Bacterial Diversity and Antibiotic Resistance in Patients with Diabetic Foot Osteomyelitis

• Published in: Antibiotics
• Main Authors: Francisco Javier Álvaro-Afonso, Yolanda García-Álvarez, Aroa Tardáguila-García, Marta García-Madrid, Mateo López-Moral, José Luis Lázaro-Martínez
• Format: Article
• Language: English
• Published: MDPI AG 2023-01-01
• Subjects: diabetic foot; diabetic foot ulcers; diabetic foot infection; diabetic foot osteomyelitis; microbiology; antibiotic resistance
• Online Access: https://www.mdpi.com/2079-6382/12/2/212

This study analysed the bacterial diversity, antibiotic susceptibility, and resistance in patients with complications of diabetic foot osteomyelitis (DFO). A retrospective observational study was carried out between September 2019 and September 2022 and involved 215 outpatients with a diagnosis of DFO at a specialized diabetic foot unit. A total of 204 positive bone cultures were isolated, including 62.7% monomicrobial cultures, and 37.3% were formed with at least two microorganisms. We observed that <i>Proteus</i> spp., Coagulase-negative staphylococci (CoNS), <i>Staphylococcus aureus</i>, <i>Pseudomonas aeruginosa</i>, <i>Escherichia coli</i>, and <i>Corynebacterium</i> were the most frequently isolated microorganisms and accounted for more than 10% of the DFO cases. With stratification by Gram-positive (GP) and Gram-negative (GN) bacteria, we observed that 91.6% of cultures presented at least one GP bacteria species, and 50.4% presented at least one GN bacteria species. The most common GP species were CoNS (29%), <i>S. aureus</i> (25.8%), and <i>Corynebacterium</i> spp. (14%). The most frequent GN species consisted of <i>Proteus</i> spp. (32%), <i>P. aeruginosa</i> (23.3%), and <i>E. coli</i> (17.5%). The main antibiotics with resistance to GP-dominated infections were penicillins without β-lactamase inhibitor, and those in GN-dominated infections were sulfonamides and penicillins without β-lactamase. Significant differences were not observed in mean healing time in DFU with acute osteomyelitis (12.76 weeks (4.50;18)) compared to chronic osteomyelitis (15.31 weeks (7;18.25); <i>p</i> = 0.101) and when comparing cases with soft tissue infection (15.95 (6;20)) and those without such an infection (16.59 (7.25;19.75), <i>p</i> = 0.618). This study shows that when treatment of DFO is based on early surgical treatment, the type of DFO and the presence of soft infection are not associated with different or worse prognoses.