Bacterial Profile and Antimicrobial Susceptibility Pattern of Isolates from Diabetic Foot Infections at Selected Public Hospitals of Addis Ababa, Ethiopia.

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Addis Abeba University


Background: Globally, diabetic foot infections continue to be a major public health problem, bringing socio economic burdens to the affected people. Clinically infected foot ulcers require treatment guided by appropriate cultures and antimicrobial susceptibility testing. Updated information is scarce in Ethiopian context in general and in the study sites in particular, hence we tried to fill this gap. Objective: To determine the Bacterial profile and Antimicrobial susceptibility pattern of isolates from Diabetic foot infections at selected public Hospitals of Addis Ababa, Ethiopia. Method: A cross sectional design was used to recruit 135 diabetic adult patients with diabetic foot infections attending selected public hospitals in Addis Ababa, Ethiopia. Convenient sampling was employed in recruiting participants for one year from May, 2018 to April, 2019. Wound Aspirates (deep wound swabs) from the foot ulcers were collected aseptically and inoculated into Blood, MacConkey, Chocolate and Manitol salt Agar. The antimicrobial susceptibility patterns were conducted according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) by disk diffusion method. A structured questionnaire was used to collect information regarding the socio-demographic status, clinical history and risk factors of the study participants. Data obtained was analyzed using the statistical package for social sciences software version 20. Statistical significance was set at 95% confidence level and p values ≤0.05 was considered significant. The associated factors of DFI were determined using multiple ordinal regressions with the test of parallel line assumption being fulfilled for each risk category separately. Results: Of the 135 patients investigated majority105 (77.8%) of them were males. The Mean age (SD) of the patients was 57.64 (± 13.20 SD) Years. According to the International Working Group on the Diabetic Foot (IWGDF) classifications, mild, moderate and severe Diabetic foot infections in our study were 36 (26.7%), 75 (55.5%) and 24(17.8%), respectively. One hundred ninty bacterial isolates were identified among 135 patients. Among them, 85 (62.96%) had mono bacterial infection while 50 (37.04%) had mixed bacterial infections. Gram negative aerobic bacterial infections were more accounting 121 cases (63.7%) than gram positive aerobic bacteria 69, (36.3%). The most commonly isolated bacteria was S. aureus (26.3%), followed by Klebsiella spp (22.1%) and Proteus spp (11.1%). In general, 140(73.68%) of the isolates in our study developed multidrug resistance to at least one drug in three different classes of antibiotics. Meropinem and Amikacin appeared to be the best antibiotics for therapy against Gram negative and Cefoxitin and Vancomycin against gram positive organisms. Moreover, Health education on proper foot care (AOR=3.743, 95% CI 1.615-8.674), Peripheral Vascular Disease (AOR=0.298,95% CI 0.116-0.765), Nephropathy (AOR=0.354, 95% CI 0.135-0.927) ,BMI normal (AOR=0.052,95% CI 0.004-0.663) and overweight (AOR=0.072, 95% CI 0.0060.935) were found to be associated with Severity of Diabetic foot infection. Conclusion: High level of multidrug resistance in this study implies, definitive therapy should be based upon culture and susceptibility analysis to promote the rational use of the Antibiotics and reduce emergence of bacterial resistance to antimicrobials.



Diabetic foot infection, Mild, Moderate, Severe, Poly microbial, Mono microbial