Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 May 19:13:881659.
doi: 10.3389/fendo.2022.881659. eCollection 2022.

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

Fang Du  1 , Jing Ma  1 , Hongping Gong  1 , Raju Bista  1 , Panpan Zha  1 , Yan Ren  1 , Yun Gao  1 , Dawei Chen  1 , Xingwu Ran  1 , Chun Wang  1
Affiliations
Review

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

Fang Du et al. Front Endocrinol (Lausanne). .

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.

Keywords: antibiotic susceptibility; diabetic foot infection; diabetic foot ulcer; microbial infection; multi-drug resistant organisms; polymicrobial infection.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of literature collecting.
Figure 2
Figure 2
Distribution of common Multiple Drug Resistant Organisms.
Figure 3
Figure 3
The proportions of GN and GP bacteria in different regions of China.
Figure 4
Figure 4
Number of pathogens and main pathogens in different geographical regions of China.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global Epidemiology of Diabetic Foot Ulceration: A Systematic Review and Meta-Analysis (Dagger). Ann Med (2017) 49:106–16. doi: 10.1080/07853890.2016.1231932 - DOI - PubMed
    1. Hurlow JJ, Humphreys GJ, Bowling FL, McBain AJ. Diabetic Foot Infection: A Critical Complication. Int Wound J (2018) 15:814–21. doi: 10.1111/iwj.12932 - DOI - PMC - PubMed
    1. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. . 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 - DOI - PubMed
    1. Peters EJ, Lipsky BA. Diagnosis and Management of Infection in the Diabetic Foot. Med Clin North Am (2013) 97:911–46. doi: 10.1016/j.mcna.2013.04.005 - DOI - PubMed
    1. Boyanova L, Mitov I. Antibiotic Resistance Rates in Causative Agents of Infections in Diabetic Patients: Rising Concerns. Expert Rev Anti Infect Ther (2013) 11:411–20. doi: 10.1586/eri.13.19 - DOI - PubMed

Publication types

Substances