Pathogens isolated from patients with different Wagner grades of diabetic foot infections and curative effects

OBJECTIVE To explore the etiological characteristics of diabetic foot infections (DFI), analyze the drug resistance and observe the curative effects so as to provide theoretical bases for targeted diagnosis, treatment, prevention and control of the infections.

METHODS A total of 182 patients with DFI who were treated in the Third People′s Hospital from Jan. 2019 to Dec. 2023 were recruited as the research subjects. The indexes were observed and compared among the patients with different Wagner grades of DFI.

RESULTS Totally 182 patients were enrolled in the study, 84 of whom were as Wagner grade 2, 62 were as grade 3, 25 were as grade 4, and 11 were as grade 5. The levels of fasting blood glucose and glycosylated hemoglobin elevated with the increase of the grade, while the albumin level reduced. Pseudomonas aeruginosa (18.35%), Staphylococcus aureus (17.89%) and Escherichia coli (15.60%) were the major strains of pathogens; the proportions of gram-negative bacteria increased with the rise of the grade (P < 0.05). The drug resistance of the main gram-negative bacteria to ampicillin, sulfamethoxazole-trimethoprim and piperacillin were more than 70%; the drug resistance of the main gram-positive bacteria to penicillin and oxacillin were more than 60%. In terms of the risk factors, the proportions of the DFI patients with hyperglycemia, neuropathy and retinopathy declined with the rise of the grade, while the proportions of the DFI patients with long-term use of antibiotics (more than 3 months), more than 2 times of hospitalization each year for the same lesion site, ulcer area no less than 4 cm² and treatment course of ulcer more than 60 days increased with the rise of the grade (all P < 0.05). In addition, the effective rate of treatment and the eradication rate of pathogens showed downward trends with the rise of Wagner grade (P < 0.05).

CONCLUSIONS The DFI is mainly caused by the gram-negative bacilli, the drug resistance rates are generally high. Wagner DF grade is associated with the distribution of pathogens and the antimicrobial effect, based on which the targeted prevention and treatment can be carried out in early stage.