kumar Sah ◽

Prince Pareek ◽

Sanjay Shah ◽

Reema Garegrat

Keyword(s):

Staphylococcus Aureus ◽

Neonatal Sepsis ◽

Late Onset ◽

Antibiotic Sensitivity ◽

Care Hospital ◽

Gram Negative ◽

Common Organism ◽

Early Onset Sepsis ◽

Sensitivity Pattern ◽

Gram Negative Organisms

Background: Sepsis is the second major cause of mortality among neonates. Present study was done to identify the common organisms which cause early and late onset neonatal sepsis in neonates admitted in our department and their antibiotic sensitivity patterns.Methods: All neonates weighing more than 1500 gms and born to mothers with pre-existing infection, admitted to neonatal intensive care unit for suspected neonatal sepsis were included in the present study. They underwent blood culture and antibiotic sensitivity profiling.Results: 210 newborns were admitted to the NICU of our department for suspected neonatal sepsis. Longer duration of rupture of membranes was found to be significantly associated with growth of organisms. Amongst the cases with gram positive organisms, most were due to Coagulase-negative staphylococci (CoNS) (n=25), followed by Staphylococcus aureus (n=14), and, Enterococcus (n=4). Gram negative organisms isolated constituted 17 organisms. Amongst the cases with gram negative organisms, mostly were due to Klebsiella (n=10), followed by Pseudomonas (n=5) and E. coli (n=2). The most common organism causing early onset sepsis was CoNS, while Staphylococcus aureus was the most common organism causing late onset sepsis. CoNS was fully sensitive to Vancomycin and Amikacin. Staphylococcus aureus was fully sensitive to Amikacin, α-hemolytic. Streptococcus were sensitive to Amikacin, Vancomycin and Piperacillin and Tazobactum and Enterococcus was sensitive to Amikacin and Vancomycin.Conclusions: Antimicrobial surveillance of neonatal septicaemia is required to know the antibiotic sensitivity pattern and thus to formulate policies on use of antibiotics and to know the changing spectrum of antimicrobial sensitivity patterns.

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Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734618793557 ◽

2018 ◽

Vol 17 (3) ◽

pp. 161-168 ◽

Cited By ~ 5

Author(s):

Mousab Yousef Al Ayed ◽

Mutasem Ababneh ◽

Asirvatham Alwin Robert ◽

Aus Alzaid ◽

Rania Ahmed Ahmed ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Saudi Arabia ◽

Diabetic Foot ◽

Antibiotic Sensitivity ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Gram Positive ◽

Gram Negative ◽

Klebsiella Spp

We sought to define the type and antibiotic sensitivity response of pathogens isolated from diabetic foot ulcers based on ulcer location and Wagner classification. This retrospective analysis was done among 126 patients between 40 and 70 years of age at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, using the swab culture method for microbiological assessment. Data on demographic variables, ulcer sites (location), and depth of ulcer (Wagner classification) were also collected. A total of 134 pathogens were isolated from 126 patients. The most common gram-negative pathogen identified was Pseudomonas aeruginosa (15.6%), followed by Klebsiella spp (6.7%). The most common gram-positive pathogen was Staphylococcus aureus (35%), followed by Streptococcus (8.9%). The most widely accepted antibiotic to which the gram-negative bacteria were sensitive was gentamycin (20.1%), followed by ciprofloxacin (19%). The most routinely used antibiotic in the treatment of the gram-positive bacteria was erythromycin (16%), with trimethoprim-sulfamethoxazole (14.1%) being the next most effective. In conclusion, Pseudomonas aeruginosa, Klebsiella spp, Staphylococcus aureus, and Streptococcus were the most common causes of diabetic foot infections. However, the frequency of encountered pathogens and respective sensitivity to antibiotic therapy may be influenced by the location site and severity of the ulceration.

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Microbiological and antibiotic profile of osteomyelitis in tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20210926 ◽

2021 ◽

Vol 8 (3) ◽

pp. 910

Author(s):

Vijayakumar A. B. ◽

Yerriswamy Parvatha Reddy ◽

Suphala B. ◽

Ananya Gopalakrishnan ◽

Vinod Kumar C. S.

Keyword(s):

Staphylococcus Aureus ◽

Tertiary Care ◽

Antibiotic Sensitivity ◽

Carbapenem Resistance ◽

Resistance Pattern ◽

Diabetic Patients ◽

Gram Negative Bacteria ◽

Care Hospital ◽

Sensitivity Testing ◽

Gram Negative

Background: Osteomyelitis has been continuing as the most important cause of morbidity among patients with bone infections. Constant change in the trend of organisms involved and resistance pattern has made management of osteomyelitis cases difficult. With this background present study aimed to look for the changing trends of microorganisms involved in osteomyelitis and their antimicrobial susceptibility pattern. Methods: A total of 100 cases studied over a period of two years. Samples collected were processed by standard microbiological techniques and antimicrobial testing was done as per the clinical and laboratory Standards Institute guidelines. Results: Among 100 cases, 62 were males and 38 were females, with the mean age of all the patient was 51.6±12.32 years. 64% of the patient were diabetic patients. Long bones are most involved with trauma (45%) as risk factor. Staphylococcus aureus (24.2%) predominant pathogen isolated followed by Pseudomonas aeruginosa (21.2%) and Acinetobacter baumannii (16.7%). Antibiotic sensitivity testing of gram positive organisms showed hundred percent sensitivity to vancomycin and gram negative bacteria showed highest sensitivity to cefoperazone+sulbactam, piperacillin+tazobactam, meropenem and imipenem. Conclusions: Osteomyelitis caused by methicillin resistant staphylococcus aureus and carbapenem resistance gram negative bacteria is a serious concern. Since multidrug resistant strains have emerged in osteomyelitis cases, emphasis should be given for hygiene and targeted antibiotherapy.

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Bacteriological Profile and Antibiotic Sensitivity Pattern in Infected Diabetic Foot Ulcers

Esculapio ◽

10.51273/esc20.2516322 ◽

2020 ◽

Vol 16 (03, july 2020-Septmber 2020) ◽

Author(s):

Afshan Zia

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Antibiotic Sensitivity ◽

Diabetic Foot Ulcer ◽

Empiric Therapy ◽

Sensitivity Pattern ◽

Pseudomonas Species ◽

Third Generation Cephalosporins ◽

Proteus Species

Objectives: To identify the common bacterial pathogens responsible for infection in diabetic foot ulcer and their sensitivity pattern to different antibiotics. Methods: This prospective observational study was conducted from 24th June 2019 to 27th December 2019 at Services Institute of Medical Sciences Lahore. Specimens of discharge from diabetic foot ulcers (DFU) were received from Diabetes Management Centre (DMC). Cultures were put up and bacteria isolated were identified by standard methods. Antibiotic sensitivity was determined by Kirby-Bauer disc diffusion method. Results: Samples from DFU of 50 patients were processed. Thirty-six (72%) samples were from males and 14(28%) were from females; mean age of patients was 53±9.5 years. Forty-nine (98%) patients had unsatisfactory glycemic control. Forty three (86%) samples were growth positive while 07(14%) were bacteriologically sterile. Monomicrobial infection was observed in 38 (76%) cases while polymicrobial infection was seen in 12 cases (24%). The most common isolates were Staphylococcus aureus 14(28%), Pseudomonas species 11 (22%) and Proteus species 10 (20%). Forty three percent of Staphylococcus aureus, were methicillin resistant (MRSA). All MRSA remained sensitive to vancomycin and linezolid. In Pseudomonas species, resistance to third generation cephalosporins, ceftazidime , was 27%, while resistance to imipenem was seen in 3 (9%) of isolates. In Proteus species, resistance to third generation cephalosporins was 90% while to imipenem resistance was 60%. Resistance to commonly prescribed quinolones was more than 70% among all the bacterial isolates. Conclusions: Common Gram positive and Gram negative organisms responsible for infection in DFU were Staphylococcus aureus, Pseudomonas species and Proteus species. The isolates were multi-drug resistant (MDR). Resistance to antibiotics used as empiric therapy was high. Keywords: Diabetic foot ulcer, antibiotic resistance, empiric therapy

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