Evaluating the Antibiotic Therapy in Diabetic Patients in diverse Clinical Settings
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. This study reevaluated the microbial distribution in DFIs based on resistance-based measures to direct optimal empirical therapy. Methods: The study (n=77) included patients with diabetic foot ulcers and getting treatment at a tertiary healthcare. The organisms were categorized as Gram-negative or Gram-positive and antibiotic susceptibility data were re-evaluated 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: Significant antimicrobial resistance burden within DFIs, which is largely mediated by Gram-negative pathogens was observed. 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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