Risk Factors for Multidrug-Resistant Bacterial Infection in Diabetic Foot Ulcers

This study aimed to analyze the distribution of multidrug-resistant (MDR) organisms (MDROs) in patients with diabetic foot ulcers (DFUs) and to identify risk factors for MDRO infections.

Patients hospitalized with DFUs were enrolled, and ulcer swabs were cultured for bacterial identification and antibiotic susceptibility testing. Hematology and blood biochemistry were also assessed.

A total of 228 patients hospitalized with DFUs were enrolled. Out of 150 patients with positive cultures, 123 (82%) were infected with single strains, whereas 27 (18%) had mixed infections. Out of the 177 bacterial strains isolated, 78 (44%) were MDROs. Among the top 5 most common bacteria, coagulase-negative Staphylococcus, Staphylococcus aureus, and Proteus exhibited MDR rates of 92%, 56%, and 55%, respectively. Pseudomonas aeruginosa and Enterobacter cloacae had low MDR rates of 5% and 8%, respectively. Single variable logistic regression analysis showed that neutrophil percent (NEU%), creatinine, C-reactive protein, and fasting plasma glucose (FPG) were risk factors for MDRO infection, whereas hemoglobin and albumin levels were protective factors. Multivariable logistic regression analysis revealed that NEU% and FPG were independent risk factors for MDRO infection.

A high percentage of the infections in patients with DFUs were caused by MDROs. To reduce MDRO infections in high-risk patients, it is important to use antibiotics rationally, improve patients' FPG levels and nutritional status, and strengthen hospital sterilization processes.