Diabetic foot complications often escalate and lead to devastating consequences, particularly lower limb amputations. This study recorded the microorganisms isolated from Major and Minor diabetic lower limb amputations over a period of four years. This retrospective observational study analysed data obtained from a tertiary care centre for diabetes in Chennai, India, from 1st January 2021 to 31st December 2024. A predominance of Gram negative microorganisms for both Major and Minor amputations were observed. Most infections were monomicrobial. Proteus mirabilis and Enterococcus spp. were most frequently isolated from Major and Minor amputations respectively. The difference between dominant pathogens isolated from Major and Minor amputations suggest complex infection dynamics within the site of infection. This study also reinforces the importance of routine microbiological surveillance. Cumulatively, these findings indicate the need for further investigation.
Tonetto IFA, Baptista MHB, Gomides DDS, Pace AE. Quality of life of people with diabetes mellitus. Rev Esc Enferm USP. 2019;53:e03424. Published 2019 Jan 31. https://doi.org/10.1590/S1980-220X2018002803424
3.
MoiniJ. Type 2 diabetes. In: MoiniJ, ed. Epidemiology of Diabetes. 1st ed. Elsevier; 2019:91‐114.
4.
MullerISde GrauwWJvan GerwenWHBartelinkMLvan den HoogenHJRuttenGE. Foot ulceration and lower limb amputation in type 2 diabetic patients in Dutch primary health care. Diabetes Care. 2002 Mar 1;25(3):570‐574. https://doi.org/10.2337/diacare.25.3.570
5.
NoorSKhanRUAhmadJ. Understanding diabetic foot infection and its management. Diabetes Metab Synd Clin Res Rev. 2017;11(2):149‐156. https://doi.org/10.1016/j.dsx.2016.06.023
6.
KorbelLSpencerJD. Diabetes mellitus and infection: An evaluation of hospital utilization and management costs in the United States. J Diabetes Complicat.2015 Mar;29(2):192‐195. https://doi.org/10.1016/j.jdiacomp.2014.11.005
Macdonald KE, Boeckh S, Stacey HJ, Jones JD. The microbiology of diabetic foot infections: a meta-analysis. BMC Infect Dis. 2021;21(1):770. Published 2021 Aug 9. https://doi.org/10.1186/s12879-021-06516-7
9.
GarousiMTabarSMMiraziHFarrokhiZKhalediAShakerimoghaddamA. Epidemiology of Pseudomonas aeruginosa in diabetic foot infections: a global systematic review and meta-analysis. Germs. 2023 Dec;13(4):362‐372. https://doi.org/10.18683/germs.2023.1406
10.
Qu YD, Ou SJ, Zhang W, et al. Microbiological profile of diabetic foot infections in China and worldwide: a 20-year systematic review. Front Endocrinol (Lausanne). 2024;15:1368046. https://doi.org/10.3389/fendo.2024.1368046
11.
Camilleri AttardFGattAFormosaC. Superficial tissue swabs versus deep tissue samples in the detection of microbiological profile of infected diabetic foot ulcerations. Int J Low Extrem Wounds.2024 Jun;23(2):315‐319. https://doi.org/10.1177/15347346211053481
12.
BozkurtF. Comparison of microbiological results of deep tissue biopsy and superficial swab in diabetic foot infections. JMID. 2011 Sep 1;1(3):122‐127. https://doi.org/10.5799/ahinjs.02.2011.03.0028
13.
WeinsteinMPTownsMLQuarteySM, et al.The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis.1997 Apr;24(4):584‐602. https://doi.org/10.1093/clind/24.4.584
14.
JaacksLMSiegelKRGujralUPNarayanKV. Type 2 diabetes: a 21st century epidemic. Best Pract Res Clin Endocrinol Metab. 2016 Jun;30(3):331‐343. https://doi.org/10.1016/j.beem.2016.05.003
15.
KumarASai PrasannaSCharishmaRSatya DivyaRSowjanyaRVV. Prevalence of DFU among diabetic patients and its management. IJPP. 2022 Jan 28;8(4):258‐262. https://doi.org/10.18231/j.ijpp.2021.046
16.
PatilPMishraSGadgilABhandarkarPRoyNDwivediLK. The burden of diabetic foot ulcers in urban India: a community healthcare setup-based study. Indian J Endocrinol Metab.2024 Sep;28(5):494‐499. https://doi.org/10.4103/ijem.ijem_346_22
17.
MaiyaAGGundmiSMatpadyP, et al.Prevalence of foot complications in people with type 2 diabetes Mellitus: a community-based survey in rural udupi. Int J Low Extrem Wounds.2018 Sep;17(3):169‐175. https://doi.org/10.1177/1534734618791853
18.
ViswanathanVThomasNTandonN, et al.Profile of diabetic foot complications and its associated complications–a multicentric study from India. J Assoc Physicians India. 2005 Nov;53:933‐936. PMID: 16515230.
FergusonLDNtukUECelis-MoralesC, et al.Men across a range of ethnicities have a higher prevalence of diabetes: findings from a cross-sectional study of 500 000 UK Biobank participants. Diabet Med. 2018 Feb;35(2):270‐276. https://doi.org/10.1111/dme.13551
22.
GurneyJKStanleyJYorkSRosenbaumDSarfatiD. Risk of lower limb amputation in a national prevalent cohort of patients with diabetes. Diabetologia. 2018 Mar;61(3):626‐635. https://doi.org/10.1007/s00125-017-4488-8
23.
CignarellaABolegoC. Mechanisms of estrogen protection in diabetes and metabolic disease. Horm Mol Biol Clin Investig.2010 Dec 1;4(2):575‐580. https://doi.org/10.1515/HMBCI.2010.084
24.
ShermanLDPattersonMSTomarAWigfallLT. Use of digital health information for health information seeking among men living with chronic disease: data from the Health Information National Trends Survey. Am J Mens Health. 2020;14(1):1‐9. https://doi.org/10.1177/1557988320901377
25.
Al SayahFSoprovichAQiuWEdwardsALJohnsonJA. Diabetic foot disease, self-care and clinical monitoring in adults with type 2 diabetes: the Alberta’s Caring for Diabetes (ABCD) cohort study. Can J Diabetes.2015 Oct;39 Suppl 3:S120‐S126. https://doi.org/10.1016/j.jcjd.2015.05.006
26.
AcarEKacıraBK. Predictors of lower extremity amputation and reamputation associated with the diabetic foot. J Foot Ankle Surg.2017 Nov;56(6):1218‐1222. https://doi.org/10.1053/j.jfas.2017.06.004
27.
ThakreSDehariyaCUpadhyaySNargeshSSSinghM. A prospective study of epidemiological factors and outcome in patients of diabetic foot wound attending J.A. Group of Hospitals: a tertiary care centre. Asian J Pharm Clin Res. 2023;16(6):149‐152. https://doi.org/10.22159/ajpcr.2023.v16i6.48316
DasAChakrabortySImaniA, et al.Barriers to access health facilities: a self-reported cross-sectional study of women in India. Health Open Res. 2023 Sep 1;5:30. https://doi.org/10.12688/healthopenres.13384.1
31.
AgnihotriN. Women empowerment and their decision-making supremacy: a literature review approach. IJEBCE. 2021 Jan 31;1(1):57‐65. https://doi.org/10.31098/ijebce.v1i1.446
32.
SaikiaNMoradhvajBoraJK. Gender difference in health-care expenditure: evidence from India Human Development Survey. PLoS One. 2016;11(7):e0158332. https://doi.org/10.1371/journal.pone.0158332
QuartuccioMSimonsickEMLanganS, et al.The relationship of health literacy to diabetes status differs by sex in older adults. J Diabetes Complicat.2018;32(4):368‐372. https://doi.org/10.1016/j.jdiacomp.2017.10.012
35.
RainaSBhatSRainaRBhallaJChaudhariA. Limb loss: Facts and statistics – diabetes mellitus and vascular insufficiency, a real harbinger of major limb amputations – A cross-sectional study among amputees reporting to a tertiary care center. J Orthop Diseases Traumatol. 2023 Sep;6(3):223‐227. https://doi.org/10.4103/jodp.jodp_42_23
36.
HuangESLaiteerapongNLiuJYJohnPMMoffetHHKarterAJ. Rates of complications and mortality in older patients with diabetes mellitus. JAMA Intern Med. 2014 Feb 1;174(2):251. https://doi.org/10.1001/jamainternmed.2013.12956
37.
YeratRRangasamyV. A clinicomicrobial study of diabetic foot ulcer infections in south India. Int J Med Public Health. 2015;5(3):236. https://doi.org/10.4103/2230-8598.161545
38.
BenwanKAMullaAARotimiVO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health.2012;5(1):1‐8. https://doi.org/10.1016/j.jiph.2011.07.004
39.
Sun H, Ma Y, Heng H, Liu X, Liang J, Geng H. Microbiological distribution, antimicrobial susceptibility and risk factors of polymicrobial infections in diabetic foot. Clin Lab.2024;70(4):1–6. https://doi.org/10.7754/Clin.Lab.2023.231114
40.
TedeschiSNegosantiLSgarzaniR, et al.Superficial swab versus deep-tissue biopsy for the microbiological diagnosis of local infection in advanced-stage pressure ulcers of spinal-cord-injured patients: a prospective study. Clin Microbiol Infect.2017 Dec;23(12):943‐947. https://doi.org/10.1016/j.cmi.2017.04.015
41.
ShanmugamPJeyaM. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagn Res. 2013;7(3):441‐445. https://doi.org/10.7860/JCDR/2013/5091.2794
42.
WinskiRXuJTownsendJ, et al.Correlating climate conditions with Pseudomonas aeruginosa prevalence in diabetic foot infections within the United States. Open Forum Infect Dis. 2024;11(11):ofae621. https://doi.org/10.1093/ofid/ofae621
43.
OuedraogoAJean PierreHBañulsAOuédraogoRGodreuilS. Emergence and spread of antibiotic resistance in West Africa: contributing factors and threat assessment. Médecine et Santé Tropicales. 2017 May;27(2):147‐154. https://doi.org/10.1684/mst.2017.0678
44.
LipskyBABerendtARCorniaPB, et al.2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infectionsa. Clin Infect Dis.2012 Jun 15;54(12):e132‐e173. https://doi.org/10.1093/cid/cis346
45.
Thanganadar AppapalamSMuniyanAVasanthi MohanKPanchamoorthyR. A study on isolation, characterization, and exploration of multiantibiotic-resistant Bacteria in the wound site of diabetic foot ulcer patients. Int J Low Extrem Wounds.2021 Mar;20(1):6‐14. https://doi.org/10.1177/1534734619884430
MahlenSD. Serratia infections: from military experiments to current practice. Clin Microbiol Rev. 2011 Oct;24(4):755‐791. https://doi.org/10.1128/CMR.00017-11
48.
YuanCYinZWangJ, et al.Comparative genomic analysis of Citrobacter and key genes essential for the pathogenicity of Citrobacter koseri. Front Microbiol. 2019;10:2774. https://doi.org/10.3389/fmicb.2019.02774
49.
YoungHMillerWBurnhamRHeardSBergCJenkinsTC. How do preoperative antibiotics affect culture yield in diabetic foot infections?. Open Forum Infect Dis. 2017;4(1):ofx016. https://doi.org/10.1093/ofid/ofx016
