Profile and Antibiotic Susceptibility of Bacterial Pathogens Associated With Diabetic Foot Ulcers From a Rural Area

Kalpana Jaju, MD; Asha Pichare, MD; Milind Davane, MD; Basavraj Nagoba, PhD


Wounds. 2019;31(6):158-162. 

In This Article

Abstract and Introduction


Objective: This cross-sectional study assesses the profile and antibiotic susceptibility of aerobic bacterial pathogens associated with diabetic foot ulcers (DFUs).

Materials and Methods: Two swab samples from 140 DFUs with various Wagner grades were processed for identification using routine culture methods and antimicrobial susceptibility by Kirby-Bauer disc diffusion method.

Results: A total of 125 (89.29%) samples were found to be positive for bacteria on culture. A higher incidence of positive culture (94.32%) was found in individuals with a blood sugar level > 200 mg/dL. The highest number of culture-positive cases was observed in Wagner grade 2 DFUs (45%). Overall infection was monomicrobial in 83.20% (104) and polymicrobial in 16.80% (21) of samples. Staphylococcus aureus (21.09%) and Pseudomonas aeruginosa (19.05%) were the most common isolates. Linezolid (100%) and imipenem (75.70%) were the most effective antimicrobial agents against gram-positive and gram-negative isolates, respectively.

Conclusions: The results show an overall increase in bacterial resistance to antimicrobial agents and emphasize the importance of an antimicrobial susceptibility pattern in the selection of appropriate antibiotic(s) to institute the rational antibiotic therapy.


Diabetes mellitus is a chronic disorder affecting a large portion of the global population. The global burden of diabetes is projected to increase from 246 million people to more than 380 million by the year 2025.[1] Diabetic foot is one of the most notable complications. About 15% of individuals with diabetes mellitus are prone to develop an ulcer, and between 10% to 30% of patients with diabetic foot ulcers (DFUs) will eventually progress to an amputation.[1] If not treated in a timely manner, a diabetic foot may progress to osteomyelitis or gangrene, which can lead to septicemia, amputation, and death.[1] Further, the risk of ulceration in the feet of individuals with diabetes from rural areas is increased; less education, low socioeconomic status, foot moisture changes, barefoot walking, and lack of adequate facilities for diabetes care are important contributing factors.[2,3]

Infections in individuals with diabetes are difficult to manage because of impaired microvascular circulation, which limits phagocytic cell and antibiotic concentration in the infected area. Optimal management of diabetic foot infections can potentially reduce the incidence of infection-related morbidities, duration of hospitalization, incidence of major limb amputation, and the cost of management.[4] Proper bacterial identification and appropriate antibiotic therapy are essential for a successful outcome.[4]

Diabetic foot infections are often mismanaged particularly in regard to antibiotics. The wide-spread, indiscriminate, and haphazard use of antibiotics precipitate the emergence of multidrug-resistant bacteria strains. Hence, a detailed knowledge of causal organisms and their susceptibility patterns play a key role in the management of diabetic foot infections.[5]

The present study assesses the profile and antibiotic susceptibility of aerobic bacterial pathogens associated with DFUs.