Bacterial Profile and Antimicrobial Susceptibility Pattern of Isolates from Diabetic Foot Infections at Selected Public Hospitals of Addis Ababa, Ethiopia.
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Date
2021-08
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
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.
Description
Keywords
Diabetic foot infection, Mild, Moderate, Severe, Poly microbial, Mono microbial