Prevalence of ESBL producing enterobacteriaceae in diabetic foot ulcers

Introduction: Diabetic foot ulcer is one of the dreaded complications among the diabetic patients which are disabling, leading to repeated hospitalizations and even amputation, drastically reducing the quality of life. Hence proper management of diabetic foot infections by choosing appropriate antibiotic is crucial. The aim of the study: This study was undertaken to know about the prevalence of ESBL producing Enterobacteriaceae in Diabetic foot ulcers and their antibiotic sensitivity pattern to aid in the effective treatment of infection. Materials and methods: A total of 200 Pus samples were collected from the patients admitted and/ or attending in-patient or out-patient departments of Rajah Muthiah Medical College and Hospital. Only Enterobacteriaceae were isolated and antibiotic sensitivity testing was done according to CLSI guidelines. All the isolates were screened for ESBL and confirmed by phenotypic confirmatory tests. Results: A total of 60 Enterobacteriaceae were isolated from diabetic foot ulcer patients among which 27 (45%) isolates were ESBL producers. ESBL production is predominantly seen in E.coli (48.1%) followed by Klebsiella (44.4%), P. mirabilis (3.3%) and P. vulgaris (3.3%). ESBL producers were sensitive to Imipenam (88.9%), Amikacin (77.8%) and Gentamicin (55.6%) whereas highly resistant to Ampicillin, Amoxyclav, Cefuroxime and Ceftriaxone. Conclusion: This study shows the higher prevalence of ESBL producing Enterobacteriaceae in diabetic foot ulcers. Imipenam, Amikacin and Gentamicin can be used for empirical treatment but early identification and treatment according to antibiotic sensitivity pattern helps in preventing the emergence and propagation of multidrug resistance strains.