Cigarette Smoking and Peripheral Vascular Disease are Associated with Increasing Risk of ESKAPE Pathogen Infection in Diabetic Foot Ulcers

Abstract

Objective

Diabetic foot ulcers (DFUs) and ESKAPE pathogens have attracted attention globally, but the role of ESKAPE pathogens in diabetic foot infection is not well described. The purpose of this study was to evaluate the clinical features, antimicrobial resistance, and risk factors for ESKAPE infection in patients with DFUs.

Methods

A retrospective study was conducted on 180 patients with diabetic foot infection admitted to The Affiliated Hospital of Southwest Medical University (Luzhou, China), from January 2017 to April 2021. Antimicrobial susceptibilities of all isolates were determined. Multivariate logistic regression analysis was performed to analyze the independent risk factors for ESKAPE infection, multidrug-resistant (MDR)-ESKAPE infection, MDR-pathogen infection, and severe group in patients with DFUs.

Results

A total of 206 isolates were collected, of which 42.2% were ESKAPE pathogens. The independent risk factors for ESKAPE infection were cigarette smoking (OR = 1.958; 95% CI, 1.015–3.777) and peripheral vascular disease (OR = 2.096; 95% CI, 1.100–3.992), while alcohol consumption (OR = 2.172; 95% CI, 1.104–4.272) was the independent risk factor for MDR-pathogen infection. Additionally, the independent risk factors for severe DFU group were invasive treatment (OR = 326.642; 95% CI, 76.644–1392.08), the duration of systemic antibiotic treatment (OR = 0.918; 95% CI, 0.849–0.992), and length of hospital stay (OR = 1.145; 95% CI, 1.043–1.256). No independent risk factors for MDR-ESKAPE infection were found.

Conclusion

Our data established the microbiological features of ESKAPE pathogens and clinical manifestations of diabetic foot infection, and provide support for monitoring and management of ESKAPE infection in patients with DFUs in southwest China.

Keywords:

• diabetic foot ulcers
• ESKAPE pathogens
• infection
• antimicrobial resistance
• risk factors

Ethics Statement

This study was approved by the Institutional Review Board of the affiliated Hospital of Southwest Medical University (KY2020043). Written informed consent was obtained from all participants, and was conducted according to the guidelines of the Declaration of Helsinki.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the grants from Sichuan Science and Technology Program (2022YFQ0093, 2020LZXNYD02) and Luxian Government and Southwest Medical University Cooperation Program (2020LXXNYKD-04).