Diabetic foot ulcer-a systematic review on relevant microbial etiology and antibiotic resistance in Asian countries

Rokaia Sultana; Iftekhar Ahmed; Sabera Saima; Moushumi Tabassoom Salam; Shahnaz Sultana

doi:10.1016/j.dsx.2023.102783

Diabetic foot ulcer-a systematic review on relevant microbial etiology and antibiotic resistance in Asian countries

Diabetes Metab Syndr. 2023 Jun;17(6):102783. doi: 10.1016/j.dsx.2023.102783. Epub 2023 May 22.

Authors

Rokaia Sultana¹, Iftekhar Ahmed², Sabera Saima³, Moushumi Tabassoom Salam⁴, Shahnaz Sultana⁵

Affiliations

¹ Institute of National Analytical Research and Service (INARS), Bangladesh Council of Scientific and Industrial Research (BCSIR), New Elephant Road, Dhaka, 1205, Bangladesh; Purdue University, West Lafayette, IN, 47907, USA. Electronic address: rsultan@purdue.edu.
² Purdue University, West Lafayette, IN, 47907, USA. Electronic address: iftekhar2727@gmail.com.
³ Department of Microbiology, University of Dhaka, Dhaka, Bangladesh. Electronic address: saberasaima123@gmail.com.
⁴ Department of Pharmacy, University of Rajshahi, Rajshahi, 6205, Bangladesh. Electronic address: moushumi5350@gmail.com.
⁵ Institute of National Analytical Research and Service (INARS), Bangladesh Council of Scientific and Industrial Research (BCSIR), New Elephant Road, Dhaka, 1205, Bangladesh. Electronic address: uqssult3@uq.edu.au.

PMID: 37257221
DOI: 10.1016/j.dsx.2023.102783

Abstract

Background and aims: Diabetic foot ulcer (DFU) is one of the most common but uncontrolled health issues of diabetic patients that needs more therapeutic considerations. This systematic review aims to study the current status of the etiological agents responsible for DFU, their frequency in some of the most occurring Asian countries, and their antibiotic resistance pattern based on available studies.

Methods: Here, the literature survey was conducted on all the DFU studies with the records of etiological agents and conventional therapeutic treatment published until March 2021 using Medical Literature Analysis and Retrieval System Online (MEDLINE) and Web of Science Core Collection (WoSCC) database.

Results: Overall, in our study, a total of 73 studies representing 12 Asian countries worldwide have been included. We found that the highest number of studies were reported from India (45%) followed by Pakistan (11%), China, Iran and others. 71% of recent studies reported DFU being attributed to poly-microbial infections while the dominant position was significantly secured by Gram- negative bacteria (77%, p = 0.34). Staphylococcus aureus was found to be the most prevalent isolate followed by Pseudomonas and then Escherichia coli (mean value - 22%, 17%, and 15% respectively). Antibiotic sensitivity pattern was determined based on availability in terms of median resistance (MR) and interquartile range (IQR) which showed the growing resistance developed by both Gram-positive and Gram-negative isolates. Gram positive pathogens were still reported as susceptible to vancomycin (MR 0%, IQR 0-22.8%), linezolid (MR 0%, IQR 0-15.53%) and imipenem (MR 11%, IQR 0-23.53%). Carbapenem genera, colistin, and amikacin were the most effective drugs against Gram-negative pathogens.

Conclusion: The findings of this study highly recommend searching for alternative and complementary therapeutic regimens instead of prescribing conventional drugs blindly without investigating the progression of the stages of the ulcer, which may help reduce the medical and economic burden of this disease.

Keywords: Antibiotic-resistance; Diabetic foot ulcer; Etiology; Pathology; Therapy.

Publication types

Systematic Review
Review

MeSH terms

Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Diabetes Mellitus* / drug therapy
Diabetic Foot* / drug therapy
Diabetic Foot* / epidemiology
Drug Resistance, Microbial
Gram-Negative Bacteria
Humans
Microbial Sensitivity Tests
Pakistan

Substances

Anti-Bacterial Agents