Bacterial ecology and antibiotic resistance mechanisms of isolated resistant strains from diabetic foot infections in th
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RESEARCH ARTICLE
Bacterial ecology and antibiotic resistance mechanisms of isolated resistant strains from diabetic foot infections in the north west of Algeria Bakhta Bouharkat 1
&
Aicha Tir Touil 1 & Catherine Mullié 2 & Nadia Chelli 1 & Boumediene Meddah 1
Received: 1 October 2019 / Accepted: 17 September 2020 # Springer Nature Switzerland AG 2020
Abstract Background In front of the polymorphic bacterial ecology and antibiotic resistance in diabetic patients with foot infections and good patient care, collaboration between clinicians and microbiologists is needed to improve assessment and management of patients with this pathology. Objective This study was designed to characterize the bacterial ecology of diabetic foot infection (DFIs) and to determine the different mechanisms of resistance involved. Methods In this study bacterial strains and antibiotic resistance profiles were determined from diabetic foot infections patients (n = 117). The identification of resistance mechanisms, such as penicillinase and/or extended-spectrum β-lactamase production (ESBL), methicillin-resistant Staphylococcus aureus (MRSA) and efflux pump over-expression were performed. Results A high prevalence of Gram-negative bacteria (61%) with Escherichia coli, and other Enterobacteriaceae and Pseudomonas aeruginosa being the predominant isolates. Gram positive bacteria mainly represented by Staphylococcus aureus accounted for 39% of the isolates. 93.5% of the Enterobacteriaceae were resistant to, at least, one molecule in the β-lactam family, while the majority of the Staphylococci were resistant to penicillin G and tetracycline (93.3% and 71.7%). The majority of non-fermenting Gram negative bacteria were also resistant to fluoroquinolones. β-lactamase detection tests revealed the presence of extended-spectrum β-lactamase in 43.5% of the Enterobacteriaceae, while methicillin-resistant Staphylococcus aureus represented 18.2% of the isolates. Additionally, 50.9% of non-fermenting Gram negative bacteria were overproducing efflux pumps. Conclusion All Acinetobacter Baumannii were Multidrug-Resistant (MDR), as the majority of Staphylococci, and Enterobacteriaceae. These results should be taken into account by the clinician in the prescription of probabilistic antibiotic therapy in this context. Keywords Diabetes Complications . Foot infection . Bacteria . Antimicrobial agents
Introduction
* Bakhta Bouharkat [email protected] 1
Laboratoire de Bioconversion, Génie Microbiologique et Sécurité Sanitaire, Faculté des Sciences de la Nature et de la vie, Université Mustapha Stambouli, 305 Route de Mamounia, 29000 Mascara, BP, Algeria
2
Laboratoire AGIR (Agents Infectieux, Résistance et Chimiothérapie) EA 4294, Université de Picardie Jules Verne, UFR de Pharmacie, 1 rue des Louvels, 80037 Amiens Cedex 1, France
Diabetes mellitus (DM) is a clinical syndrome associated with a deficiency in insulin secretion or action [1]. It is a chronic metabolic syndrome with a high risk of developing complications [2], like cardiovascular disea
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