Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer

Figures & data

Table 1 Baseline Data of Patients with Diabetic Foot Ulcer

Characteristics	Total (N=348)	MDRM+ (N=202)	MDRM- (N=146)	p-value
Age (years)	63.99±11.40	63.74±11.97	64.34±10.59	0.63
Sex [n (%)]				0.35
Male	250 (71.8)	149 (73.8)	101 (69.2)
Female	98 (28.2)	53 (26.2)	45 (30.8)
Previous hospitalization [n (%)]				<0.01
Yes	177 (50.9)	122 (60.4)	55 (37.7)
No	171 (49.1)	80 (39.6)	91 (62.3)
Previous antibiotic therapy [n (%)]				0.01
Yes	275 (79)	172 (85.1)	103 (70.5)
No	73 (21)	30 (14.9)	43 (29.5)
Diabetes duration (years)	15.0 (9.3,21)	15.0 (10.0,20.0)	15.0 (8.0,23.3)	0.72
Ulcer duration (weeks)	8.0 (3.0,16.0)	8.0 (3.0,16.0)	8.0 (2.0,16.0)	0.91
Ulcer size>4cm^2 [n (%)]				<0.01
Yes	186 (53.4)	128 (63.4)	58 (39.7)
No	162 (46.6)	74 (36.6)	88 (60.3)
Osteomyelitis [n (%)]				0.32
Yes	246 (70.7)	147 (72.8)	99 (67.8)
No	102 (29.3)	55 (27.2)	47 (32.2)
Retinopathy [n (%)]				0.37
Yes	179 (51.4)	108 (53.5)	71 (48.6)
No	169 (48.6)	94 (46.5)	75 (51.4)
DKD [n (%)]				0.11
Yes	182 (52.3)	113 (55.9)	69 (47.3)
No	166 (47.7)	89 (44.1)	77 (52.7)
Surgical therapy [n (%)]				<0.01
Yes	59 (17.0)	47 (23.3)	12 (8.2)
No	289 (83.0)	155 (76.7)	134 (91.8)
SBP (mmHg)	137.51±19.58	137.61±20.19	137.38±18.77	0.91
DBP (mmHg)	77.01±12.16	76.82±11.94	77.28±12.49	0.73
Fibrinogen (g/L)	5.28±1.88	5.41±1.97	5.10±1.75	0.12
D-Dimer (mg/L)	0.78 (0.47,1.34)	0.85 (0.49,1.47)	0.67 (0.44,1.09)	<0.01
HbA1c (%)	8.58±2.03	8.59±1.91	8.56±2.18	0.88
TG (mmol/L)	1.35±0.74	1.38±0.77	1.32±0.69	0.47
TC (mmol/L)	4.28±1.30	4.23±1.28	4.35±1.33	0.38
LDL-C (mmol/L)	2.98±1.00	2.96±0.98	3.02±1.03	0.62
CRP (mg/L)	24.59 (0.50,73.07)	30.61 (6.33,81.04)	18.6 (3.61,49.82)	<0.01

Table 2 Logistic Regression Analysis of MDRO Infection in DFU Patients

Characteristics	Univariable Analysis			Multivariable Analysis
	OR	95% CI	p-value	OR	95% CI	p-value
Age	1.00	0.98–1.01	0.63
Male gender	0.80	0.50–1.29	0.35
Previous hospitalization	2.52	1.63–3.91	<0.01	1.91	1.11–3.28	0.02
Previous antibiotic therapy	2.39	1.41–4.05	<0.01	1.17	0.63–2.20	0.62
Diabetes duration	1.00	0.98–1.02	0.98
Ulcer duration	1.00	0.99–1.00	0.58
Ulcer size>4cm^2	2.62	1.69–4.07	<0.01	1.68	1.03–2.76	0.04
Osteomyelitis	1.27	0.80–2.02	0.32
Retinopathy	1.21	0.79–1.86	0.37
DKD	0.71	0.46–1.08	0.11
Surgical therapy	3.39	1.72–6.65	<0.01	2.14	1.03–4.47	0.04
SBP	1.00	0.99–1.01	0.91
DBP	1.00	0.98–1.02	0.73
Fibrinogen	1.10	0.98–1.23	0.12
D-Dimer	1.20	1.01–1.42	0.04	1.09	0.92–1.28	0.32
HbA1c	1.01	0.91–1.12	0.88
TG	1.12	0.83–1.50	0.47
TC	0.93	0.79–1.09	0.38
LDL-C	0.95	0.77–1.17	0.62
CRP	1.01	1.00–1.01	<0.01	1.01	1.00–1.01	0.03

Table 3 Bacterial Distribution and Drug Resistance Rate

Bacteria	MDRO+	MDRO-	Resistant Rates
Gram positive
Staphylococcus spp.
Staphylococcus aureus	21	29	0.42
Staphylococcus epidermidis	21	2	0.91
Other Staphylococcus spp.	8	3	0.73
Streptococcus spp.	20	24	0.45
Enterococcus spp.	18	3	0.86
Gram negative
Escherichia coli	20	6	0.77
Enterobacter cloacae	8	17	0.32
Morganella morganii	5	8	0.38
Proteus spp.	14	13	0.52
Serratia marcescens	5	13	0.28
Klebsiella pneumoniae	16	31	0.34
Pseudomonas aeruginosa	12	37	0.24
Stenotrophomonas maltophilia	5
Acinetobacter baumannii	33	14	0.70
Others	34	35	0.49
Total	240	235	0.51

Table 4 Resistance Rate of Common MDRO to Commonly Used Antibiotics

Antibiotic	Staphylococcus aureus		Pseudomonas aeruginosa		Acinetobacter baumannii		Escherichia coli		Klebsiella pneumoniae		Enterococcus spp.
	Strains	Resistance Rates (%)	Strains	Resistance Rates (%)	Strains	Resistance Rates (%)	Strains	Resistance Rates (%)	Strains	Resistance Rates (%)	Strains	Resistance Rates (%)
Oxacillin or cefoxitin	6	28.6
Levofloxacin	9	42.9	5	41.7	30	90.9	18	90.0	16	100.0	7	38.9
Moxifloxacin	8	38.1					12	60.0	12	75.0
Penicillin	21	100.0									1	0.1
Vancomycin	0	0.0									0	0.0
Gentamicin	12	57.1	2	16.7			9	45.0	9	56.3	9	50.0
Tobramycin			0	0.0	23	69.7	9	45.0	8	50.0
Erythromycin	16	76.2									18	100.0
Clindamycin	16	76.2									18	100.0
Quinupristin/Dalfopristin	0	0.0									17	94.4
Amoxicillin/Clavulanic acid			12	100.0	33	100.0	6	30.0	9	56.3
Piperacillin/Tazobactam			6	50.0	28	84.8	3	15.0	8	50.0
Meropenem			4	33.3	30	90.9	1	5.0	0	0.0
Imipenem			3	25.0	29	87.9	1	5.0	1	0.1
Ertapenem			12	100.0			1	5.0	0	0.0
Cefazolin			12	100.0			20	100.0	16	100.0
Cefuroxim			12	100.0	33	100.0	15	75.0	15	93.8
Ceftriaxone			12	100.0			13	65.0	9	56.3
Ceftazidime			4	33.3	28	84.4	5	25.0	3	18.8
Cefepime			3	25.0	28	84.4	4	20.0	1	0.1
Tetracycline	3	14.3	12	100.0	26	78.8	15	75.0	14	87.5	17	94.4
Aztreonam					33	100.0	6	30.0	5	31.3
Sulfamethoxazole	13	61.9	12	100.0	12	36.4	11	55.0	11	68.8
Polymyxin					0	0.0