Microbial Infection and Antibiotic Susceptibility of Diabetic Foot Ulcer in China: Literature Review

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2022 Jun 6

PMID 35663325

Authors

Fang Du

Jing Ma

Hongping Gong

Raju Bista

Panpan Zha

Yan Ren

Yun Gao

Dawei Chen

Xingwu Ran

Chun Wang

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the microbial spectrum isolated from foot ulcers among diabetic patients in China, which was conducted to help clinicians choose optimal antibiotics empirically.

Method: The PubMed, MEDLINE, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases were searched for studies published between 2015 to 2019, that report primary data on diabetic foot infection (DFI) and antibiotic susceptibility in China.

Result: A total of 63 articles about DFI and antibiotic susceptibility tests among diabetic patients in China were included. There were 11,483 patients with an average age of 60.2 ± 10.1 years and a mean course of 10.6 ± 5.0 years between 2010 and 2019, covering most geographical regions of China. The prevalence of Gram-positive (GP) bacteria (43.4%) was lower than that of Gram-negative (GN) (52.4%). The most prevalent pathogens isolated were Staphylococcus aureus (17.7%), Escherichia coli (10.9%), Pseudomonas aeruginosa (10.5%), Klebsiella pneumoniae (6.2%), Staphylococcus epidermidis (5.3%), Enterococcus faecalis (4.9%), and fungus (3.7%). The prevalence of polymicrobial infection was 22.8%. GP bacteria were sensitive to linezolid, vancomycin, and teicoplanin. More than 50% of GN bacteria were resistant to third-generation cephalosporins, while the resistance rates of piperacillin/tazobactam, amikacin, meropenem, and imipenem were relatively low. Among the 6017 strains of the isolated organisms, 20% had multi-drug resistance (MDR). Staphylococcus aureus (30.4%) was the most predominant MDR bacteria, followed by extended-spectrum β-lactamase (ESBL) (19.1%).

Conclusion: The microbial infection of foot ulcers among diabetic patients in China is diverse. The microbial spectrum is different in different geographic regions and Staphylococcus aureus is the predominant bacteria. Polymicrobial and MDR bacterial infections on the foot ulcers are common. This study could be valuable in guiding the empirical use of antibiotics for diabetic foot infections.

Citing Articles

A systematic review and meta-analysis of randomized controlled trials of systemic antibiotics for diabetes-related foot infections.

Lee M, Hua Y, Toh H, Su H, Chen P Diab Vasc Dis Res. 2025; 22(1):14791641241311293.

PMID: 39931793 PMC: 11811984. DOI: 10.1177/14791641241311293.

Probiotic active gel promotes diabetic wound healing through continuous local glucose consumption and antioxidant.

Wang Y, Shi L, Lu J, Wang F, Zhou Z, Wang Y J Nanobiotechnology. 2025; 23(1):62.

PMID: 39885505 PMC: 11780939. DOI: 10.1186/s12951-025-03115-5.

Clinical efficacy of antibiotic-loaded bone cement and negative pressure wound therapy in multidrug-resistant organisms diabetic foot ulcers: a retrospective analysis.

Guo H, Xue Z, Mei S, Li T, Yu H, Ning T Front Cell Infect Microbiol. 2025; 14():1521199.

PMID: 39831106 PMC: 11739815. DOI: 10.3389/fcimb.2024.1521199.

Portable direct spraying porous nanofibrous membranes stent-loaded polymyxin B for treating diabetic wounds with difficult-to-heal gram-negative bacterial infections.

Ou X, Guo W, Tian H, Yu D, Li R, Gao G Mater Today Bio. 2024; 29:101365.

PMID: 39687800 PMC: 11648811. DOI: 10.1016/j.mtbio.2024.101365.

The antimicrobial and antibiofilm effects of gentamicin, imipenem, and fucoidan combinations against dual-species biofilms of Staphylococcus aureus and Acinetobacter baumannii isolated from diabetic foot ulcers.

Nazari M, Taheri M, Nouri F, Bahmanzadeh M, Alikhani M Ann Clin Microbiol Antimicrob. 2024; 23(1):101.

PMID: 39548455 PMC: 11568526. DOI: 10.1186/s12941-024-00760-w.

References

Sekhar S, Vyas N, Unnikrishnan M, Rodrigues G, Mukhopadhyay C . Antimicrobial susceptibility pattern in diabetic foot ulcer: a pilot study. Ann Med Health Sci Res. 2014; 4(5):742-5. PMC: 4199167. DOI: 10.4103/2141-9248.141541. View

von Eiff C, Peters G, Heilmann C . Pathogenesis of infections due to coagulase-negative staphylococci. Lancet Infect Dis. 2002; 2(11):677-85. DOI: 10.1016/s1473-3099(02)00438-3. View

Aamir A, Nasir A, Jadoon M, Mehmood K, Ali S . Diabetic foot infections and their management in a tertiary care hospital. J Ayub Med Coll Abbottabad. 2012; 23(1):58-62. View

Commons R, Robinson C, Gawler D, Davis J, Price R . High burden of diabetic foot infections in the top end of Australia: An emerging health crisis (DEFINE study). Diabetes Res Clin Pract. 2015; 110(2):147-57. PMC: 4684095. DOI: 10.1016/j.diabres.2015.09.016. View

Benwan K, Mulla A, Rotimi V . A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health. 2012; 5(1):1-8. DOI: 10.1016/j.jiph.2011.07.004. View

Hurlow J, Humphreys G, Bowling F, McBain A . Diabetic foot infection: A critical complication. Int Wound J. 2018; 15(5):814-821. PMC: 7949853. DOI: 10.1111/iwj.12932. View

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y . Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis . Ann Med. 2016; 49(2):106-116. DOI: 10.1080/07853890.2016.1231932. View

Ramakant P, Verma A, Misra R, Prasad K, Chand G, Mishra A . Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose?. Diabetologia. 2010; 54(1):58-64. DOI: 10.1007/s00125-010-1893-7. View

Pouget C, Dunyach-Remy C, Pantel A, Schuldiner S, Sotto A, Lavigne J . Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance. Microorganisms. 2020; 8(10). PMC: 7602394. DOI: 10.3390/microorganisms8101580. View

10.

Livermore D . The need for new antibiotics. Clin Microbiol Infect. 2004; 10 Suppl 4:1-9. DOI: 10.1111/j.1465-0691.2004.1004.x. View

11.

Cervantes-Garcia E, Garcia-Gonzalez R, Resendiz-Albor A, Salazar-Schettino P . Infections of diabetic foot ulcers with methicillin-resistant Staphylococcus aureus. Int J Low Extrem Wounds. 2015; 14(1):44-9. DOI: 10.1177/1534734614564053. View

12.

Bansal E, Garg A, Bhatia S, Attri A, Chander J . Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol. 2008; 51(2):204-8. DOI: 10.4103/0377-4929.41685. View

13.

Banu A, Noorul Hassan M, Rajkumar J, Srinivasa S . Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: A prospective study. Australas Med J. 2015; 8(9):280-5. PMC: 4592943. DOI: 10.4066/AMJ.2015.2422. View

14.

Tascini C, Piaggesi A, Tagliaferri E, Iacopi E, Fondelli S, Tedeschi A . Microbiology at first visit of moderate-to-severe diabetic foot infection with antimicrobial activity and a survey of quinolone monotherapy. Diabetes Res Clin Pract. 2011; 94(1):133-9. DOI: 10.1016/j.diabres.2011.07.017. View

15.

Uckay I, Gariani K, Pataky Z, Lipsky B . Diabetic foot infections: state-of-the-art. Diabetes Obes Metab. 2013; 16(4):305-16. DOI: 10.1111/dom.12190. View

16.

Lipsky B, Berendt A, Cornia P, Pile J, Peters E, Armstrong D . 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012; 54(12):e132-73. DOI: 10.1093/cid/cis346. View

17.

Miyan Z, Fawwad A, Sabir R, Basit A . Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country. J Pak Med Assoc. 2017; 67(5):665-669. View

18.

Mlinaric Missoni E, Vukelic M, de Soy D, Belicza M, Vazic Babic V, Missoni E . Fungal infection in diabetic foot ulcers. Diabet Med. 2005; 22(8):1124-5. DOI: 10.1111/j.1464-5491.2005.01611.x. View

19.

Stacey H, Clements C, Welburn S, Jones J . The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol. 2019; 56(8):907-921. PMC: 6597605. DOI: 10.1007/s00592-019-01301-0. View

20.

Citron D, Goldstein E, Merriam C, Lipsky B, Abramson M . Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007; 45(9):2819-28. PMC: 2045270. DOI: 10.1128/JCM.00551-07. View