Azizul Hasan Aamir, Ahmed Nasir, Mohammad Zahid Jadoon, Khalid Mehmood, Sobia Sabir Ali


Background: Diabetic foot is a common complication of diabetes world over. We conducted this study
to determine common microbiological pathogens in Diabetic Foot Infections (DFI) at a tertiary care
hospital and their management. Methods: In this observational study deep wound swabs of all admitted
diabetic patients were taken, pathogens isolated, antibiotic used and its response depending on complete
resolution of symptoms and biochemical markers were recorded. Data were analysed on SPSS-11.
Results: A total of 114 cases were recorded. Sixty-eight (59%) cases had ulcers on forefoot, 28 (25%)
mid-foot and 18 (16%) hind-foot. One hundred and four pathogens were isolated from wound swabs
after debridement. Commonest pathogen isolated was Staphylococcus aureus (52, 46%) followed by E.
coli (11, 10%), MRSA was found in 10 (9%) cases, streptococcus in 6 (5%) and pseudomonas in 5 (4%)
cases. Polymicrobial infection was also seen in a few cases. Surgical intervention included superficial
debridement in 88 (77%) cases, toe amputation/forefoot amputation in 19 (17%) cases, and below/above
knee (major) amputation in 7 (6%) cases. Commonest antibiotic used was Cefoperazone/Sulbactam in
43 (38%) cases, alone or in combination, followed by Ceftraixone 36 (33%) cases. Linezolid was used
for MRSA. Ninety-four (82%) patients responded to treatment and were recorded as ‘cured’.
Conclusion: Diabetic Foot ulcers often present with serious foot infections. Commonest pathogens are
Staph. aureus, E. coli, Pseudomonas spp. and MRSA. Treatment was effective with
Cefoperazone/Sulbactam and Ceftraixone. MRSA was treated successfully with Linezolid.
Keywords: Diabetic foot, Diabetic foot infections (DFI), Staph. Aureus, E. coli, MRSA, antibiotics

Full Text:



Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths

J, et al. The north-west diabetes foot care study: incidence of, and

risk factor for, new diabetic foot ulceration in community-based

patient cohort. Diabet Med 2002;19:377–84.

Katsilambros N, Dounis E, Nicholas Tentolouris, Tsapogas P.

Atlas of the diabetic foot. Hoboken NJ: Jon Wiley & Sons Ltd;

International Diabetes Federation. Diabetes atlas. Executive

summary. 2nd ed. Belgium IDF; 2003.

Boulton AJ, Kirsner RS, Vileikyte L. Clinical practice:

neuropathic diabetic foot ulcers. N Engl J Med 2004;351:48–55.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in

patients with diabetes. JAMA 2005;293:217–28.

Levin ME. Classification of diabetic foot wounds. Diabetes Care


Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and

amputations in diabetes. In: Diabetes in America, Vol 2.

Bethesda, MD: National Institutes of Health 1995.p. 409–27.

Ali SM, Basit A, Sheikh T, Mumtaz S, Hydrie MZ. Diabetic foot

ulcer-A prospective study. J Pak Med Assoc 2001;51:78–81.

Rooh UM, Ahmed M, Griffin S. Evaluation and management of

diabetic foot according to Wagner’s classification. A study of 100

cases. J Ayub Med Coll Abbottabad 2003;15(3):39–42.

Faizur Rehman, Nadir S. Diabetic Foot. J Postgrad Med Inst


Esposito S, Leone S, Noviello S, Foire M, Ianniello F, Felaco

FM, et al. Foot infections in diabetes (DFI) in the out-patient

setting: an italian multicentre observational survey. Diabet Med


World Health Organization Expert Committee. Definition,

diagnosis and classification of diabetes mellitus and its

complications. Report of a WHO consultation, part 1: Diagnosis

and Classification of Diabetes Mellitus. Geneva: World Health

Organization 1999.

Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS,

Karchmer AW. Diagnosis and treatment of diabetic foot

infections. Clin Infect Dis 2004;39:885–910.

Young MJ, Boulton AJ, Mac Leod AF, Williams DR, Sonksen

PH. A multicentre study of the prevalence of diabetic peripheral

neuropathy in the United Kingdom hospital clinic population.

Diabetologia 1993;36:150–4.

Wagner FW Jr. The dysvascular foot: a system for diagnosis and

treatment. Foot Ankle 1981;2:64–122.

Zafar A. Management of diabetic foot: two years experience. J

Ayub Med Coll Abbottabad 2001;13(1):14–6.

Ali SM, Basit A, Fawwad A, Ahmedani MY, Miyan Z, Malik

RA. Presentation and outcome of diabetic foot at a tertiary care

unit. Pak J Med Sci 2008;24:651–6.

Levin ME. Classification of diabetic foot wounds. Diabetes Care


Lipsky BA, Sheehan P, Armstrong DG, Tice AD, Polis AB,

Abramson MA. Clinical predictors of treatment failure for

diabetic foot infections: data from a perspective trial. Int Wound J


Boulton A. Lawrence lecture. The diabetic foot: neuropathic in

aetiology? Diabet Med 1990;7:852–8.

J Ayub Med Coll Abbottabad 2011;23(1)


Lipsky BA, Armstrong DG, Citron DM, Tice AD, Morgenstern

DE, Abramson MA. Ertapenem versus piperacillin/ tazobactam

for diabetic foot infections (SIDESTEP): prospective,

randomised, controlled, double- blinded, multicentre trial, Lancet


Kaufman J, Breeding L, Rosenberg N. Anatomic location of

acute diabetic infection. Its influence on the outcome of

treatment. Am Surg 1987;53:109–112.

Vijay V, Snehalatha C, Ramachandran A. Sociocultural practice

that may affect the development of the diabetic foot. IDF Bull


Sapico FL, Witte JL, Canawati HN, Montgomerie JZ, Bessman

AN. The infected foot of the diabetic patient: quantitative

microbiology and analysis of clinical features. Rev Infec Dis

;6(Suppl 1):171–6.

Ge Y, MacDonald D, Hait H, Lipsky BA, Zasloff M, Holroyd K,

Microbiological profile of infected diabetic foot ulcers. Diabet

Med 2002;19:1032–5.

Wheat LJ, Allen SD, Henry M, Kernek CB, Siders JA, Kuebler

T. Diabetic foot infections. Arch Intern Med 1986;146:1935–40.

Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA.

Bacteriological study of diabetic foot infections. J Diabetes

Complications 2005;19:138–41.

Mantey I, Hill RL, Foster AV, Wilson S, Wade JJ, Edmonds ME.

Infection of foot ulcers with Staphylococcus aureus associated

with increase mortality in diabetic patients. Commun Dis Public

Health 2000;3:288–90.

Dang CN, Prasad YD, Boulton AW, Jude EB. Methicillinresistant Staphylococcus aureus in the diabetic foot clinic: a

worsening problem. Diabet Med 2003;20:159–61.

Fluckiger U, Widmer AF. Epidemiology of methicillin-resistant

Staphylococcus aureus. Chemotherapy 1999;45:121–34.

Centers for Disease Control and Prevention. Vancomycinresistant Staphylococcus aureus-Pennsylvania, 2002. MMWR

Morb Mortal Wkly Rep 2002;51:902.

Rubinstein E, Cammarata SK, Oliphant TH, Wunderink RG.

Linezolid (PNU-100766) versus vancomycin in the treatment of

hospitalized patients with nosocomial pneumonia: a randomized,

double-blind, multicenter study. Linezolid Nosocomial

Pneumonia Study Group. Clin Infect Dis 2001;32:402–12.

Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH, Hafkin B.

Linezolid versus vancomycin for the treatment of methicillinresistant Staphylococcus aureus infections. Linezolid MRSA

Study Group. Clin Infect Dis 2002;34:1481–90.

Lovering AM, Zhang J, Bannister GC, Lankester BJ, Brown JH,

Narendra G, et al. Penetration of linezolid into bone, fat, muscle

and haematoma of patients undergoing routine hip replacement. J

Antimicrob Chemother 2002;50:73–7.

Rana B, Butcher I, Grigoris P, Murnaghan C, Seaton RA, Tobin

CM. Linezolid penetration into osteo-articular tissues. J

Antimicrob Chemother 2002;50:747–50.

Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB,

Boulton AJ. A Comparison of Two Diabetic Foot Ulcer

Classification Systems. Diabetes Care 2001;24:84–8.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]