Microbiological pattern of in-hospital patients with diabetic foot infection

Aim: The aim of this study was to evaluate the microbiological pattern and its relationship with outcomes of patients admitted for diabetic foot infection (DFI). Method: The study is a retrospective observational study which includes in-hospital patients with DFI. The microbiological pattern of each infected ulcer was recorded, as well as the type of bacteria, the presence of multidrug-resistant bacteria, polymicrobial infection and the type of infection (soft tissue or bone). The correlation between microbiological characteristics and amputations was also analysed. Results and Discussion: One-hundred-twenty-three patients were included. The mean age was 67.8±10.6 years, 74.5% were male, 97.5% had type 2 diabetes; 22% had osteomyelitis and 78% soft tissue infection. The most isolated bacteria were Methicillin-susceptible Staphylococcus aureus (MSSA) (26%), Enterococcus faecalis (12.2%), Pseudomonas aeruginosa (10.6%), and Methicillin-resistant Staphylococcus aureus (MRSA) (7.3%). Polymicrobial infections were found in 37.8% of cases. The rate of in-hospital minor and major amputation was 56.3% and 4.2% respectively. Amputees were older (70.1±8.9 vs 60.9±12.1, p=0.006), had higher rates of ischaemic DFUs (91.7 vs 70.6%, p=0.002), and higher level of white blood cells (WBC) (10.9±6.5 vs 8.3 ±3.4, p=0.01) in comparison to not amputees. No correlation was found between any amputation and the type of bacteria, the presence of polymicrobial infection, the type of infection (bone or soft tissue), and antibiotic resistance. Severe infection with WBC>10000 x103µL (vs moderate infection) resulted as an independent predictor of amputation. Conclusion: Staphylococcus aureus (both MSSA and MRSA) was the most isolated bacteria in patients admitted with DFI. Microbiological characteristics are not independently related to in-hospital amputation, whereas amputation was related to the clinical severity of infection.