Evaluating the Antibiotic therapy in diabetic patients in diverse clinical settings
Antibiotic therapy in diabetic patients
Keywords:
Diabetic Foot Infection, Antimicrobial Resistance, Resistance Burden Index, Gram-Negative Pathogens, Therapeutic StratificationAbstract
Background: Diabetic foot infections (DFIs) are considered a complicated combination of microbial pathogenicity, dysfunction of metabolic processes in the hosts, and response to therapy. The secondary analysis sought to reevaluate microbial distribution in DFIs based on resistance-based measures to direct optimal empirical therapy. Methods: The secondary evaluation of analyses was conducted on microbiological data of 77 patients with diabetic foot ulcers and getting treatment at the Fatima Memorial Hospital in Lahore, Pakistan. The organisms were categorized as Gram-negative or Gram-positive and antibiotic susceptibility data were reevaluated to calculate multidrug resistance (MDR) frequency and a resistance burden index (RBI). Chi-square and independent t-tests were used to support descriptive statistics with comparative analysis. The significance cut off of p was < 0.05. Results: Escherichia coli (21.6%) and Klebsiella pneumoniae (10.8%) were the most common Gram-negative (≥60%) and methicillin-resistant Staphylococcus aureus (MRSA) was of the most common Gram-positive pathogen (10.8%). Overall, 38.9% of the isolates passed multidrug resistance criteria. Mean resistance burden index was higher among Gram-negative organisms as opposed to Gram-positive isolates (p < 0.05). The highest sensitivity score (22.9%) was observed for Cefotaxime followed by imipenem and colistin, whereas fluoroquinolones had least effectiveness. Resistant burden was not statistically significantly related to any of the patient comorbidities (hypertension, obesity; p > 0.05). Conclusion: Quantitative resistance profiling serves the purpose of supporting the necessity of locally-constrained empirical regimens and endorsing cefotaxime-based strategies as well as reinforcing the imperative to practice antimicrobial stewardship.
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