Predominance of multidrug-resistant bacteria with high resistance to empiric antibiotics in diabetic foot ulcers: a cross-sectional study

A cross-sectional study of 153 patients with diabetic foot ulcers (DFUs) found that these chronic wounds frequently contain polymicrobial infections with high levels of antibiotic resistance, complicating treatment and increasing amputation risk. The majority of isolates were Gram-positive bacteria (62%), mainly Staphylococcus aureus and coagulase-negative staphylococci, alongside Gram-negative pathogens such as Pseudomonas aeruginosa and Klebsiella pneumoniae. Alarmingly, multidrug resistance was extremely common, affecting about 95% of Gram-negative bacteria and 60–87% of Gram-positive bacteria, with many strains resistant to 9–11 commonly used antibiotics. Using the WHO AWaRe classification, the study highlights the need to prioritize Access and Watch antibiotics while reserving last-line drugs for MDR infections. Overall, the findings stress the importance of routine microbiological testing, antimicrobial stewardship, and updated treatment guidelines to improve outcomes for DFU patients.