Clinical microbiology study of diabetic foot ulcer in Iran; pathogens and antibacterial susceptibility

The aim of this study was to investigate microbial pathogens and their antibiotic susceptibility profile in infected diabetic foot ulcers in Iranian patients. This was a one-year cross sectional study on diabetic patients with infected diabetic foot ulcer at Shariati Teaching Hospital, Tehran, Iran. Grade of ulcer was determined by Wagner's criteria. Specimens were obtained from the base of ulcer, deep part of the wound or aspiration and were tested with gram staining and antibacterial susceptibility was determined with both disk diffusion and E-Test methods. Total of 546 pathogens were isolated from 165 ulcers of 149 patients. Gram positive aerobes including Enterococcal species and methicillin resistant Staphylococcus aureus (S. aureus) (21.4 and 19.4%, respectively) were identified as the most common pathogens followed by Gram negative isolates including Escherichia coli and Pseudomonas-aeruginosa (12.6 and 5.4%, respectively). The majority of wounds were classified as Wagner grades 2 and 3 (15.7 and 75.7%). Appropriate empiric treatment to cover both these Gram positive and Gram negative pathogens is crucially important.