Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan.
Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan.
J Appl Microbiol. 2021 Nov;131(5):2552-2566. doi: 10.1111/jam.15096. Epub 2021 Apr 30.
The aim of this study was to isolate and characterize staphylococcal isolates from diabetic foot ulcers (DFU) in Jordanian patients.
Selected aerobic pathogens recovered from DFU specimens and patients' nares with a focus on staphylococci were investigated. Antimicrobial susceptibilities and the prevalence of methicillin-resistant staphylococci (MRS) were determined. SCCmec types and toxigenic characteristics were analysed and spa typing was performed for methicillin-resistant Staphylococcus aureus (MRSA) isolates. The relationship between toxigenic characteristics of MRSA and the Wagner ulcer grading system was statistically analysed. A total number of 87 DFU patients were recruited for the study. The DFU cultures were polymicrobial. Members of the genus Staphylococcus were the most common among DFU-associated isolates found in 48·3% (n = 42) of all patients enrolled. Coagulase-negative staphylococci (CoNS) comprised 63·3% of staphylococci isolated from DFUs predominated by Staphylococcus epidermidis in both DFU (7·6%) and nares (39·2%). Staphylococcus aureus was isolated from DFUs and nares in 14·2 and 9·8%, respectively, while 93 and 70% of these isolates were MRSA. Most of MRSA carried SCCmec type IV (76·2%) while SCCmec elements were non-typeable in most methicillin resistant coagulase negative staphylococci (MR-CoNS) (61·9%). The most frequent MRSA spa type was t386 (23·8%). Most MRSA and MR-CoNS exhibited resistance towards aminoglycosides, fluoroquinolones and macrolides and susceptibility towards vancomycin, mupirocin and linezolid. No association was found between the possession of pvl, tst, sea and hlg toxins and Wagner ulcer grading system (P value >0·05).
This analysis of Jordanian DFU culture demonstrated its polymicrobial nature with predominance of Staphylococcus sp.
This study is the first of its type to assess the microbiology of DFU among Jordanian patients. The results will help in the appropriate application of antimicrobial chemotherapy in the management of DFU.
本研究旨在从约旦糖尿病足溃疡（DFU）患者中分离和鉴定葡萄球菌。
从 DFU 标本和患者鼻腔中选择性地分离出需氧病原体，重点是葡萄球菌。测定了抗菌药物敏感性和耐甲氧西林葡萄球菌（MRS）的流行率。分析了 SCCmec 型和产毒特征，并对耐甲氧西林金黄色葡萄球菌（MRSA）分离株进行了 spa 分型。对 MRSA 的产毒特征与 Wagner 溃疡分级系统之间的关系进行了统计学分析。共招募了 87 例 DFU 患者进行研究。DFU 培养物为混合微生物。在所有入组患者中，48.3%（n=42）的患者发现葡萄球菌属是 DFU 相关分离株中最常见的，占主导地位的是表皮葡萄球菌（7.6%）和凝固酶阴性葡萄球菌（39.2%）。金黄色葡萄球菌从 DFU 和鼻腔中分离出来，分别占 14.2%和 9.8%，而这些分离株中有 93%和 70%为 MRSA。大多数 MRSA 携带 SCCmec 型 IV（76.2%），而大多数耐甲氧西林凝固酶阴性葡萄球菌（MR-CoNS）的 SCCmec 元素不可分型（61.9%）。最常见的 MRSA spa 型为 t386（23.8%）。大多数 MRSA 和 MR-CoNS 对氨基糖苷类、氟喹诺酮类和大环内酯类耐药，对万古霉素、莫匹罗星和利奈唑胺敏感。未发现 pvl、tst、sea 和 hlg 毒素与 Wagner 溃疡分级系统之间存在关联（P 值>0.05）。
本研究对约旦 DFU 培养物的分析表明其为混合微生物，以葡萄球菌属为主。
本研究是首次评估约旦 DFU 患者的微生物学。研究结果将有助于在 DFU 的管理中适当应用抗菌化疗。
