Skip to main content
Top
Published in: International Journal of Diabetes in Developing Countries 1/2017

01-03-2017 | Original Article

Frequency of MRSA in diabetic foot infections

Authors: Mohammad Taghi Akhi, Reza Ghotaslou, Mohammad Yousef Memar, Mohammad Asgharzadeh, Mojtaba Varshochi, Tahereh Pirzadeh, Naser Alizadeh

Published in: International Journal of Diabetes in Developing Countries | Issue 1/2017

Login to get access

Abstract

Staphylococcus aureus is one of the most common bacterial pathogens isolated from diabetic foot infections (DFIs). The increasing prevalence of meticillin-resistant S. aureus (MRSA) in patients with diabetes is associated with complications. The aim of this study was to determine the prevalence of S. aureus in DFIs and antibiotic susceptibility patterns of MRSA and non-MRSA isolates. Identification of S. aureus and MRSA was performed by the phenotypic and molecular methods. The Kirby-Bauer and agar dilution methods were performed for determination of antibiotic susceptibility patterns. Thirty-four isolates of S. aureus were isolated from March 2014 to February 2015. The rate of MRSA was 38.23 % according to the disk cefoxitin and oxacillin agar dilution methods, and as by PCR method 12) 35.29 %), isolates were found to have the mecA gene. All MRSA and non-MRSA isolates were susceptible to linezolid and vancomycin. The resistance rate to ceftriaxone was high followed by amoxicillin-clavulanic acid, tetracycline, gentamicin, and erythromycin. The most common bacterial pathogen isolated from DFIs was S. aureus. To ensure effective treatment, accurate detection of MRSA is critical. Our findings showed that MRSA isolates had high-level resistance to antimicrobial agents and that appropriate antibiotic therapy, based on the antibiotic susceptibility pattern, is essential to ensure a good result.
Literature
1.
go back to reference Ako-Nai A, Ikem I, Akinloye O, Aboderin A, Ikem R, Kassim O. Characterization of bacterial isolates from diabetic foot infections in Ile-Ife, Southwestern Nigeria. Foot. 2006;16(3):158–64.CrossRef Ako-Nai A, Ikem I, Akinloye O, Aboderin A, Ikem R, Kassim O. Characterization of bacterial isolates from diabetic foot infections in Ile-Ife, Southwestern Nigeria. Foot. 2006;16(3):158–64.CrossRef
2.
go back to reference Roberts AD, Simon GL. Diabetic foot infections: the role of microbiology and antibiotic treatment. Semin Vasc Surg. 2012;25(2):75–81.CrossRefPubMed Roberts AD, Simon GL. Diabetic foot infections: the role of microbiology and antibiotic treatment. Semin Vasc Surg. 2012;25(2):75–81.CrossRefPubMed
3.
go back to reference Shankar E, Mohan V, Premalatha G, Srinivasan R, Usha A. Bacterial etiology of diabetic foot infections in South India. Eur J Int Med. 2005;16(8):567–70.CrossRef Shankar E, Mohan V, Premalatha G, Srinivasan R, Usha A. Bacterial etiology of diabetic foot infections in South India. Eur J Int Med. 2005;16(8):567–70.CrossRef
4.
go back to reference Zubair M, Malik A, Ahmad J. Clinico-microbiological study and antimicrobial drug resistance profile of diabetic foot infections in North India. Foot. 2011;21(1):6–14.CrossRef Zubair M, Malik A, Ahmad J. Clinico-microbiological study and antimicrobial drug resistance profile of diabetic foot infections in North India. Foot. 2011;21(1):6–14.CrossRef
5.
go back to reference Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini A, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care. 2006;29(8):1727–32.CrossRefPubMed Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini A, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care. 2006;29(8):1727–32.CrossRefPubMed
6.
go back to reference Akhi MT, Ghotaslou R, Asgharzadeh M, Varshochi M, Pirzadeh T, Memar MY, et al. Bacterial etiology and antibiotic susceptibility pattern of diabetic foot infections in Tabriz, Iran. GMS Hyg Infect Control. 2015;10:1–6. Akhi MT, Ghotaslou R, Asgharzadeh M, Varshochi M, Pirzadeh T, Memar MY, et al. Bacterial etiology and antibiotic susceptibility pattern of diabetic foot infections in Tabriz, Iran. GMS Hyg Infect Control. 2015;10:1–6.
7.
go back to reference Tentolouris N, Petrikkos G, Vallianou N, Zachos C, Daikos G, Tsapogas P, et al. Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers. Clin Microbiol Infect. 2006;12(2):186–9.CrossRefPubMed Tentolouris N, Petrikkos G, Vallianou N, Zachos C, Daikos G, Tsapogas P, et al. Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers. Clin Microbiol Infect. 2006;12(2):186–9.CrossRefPubMed
8.
go back to reference Mohammadi S, Sekawi Z, Monjezi A, Maleki M-H, Soroush S, Sadeghifard N, et al. Emergence of SCCmec type III with variable antimicrobial resistance profiles and spa types among methicillin-resistant Staphylococcus aureus isolated from healthcare- and community-acquired infections in the west of Iran. Int J Infect Dis. 2014;25:152–8.CrossRefPubMed Mohammadi S, Sekawi Z, Monjezi A, Maleki M-H, Soroush S, Sadeghifard N, et al. Emergence of SCCmec type III with variable antimicrobial resistance profiles and spa types among methicillin-resistant Staphylococcus aureus isolated from healthcare- and community-acquired infections in the west of Iran. Int J Infect Dis. 2014;25:152–8.CrossRefPubMed
9.
go back to reference Sobhy N, Aly F, El Kader OA, Ghazal A, Elbaradei A. Community-acquired methicillin-resistant Staphylococcus aureus from skin and soft tissue infections (in a sample of Egyptian population): analysis of mec gene and staphylococcal cassette chromosome. Braz J Infect Dis. 2012;16(5):426–31.CrossRefPubMed Sobhy N, Aly F, El Kader OA, Ghazal A, Elbaradei A. Community-acquired methicillin-resistant Staphylococcus aureus from skin and soft tissue infections (in a sample of Egyptian population): analysis of mec gene and staphylococcal cassette chromosome. Braz J Infect Dis. 2012;16(5):426–31.CrossRefPubMed
10.
go back to reference Hiramatsu K, Cui L, Kuroda M, Ito T. The emergence and evolution of methicillin-resistant Staphylococcus aureus. Trends Microbiol. 2001;9(10):486–93.CrossRefPubMed Hiramatsu K, Cui L, Kuroda M, Ito T. The emergence and evolution of methicillin-resistant Staphylococcus aureus. Trends Microbiol. 2001;9(10):486–93.CrossRefPubMed
11.
go back to reference Zenelaj B, Bouvet C, Lipsky BA, Uçkay I. Do diabetic foot infections with methicillin-resistant staphylococcus aureus differ from those with other pathogens? Int J Lower Extrem Wounds. 2014;13(4):263–72. doi:10.1177/1534734614550311. Zenelaj B, Bouvet C, Lipsky BA, Uçkay I. Do diabetic foot infections with methicillin-resistant staphylococcus aureus differ from those with other pathogens? Int J Lower Extrem Wounds. 2014;13(4):263–72. doi:10.​1177/​1534734614550311​.
12.
go back to reference Dang C, Prasad Y, Boulton A, Jude E. Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med. 2003;20(2):159–61.CrossRefPubMed Dang C, Prasad Y, Boulton A, Jude E. Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med. 2003;20(2):159–61.CrossRefPubMed
13.
go back to reference Taha AB. Relationship and susceptibility profile of Staphylococcus aureus infection diabetic foot ulcers with Staphylococcus aureus nasal carriage. Foot. 2013;23(1):11–6.CrossRef Taha AB. Relationship and susceptibility profile of Staphylococcus aureus infection diabetic foot ulcers with Staphylococcus aureus nasal carriage. Foot. 2013;23(1):11–6.CrossRef
14.
go back to reference Araj G, Talhouk R, Simaan C, Maasad M. Discrepancies between mecA PCR and conventional tests used for detection of methicillin resistant Staphylococcus aureus. Int J Antimicrob Agents. 1999;11(1):47–52.CrossRefPubMed Araj G, Talhouk R, Simaan C, Maasad M. Discrepancies between mecA PCR and conventional tests used for detection of methicillin resistant Staphylococcus aureus. Int J Antimicrob Agents. 1999;11(1):47–52.CrossRefPubMed
15.
go back to reference Hasan MR, Brunstein JD, Al-Rawahi G, Tan R, Thomas E, Tilley P. Optimal use of MRSASelect and PCR to maximize sensitivity and specificity of MRSA detection. Curr Microbiol. 2013;66(1):61–3.CrossRefPubMed Hasan MR, Brunstein JD, Al-Rawahi G, Tan R, Thomas E, Tilley P. Optimal use of MRSASelect and PCR to maximize sensitivity and specificity of MRSA detection. Curr Microbiol. 2013;66(1):61–3.CrossRefPubMed
16.
go back to reference Bode LG, van Wunnik P, Vaessen N, Savelkoul PH, Smeets LC. Rapid detection of methicillin-resistant Staphylococcus aureus in screening samples by relative quantification between the mecA gene and the SA442 gene. J Microbiol Methods. 2012;89(2):129–32.CrossRefPubMed Bode LG, van Wunnik P, Vaessen N, Savelkoul PH, Smeets LC. Rapid detection of methicillin-resistant Staphylococcus aureus in screening samples by relative quantification between the mecA gene and the SA442 gene. J Microbiol Methods. 2012;89(2):129–32.CrossRefPubMed
17.
go back to reference Akhi MT, Ghotaslou R, Beheshtirouy S, Asgharzadeh M, Pirzadeh T, Asghari B, et al. Antibiotic susceptibility pattern of aerobic and anaerobic bacteria isolated from surgical site infection of hospitalized patients. Jundishapur J Microbiol. 2015;8(7):e20309. doi:10.5812/jjm.20309v2.PubMedPubMedCentral Akhi MT, Ghotaslou R, Beheshtirouy S, Asgharzadeh M, Pirzadeh T, Asghari B, et al. Antibiotic susceptibility pattern of aerobic and anaerobic bacteria isolated from surgical site infection of hospitalized patients. Jundishapur J Microbiol. 2015;8(7):e20309. doi:10.​5812/​jjm.​20309v2.PubMedPubMedCentral
18.
go back to reference Mahon CR, Lehman DC. Manuselis Jr G. Elsevier Health Sciences: Textbook of diagnostic microbiology. Philadelphia: Saunders; 2014. Mahon CR, Lehman DC. Manuselis Jr G. Elsevier Health Sciences: Textbook of diagnostic microbiology. Philadelphia: Saunders; 2014.
19.
go back to reference Sadeghi J, Mansouri S. Molecular characterization and antibiotic resistance of clinical isolates of methicillin-resistant Staphylococcus aureus obtained from Southeast of Iran (Kerman). APMIS. 2014;122(5):405–11.CrossRefPubMed Sadeghi J, Mansouri S. Molecular characterization and antibiotic resistance of clinical isolates of methicillin-resistant Staphylococcus aureus obtained from Southeast of Iran (Kerman). APMIS. 2014;122(5):405–11.CrossRefPubMed
20.
go back to reference Wayne P. Clinical and Laboratory Standards Institute. Pennsylvania: Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing; 2011. p. 21. Wayne P. Clinical and Laboratory Standards Institute. Pennsylvania: Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing; 2011. p. 21.
21.
go back to reference Asgharzadeh M, Kafil HS, Khakpour M. Comparison of mycobacterial interspersed repetitive unit-variable number tandem repeat and IS6110-RFLP methods in identifying epidemiological links in patients with tuberculosis in Northwest of Iran. Ann Microbiol. 2008;58(2):333–9.CrossRef Asgharzadeh M, Kafil HS, Khakpour M. Comparison of mycobacterial interspersed repetitive unit-variable number tandem repeat and IS6110-RFLP methods in identifying epidemiological links in patients with tuberculosis in Northwest of Iran. Ann Microbiol. 2008;58(2):333–9.CrossRef
22.
go back to reference Pappu AK, Sinha A, Johnson A. Microbiological profile of diabetic foot ulcer. Calicut Med J. 2011;9(3):e2. Pappu AK, Sinha A, Johnson A. Microbiological profile of diabetic foot ulcer. Calicut Med J. 2011;9(3):e2.
23.
go back to reference Kandemir Ö, Akbay E, Şahin E, Milcan A, Gen R. Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. J Infect. 2007;54(5):439–45.CrossRefPubMed Kandemir Ö, Akbay E, Şahin E, Milcan A, Gen R. Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. J Infect. 2007;54(5):439–45.CrossRefPubMed
24.
go back to reference Mendes J, Marques-Costa A, Vilela C, Neves J, Candeias N, Cavaco-Silva P, et al. Clinical and bacteriological survey of diabetic foot infections in Lisbon. Diabet Res Clin Pract. 2012;95(1):153–61.CrossRef Mendes J, Marques-Costa A, Vilela C, Neves J, Candeias N, Cavaco-Silva P, et al. Clinical and bacteriological survey of diabetic foot infections in Lisbon. Diabet Res Clin Pract. 2012;95(1):153–61.CrossRef
25.
go back to reference Benwan KA, Mulla AA, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health. 2012;5(1):1–8.CrossRefPubMed Benwan KA, Mulla AA, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health. 2012;5(1):1–8.CrossRefPubMed
26.
go back to reference Raja NS. Microbiology of diabetic foot infections in a teaching hospital in Malaysia: a retrospective study of 194 cases. J Microbiol Immunol Infect. 2007;40(1):39.PubMed Raja NS. Microbiology of diabetic foot infections in a teaching hospital in Malaysia: a retrospective study of 194 cases. J Microbiol Immunol Infect. 2007;40(1):39.PubMed
27.
go back to reference Shanmugam P, Jeya M. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagn Res: JCDR. 2013;7(3):441.PubMedPubMedCentral Shanmugam P, Jeya M. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagn Res: JCDR. 2013;7(3):441.PubMedPubMedCentral
28.
go back to reference Perez LRR, Dias C, d’Azevedo PA. Agar dilution and agar screen with cefoxitin and oxacillin: what is known and what is unknown in detection of meticillin-resistant Staphylococcus aureus. J Med Microbiol. 2008;57(8):954–6.CrossRefPubMed Perez LRR, Dias C, d’Azevedo PA. Agar dilution and agar screen with cefoxitin and oxacillin: what is known and what is unknown in detection of meticillin-resistant Staphylococcus aureus. J Med Microbiol. 2008;57(8):954–6.CrossRefPubMed
29.
go back to reference Palazzo ICV, Rehder A, Darini ALC. Quantitative disk diffusion as a convenient method for determining minimum inhibitory concentrations of oxacillin for staphylococci strains. J Microbiol Methods. 2007;71(3):186–90.CrossRefPubMed Palazzo ICV, Rehder A, Darini ALC. Quantitative disk diffusion as a convenient method for determining minimum inhibitory concentrations of oxacillin for staphylococci strains. J Microbiol Methods. 2007;71(3):186–90.CrossRefPubMed
30.
go back to reference Hartemann-Heurtier A, Robert J, Jacqueminet S, Ha Van G, Golmard J, Jarlier V, et al. Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabetic Med. 2004;21(7):710–5.CrossRefPubMed Hartemann-Heurtier A, Robert J, Jacqueminet S, Ha Van G, Golmard J, Jarlier V, et al. Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabetic Med. 2004;21(7):710–5.CrossRefPubMed
31.
go back to reference Eleftheriadou I, Tentolouris N, Argiana V, Jude E, Boulton AJ. Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs. 2010;70(14):1785–97.CrossRefPubMed Eleftheriadou I, Tentolouris N, Argiana V, Jude E, Boulton AJ. Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs. 2010;70(14):1785–97.CrossRefPubMed
32.
go back to reference Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J. 2004;1(2):123–32.CrossRefPubMed Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J. 2004;1(2):123–32.CrossRefPubMed
33.
go back to reference Tentolouris N, Jude E, Smirnof I, Knowles E, Boulton A. Methicillin-resistant Staphylococcus aureus: an increasing problem in a diabetic foot clinic. Diabetic Med. 1999;16(9):767–71.CrossRefPubMed Tentolouris N, Jude E, Smirnof I, Knowles E, Boulton A. Methicillin-resistant Staphylococcus aureus: an increasing problem in a diabetic foot clinic. Diabetic Med. 1999;16(9):767–71.CrossRefPubMed
34.
go back to reference Bader MS. Diabetic foot infection. Am Fam Physician. 2008;78(1):71–9.PubMed Bader MS. Diabetic foot infection. Am Fam Physician. 2008;78(1):71–9.PubMed
35.
go back to reference Cervantes-García E, García-González R, Reséndiz-Albor A, Salazar-Schettino PM. Infections of diabetic foot ulcers with methicillin-resistant Staphylococcus aureus. Int J Lower Extrem Wounds. 2015;14(1):44–9.CrossRef Cervantes-García E, García-González R, Reséndiz-Albor A, Salazar-Schettino PM. Infections of diabetic foot ulcers with methicillin-resistant Staphylococcus aureus. Int J Lower Extrem Wounds. 2015;14(1):44–9.CrossRef
Metadata
Title
Frequency of MRSA in diabetic foot infections
Authors
Mohammad Taghi Akhi
Reza Ghotaslou
Mohammad Yousef Memar
Mohammad Asgharzadeh
Mojtaba Varshochi
Tahereh Pirzadeh
Naser Alizadeh
Publication date
01-03-2017
Publisher
Springer India
Published in
International Journal of Diabetes in Developing Countries / Issue 1/2017
Print ISSN: 0973-3930
Electronic ISSN: 1998-3832
DOI
https://doi.org/10.1007/s13410-016-0492-7

Other articles of this Issue 1/2017

International Journal of Diabetes in Developing Countries 1/2017 Go to the issue