Antibiotic resistance of pathogens of lower extremity infections in patients with diabetic foot syndrome

BACKGROUND: One of the common and unfavorable complications in patients with long-term diabetes mellitus (DM) is diabetic foot syndrome (DFS). The type of pathogen plays a key role in the course of the infectious process, its severity, the nature of tissue damage, the rate of spread and the outcome of the disease. Improving the rationality and efficacy of antibiotic therapy (ABT) in patients with SDS infection is currently an important practical task, both to improve patient outcomes and to prevent the spread of antibiotic resistance (ABR).

AIM: To study the species diversity and ABR profile of etiologic agents of lower extremity infections in patients with SDS.

MATERIALS AND METHODS: Retrospective descriptive clinical and epidemiologic study. The analysis of 83 cases of hospitalization of patients with SDS in City Clinical Hospital №3 named after B.I.Alperovich (Tomsk) in 2023–2024 was carried out. 118 isolates — microorganisms identified in patients from wound discharge were studied.

RESULTS: The structure of pathogens was represented by Gram-negative (67,8%), Gram-positive (29,7%) flora and fungi (2,5%). In the species structure, the predominant role belonged to S. aureus (20,3 %), K. pneumoniae (17,8%), P. aeruginosa (13,6%), E. coli (8,5%) and P. mirabilis (8,5%). K. pneumoniae lost sensitivity to ampicillin and significantly decreased sensitivity to amoxicillin/clavulanic acid. The frequency of ABR of K. pneumoniae and E. coli to fluoroquinolones was often higher than to drugs from the group of cephalosporins. At the same time, pathogens demonstrated good sensitivity to carbapenems and aminoglycosides. The ABR of S. aureus strains to erythromycin was 25,0%, 12,5% of isolates were insensitive to oxacillin.

CONCLUSION: Gram-negative etiologic agents are characterized by an unfavorable sensitivity profile mainly to cephalosporins and fluoroquinolones. The etiologic share of MRSA accounts for 12,5% of SDS-associated infections. The data obtained have important clinical significance in the optimization of empirical ABT of infections in diabetic foot patients.

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