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Bacteriological profile and antibiotic resistance in diabetic foot infections Volume 31, issue 5-6, Septembre-Décembre 2022

Authors
Laboratoire de microbiologie, laboratoire central d’analyses médicales, CHU Hassan II, Fès, Maroc
* Tirés à part : S. Kouara

Introduction: diabetic foot infections represent a public health problem in Morocco requiring multidisciplinary care, it is a frequent and formidable complication of diabetes. They constitute a major risk factor for amputation and remain among the main causes of hospitalization for diabetics. Objective: this study aims to characterize the bacterial ecology of diabetic foot infections and to determine the resistance profile of the main bacteria isolated. Materials and methods: this is a retrospective study carried out in the microbiology laboratory of the CHU Hassan II in Fez, over a period of 12 years, from March 2009 to March 2021, carried out on 517 clinically infected diabetic foot samples. A direct examination with Gram staining was carried out for each sample, then a culture on Chapman agar, blood agar and chocolate agar. The identification of the bacterial strains was based on the study of the morphological, cultural and biochemical characters thanks to API galleries or by automated method on Phoenix 100 from Becton Dickinson. The antibiogram was carried out by diffusion method in agar medium according to the recommendations of the CASFM/EUCAST. Results: during the period of our study, 517 samples were taken, of which 377 proved positive, i.e. a percentage of 72.9%. Furthermore, 11.19% of the positive cultures were polymicrobial. Among the germs identified, Gram-negative bacilli were the most represented with a rate of 85.67% and a clear predominance of enterobacteriaceae with a frequency of 85%. While Gram-positive cocci were isolated in 14.33 % with a predominance of Staphylococcus aureus at 52%. Escherichia coli (46%), Klebsiella pneumoniae (19%) and Enterobacter cloacae (14%) were the main germs isolated within the enterobacteriaceae family. The non-fermenting Gram-negative bacilli were mainly represented by Pseudomonas aeruginosa (75%). The antibiotic resistance profile showed high resistance of enterobacteriaceae to aminopenicillins and amoxicillin-clavulanic acid with respective percentages of 94.5% and 81% and the presence of extended-spectrum beta-lactamases in 16% of cases and a carbapenemase in 1.8% of cases. Almost all Staphylococcus aureus strains showed penicillinase, 14 % had resistance to methicillin and we did not note any resistances for glycopeptides. Conclusion: This study demonstrates the worrying increase in antibiotic resistance of diabetic foot infections. This requires a rational prescription of antibiotics, an improvement in hospital hygiene and continuous monitoring of the evolution of resistance.