Association of bacteria in diabetic and non-diabetic foot infection - An investigation in patients from Bangladesh

ABSTRACT

The microbial community on a host relies on its immune status and pathophysiological condition. Diabetes mellitus is a metabolic disorder associated with a 25% increased risk of developing foot infection. The pathophysiological differences between diabetic foot infection [DPI] and non-DFI patients may alter the microbial composition in infections. The present study aims to comparatively analyze the microbes colonized in DPI and non-DFI patients in Bangladesh. Pus specimens were collected from 67 DPI and 12 non-DFI patients to investigate the bacteria associated with foot infection. For this investigation, an array of microbiological, molecular biological and immunological approaches were performed. Common bacteria detected in both DFI/non-DFI samples were Pseudomonas spp. [22/29%], Bacillus spp. [12/3%], Enterobacter spp. [22/7%], Staphylococcus spp. [13/13%] and Acinetobacter spp. [10/10%]. Enterococcus spp. [9%] and Klebsiella spp. [8%] occurred only in DFI patients, whereas Citrobacter spp. [29%] was only detected in non-DFI samples. The rate of occurrence of three organisms, namely, Enterococcus spp. |Z| =2.2125, Klebsiella spp. |Z| = 1.732, Bacillus spp. |Z| = 1.9034, were also statistically significant. Most of the isolates from DFI patients were commonly resistant to the cephalosporin [Ceftazidime, Ceftriazone, Cefurozime] and monobactam [Aztreonam] groups of antibiotics. DFI patients had comparatively higher C-reactive protein [CRP] levels than non-DFI patients, and a positive correlation was observed between multi-antibiotic resistance and CRP levels [one of the markers of chronic subclinical inflammation]. The present investigation implicated a complex association of the bacterial population in DPI compared with non-DFI with different antimicrobial resistance properties, which was linked with CRP levels