Saleem Mohd, Khan Mohd Shahid, Neyaz Arslan, Ahmad Irfan, Qattan Malak Yahia, Ahmad Nadeem
Department of Pathology, College of Medicine, University of Ha'il, Hail, Saudi Arabia.
Department of Microbiology, Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, Uttar Pradesh, 261303, India.
Naunyn Schmiedebergs Arch Pharmacol. 2025 May 23. doi: 10.1007/s00210-025-04284-8.
This prospective cohort study systematically analyzed the demographic profile, clinical characteristics, spectrum of microorganisms, and antimicrobial resistance pattern in 248 patients with diabetic foot ulcer (DFU) over 2.7 years. Most patients were male (75.4%) and had a mean age of 56.1 years, and high comorbidity rates (81% neuropathy, 77% retinopathy, and 67.7% hypertension). A combined 439 bacterial isolates were obtained, with the dominance of Gram-negative pathogens, including Escherichia coli (16.6%) and Pseudomonas aeruginosa (15.3%). Staphylococcus aureus was also the dominant Gram-positive pathogen (12.8%). Polymicrobial infections were found in 43.1% of cases, and 71% of strains were biofilm-producing. The prevalence of multidrug-resistant (MDR) was alarmingly high (67%), particularly among Escherichia coli (97.3%), Staphylococcus aureus (83.9%), and Proteus mirabilis (90.5%). MDR infections were associated with tobacco use, biofilm formation, polymicrobial infection, and clinical complications. In specific, seven bacterial types, Pseudomonas aeruginosa, Staphylococcus aureus, Providencia rettgeri, Enterococcus faecalis, Enterobacter cloacae, Pseudomonas flourescens, and Staphylococcus epidermidis, as described, were statistically associated with amputation. Beta-lactams (ampicillin, piperacillin) showed 100% resistance. Cephalosporins (ceftazidime, ceftriaxone, cefotaxime, cefepime) had resistance rates ranging from 25 to 96%. Amoxicillin-clavulanic acid showed 30 to 92.3% resistance, while piperacillin-tazobactam ranged from 7.7 to 71.4% resistance. Out of 338 Gram-negative isolates, 105 (31.1%) were ESBL producers, and molecular characterization shows blaCTX-M as the most predominant, 40 (38.1%), followed by blaSHV 20 (19.0%), and blaTEM 7 (6.7%) isolates. Methicillin and vancomycin resistance were common among Gram-positive isolates, particularly Methicillin-resistant Staphylococcus aureus (MRSA) (51.8%) and Vancomycin-resistant Enterococci (VRE) (33.3%). Despite widespread resistance, antibacterial drugs such as colistin (100%), polymyxin B (100%), linezolid (100%), and vancomycin (100%) retained efficacy. These data emphasize the significant burden of MDR infections in DFUs and emphasize the urgent actions needed for aggressive antimicrobial stewardship, early infection control, and personalized treatment approaches to prevent amputation and enhance patient outcomes.
这项前瞻性队列研究在2.7年的时间里，对248例糖尿病足溃疡（DFU）患者的人口统计学特征、临床特征、微生物谱和抗菌药物耐药模式进行了系统分析。大多数患者为男性（75.4%），平均年龄56.1岁，合并症发生率较高（神经病变81%、视网膜病变77%、高血压67.7%）。共获得439株细菌分离株，以革兰氏阴性病原体为主，包括大肠杆菌（16.6%）和铜绿假单胞菌（15.3%）。金黄色葡萄球菌也是主要的革兰氏阳性病原体（12.8%）。43.1%的病例存在多微生物感染，71%的菌株可产生生物膜。多重耐药（MDR）的患病率高得惊人（67%），尤其是在大肠杆菌（97.3%）、金黄色葡萄球菌（83.9%）和奇异变形杆菌（90.5%）中。MDR感染与吸烟、生物膜形成、多微生物感染和临床并发症相关。具体而言，如所述的七种细菌类型，铜绿假单胞菌、金黄色葡萄球菌、雷氏普罗威登斯菌、粪肠球菌、阴沟肠杆菌、荧光假单胞菌和表皮葡萄球菌，与截肢在统计学上相关。β-内酰胺类药物（氨苄西林、哌拉西林）显示出100%的耐药性。头孢菌素类药物（头孢他啶、头孢曲松、头孢噻肟、头孢吡肟）的耐药率在25%至96%之间。阿莫西林-克拉维酸显示出30%至92.3%的耐药性，而哌拉西林-他唑巴坦的耐药率在7.7%至71.4%之间。在338株革兰氏阴性分离株中，105株（31.1%）产超广谱β-内酰胺酶（ESBL），分子特征显示blaCTX-M最为常见，有40株（38.1%），其次是blaSHV 20株（19.0%）和blaTEM 7株（6.7%）。甲氧西林和万古霉素耐药在革兰氏阳性分离株中很常见，尤其是耐甲氧西林金黄色葡萄球菌（MRSA）（51.8%）和耐万古霉素肠球菌（VRE）（33.3%）。尽管耐药普遍存在，但黏菌素（100%）、多黏菌素B（100%）、利奈唑胺（100%）和万古霉素（100%）等抗菌药物仍保持疗效。这些数据强调了DFU中MDR感染的重大负担，并强调了积极的抗菌药物管理、早期感染控制和个性化治疗方法以预防截肢并改善患者预后所需采取的紧急行动。
