Risk Factors Associated with Multi-drug Resistant Organism (MDRO) Isolates in Infected Diabetic Foot Ulcers (DFU)
An Analytical Cross-sectional Study
DOI:
https://doi.org/10.15605/jafes.041.02.6303Keywords:
diabetic foot infection, diabetic foot ulcer, diabetes complicationsAbstract
Background. Increasing use and abuse of antibiotics has led to a rise in multi-drug resistant organisms (MDRO) isolates among infected diabetic foot ulcers (DFUs) and is seen in more than half of all diabetic foot infection cases. This study aimed to identify risk factors for MDRO infection in DFUs since no Filipino studies are available to establish such association.
Methodology. A cross-sectional, analytical study was conducted to evaluate risk factors for MDRO in DFUs. Adult patients admitted in a tertiary hospital from January 2019 - December 2023 for DFU were included in the study. Based on retrospective chart review, patients with DFU described to be infected with accompanying superficial or deep wound cultures were studied. Patients were classified under the MDRO-positive group if their cultures reported any of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamases (ESBL), amp C and carbapenamases-producing Enterobacteriaceae, Metallo-beta-lactamases (MBL)-producing Pseudomonas, Acinetobacter species, or any isolate with at least one drug resistance in three different antibiotic classes. Those who did not fall into this definition, including cultures without growth, were classified under the MDRO-negative group. Clinical risk factors and pertinent laboratory findings were obtained from their data.
Results. One hundred fifty-one (151) patients were included in the study and 52 (34.43%) patient had MDRO isolates. The most common isolates seen were Klebsiella pneumoniae for gram-negative organisms and Staphylococcus aureus for gram-positive organisms. For gram-negative isolates, erythromycin had the most resistance at 17.53% followed by oxacillin and clindamycin both at 13.4%. For gram-positive isolates, highest resistance were seen with ampicillin at 18.99% followed by cefuroxime at 13.57% and amoxicillin-clavulanate at 11.63%.
Higher ulcer grade (Crude OR = 1.11 [95% CI 1.00 - 1.23], p-value 0.04; Crude OR = 1.29, [95% CI 1.04 - 1.60], p-value 0.02), as well as previous admission for diabetic foot ulcer (Crude OR = 2.28, [95% CI 1.10 to 4.73], p-value 0.04) were associated with multi-drug resistance. Logistic regression showed that only a previous admission had significant association for MDRO positivity (Adjusted OR = 3.00 [95% CI: 1.04 – 8.62], p-value 0.04).
Conclusion. There is a high burden of multi-drug resistant organism infection in diabetic foot ulcers with significant association in higher ulcer grades. A previous admission for diabetic foot ulcer significantly increases the odds for MDRO infection in succeeding diabetic foot infections.
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