Zambelli Roberto, Santos Ana Flavia, Moreira Larissa Resende, Ribeiro Hugo Miguel, Simões Rodrigo, Magalhães João Murilo, Constantino Priscila, Salomão Maria Clara, Netto Cesar de Cesar, Leopoldino Amanda Oliveira
Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil; Rede Mater Dei de Saúde, Serviço de Ortopedia, Belo Horizonte, MG, Brazil.
Rede Mater Dei de Saúde, Controle de Infecção Hospitalar, Belo Horizonte, MG, Brazil.
Braz J Infect Dis. 2025 Jul 31;29(5):104570. doi: 10.1016/j.bjid.2025.104570.
Diabetic Foot Infections (DFI) are severe complications of diabetes, often resulting in poor clinical outcomes, including amputations. The objective of this study is to identify the main pathogens causing infections in the diabetic foot ulcers, as well as the antibiotic resistance profile.
This study included all patients treated for diabetic foot infections at a private tertiary hospital between 2013 and 2022. Demographic data, including age, sex, Body Mass Index (BMI), and the level of amputation were extracted from electronic medical records and collected for all patients. Microbiological and resistance patterns were evaluated following standardized protocols. Cases with incomplete demographic or microbiological data were excluded.
This retrospective cohort study analyzed data from 459 diabetic patients, among them, 337 patients with positive cultures were included, resulting in 507 culture results from surgical samples. Gram-negative bacteria accounted for 55.2 % of isolates, with Enterobacterales (41 %) and non-fermenters (14.2 %) being most prevalent. Proteus sp. (10.3 %) and Escherichia coli (8.3 %) were the most common Gram-negative organisms, with significant resistance to ESBL (15.4 %) and quinolones (29.3 %). Among Gram-positive cocci (43.6 %), Staphylococcus aureus (16.8 %) showed 21.1 % methicillin resistance, while Enterococcus sp. exhibited vancomycin resistance (7 %). Multidrug resistance was identified in 16 % of Pseudomonas sp. and 63.6 % of Acinetobacter sp., raising concerns about limited therapeutic options.
The predominance of Gram-negative bacteria and high levels of antimicrobial resistance highlight the need for regular monitoring of local microbiological profiles. Targeted antimicrobial strategies can significantly reduce the morbidity associated with DFI and improve clinical outcomes in diabetic patients.
糖尿病足感染（DFI）是糖尿病的严重并发症，常常导致包括截肢在内的不良临床结局。本研究的目的是确定导致糖尿病足溃疡感染的主要病原体以及抗生素耐药情况。
本研究纳入了2013年至2022年期间在一家私立三级医院接受糖尿病足感染治疗的所有患者。从电子病历中提取包括年龄、性别、体重指数（BMI）和截肢水平在内的人口统计学数据，并收集所有患者的数据。按照标准化方案评估微生物学和耐药模式。排除人口统计学或微生物学数据不完整的病例。
这项回顾性队列研究分析了459例糖尿病患者的数据，其中包括337例培养结果呈阳性的患者，手术样本共获得507份培养结果。革兰氏阴性菌占分离株的55.2%，其中肠杆菌科（41%）和非发酵菌（14.2%）最为常见。变形杆菌属（10.3%）和大肠埃希菌（8.3%）是最常见的革兰氏阴性菌，对超广谱β-内酰胺酶（ESBL，15.4%）和喹诺酮类（29.3%）耐药性显著。在革兰氏阳性球菌中（43.6%），金黄色葡萄球菌（16.8%）的耐甲氧西林率为21.1%，而肠球菌属对万古霉素耐药（7%）。在16%的铜绿假单胞菌和63.6%的不动杆菌属中发现了多重耐药，这引发了对治疗选择有限的担忧。
革兰氏阴性菌的优势和高水平的抗菌药物耐药性凸显了定期监测当地微生物谱的必要性。针对性的抗菌策略可以显著降低与糖尿病足感染相关的发病率，并改善糖尿病患者的临床结局。
