Antimicrobial Resistance in Diabetic Foot Infections in Latin America and the Caribbean: A Systematic Review and...

Diabetic foot infections (DFIs) are a leading cause of nontraumatic lower limb amputations globally, and antimicrobial resistance increasingly complicates their management. Latin America and the Caribbean face a rapidly growing diabetes burden, yet comprehensive regional data on resistance patterns in DFIs remain fragmented. We conducted a systematic review and meta-analysis of studies reporting antimicrobial resistance in DFIs from Latin American and Caribbean countries published between January 1980 and December 2025. Seven databases and gray literature sources were searched. Primary outcomes were prevalence of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, carbapenem resistance, and multidrug-resistant (MDR) organisms. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed. Thirty-one studies comprising 6207 patients and 9891 isolates were included. Pooled MRSA prevalence was 37.8% (95% CI 31.8%-44.1%; 19 studies; I ² = 94.1%). ESBL rates ranged from 6.4% to 34.2% across studies. Carbapenem resistance pooled prevalence was 11.6% (95% CI 8.6%-15.1%; nine studies; I ² = 69.2%). Pooled MDR prevalence was 52.8% (95% CI 45.1%-60.5%; 11 studies; I ² = 92.8%). Eighteen countries had no eligible studies identified. Antimicrobial resistance in DFIs is highly prevalent across Latin America and the Caribbean, with more than half of patients affected by MDR organisms. ESBL rates vary substantially, and MRSA prevalence exceeds one-third of S. aureus isolates. These findings mandate urgent implementation of antimicrobial stewardship programs, strengthened surveillance systems, and infection control measures tailored to DFI care in the region. PROSPERO Registration: CRD420261327791.