Determination of Pathogenic Bacterial Infection in the Wounds of Diabetic Patients Admitted in Rehman Medical Institute Hayatabad Peshawar

Abstract

Background: Diabetic wound infections (DWI) represent a significant clinical challenge, particularly in Pakistan which harbors one of the world's largest diabetic populations. The microbiological profile of these infections exhibits considerable geographical variation, necessitating region-specific studies to guide appropriate therapeutic interventions. Objective: This study aimed to determine the prevalence, microbiological profile, antibiotic susceptibility patterns, and minimum inhibitory/bactericidal concentrations of pathogenic bacteria isolated from diabetic wound infections at Rehman Medical Institute, Peshawar. Methods: A total of 150 wound samples were collected from diabetic patients admitted to Rehman Medical Institute. Standard microbiological techniques including culture on selective media, Gram staining, and biochemical tests (coagulase, oxidase, indole, urease, catalase, citrate utilization, and triple sugar iron tests) were employed for bacterial identification. Antibiotic susceptibility was evaluated using the Kirby-Bauer disc diffusion method, while minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for ciprofloxacin were determined through broth dilution. Demographic data and risk factors were collected using a structured proforma. Results: Among 150 samples, 108 (72%) demonstrated positive bacterial cultures. Males showed higher infection rates (68, 63%) compared to females (40, 37%), with the 41-60 years age group being most affected (49.08%). Gram-positive isolates included Staphylococcus aureus (42%), Enterococcus spp (24%), S. epidermidis (18%), and Bacillus spp (16%). Gram-negative isolates comprised E. coli (22.35%), P. aeruginosa (18.82%), Salmonella spp (16.47%), Enterobacter spp (14.11%), Proteus spp (12.94%), Klebsiella spp (9.4%), and Shigella spp (5.90%). High resistance was observed against Ampicillin (60%) and Amoxicillin (59%), while Imipenem demonstrated 70% sensitivity across all isolates. The Enterobacter spp exhibited the highest MIC and MBC values, whereas E. coli and S. aureus showed lower values. Hypertension (64%) and retinopathy (55%) emerged as significant associated risk factors. Conclusion: The predominance of S. aureus and E. coli in diabetic wounds, coupled with alarming resistance to commonly used antibiotics, underscores the critical need for culture-guided antimicrobial therapy. Imipenem's consistent efficacy suggests its potential as a reliable therapeutic option in this region.

Keywords: Diabetic wound infection, Staphylococcus aureus, antibiotic resistance, minimum inhibitory concentration, risk factors, Pakistan