Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon

  • Michele Obeid Lebanese American University, Byblos, Lebanon
  • Eric Moughames Lebanese American University, Byblos, Lebanon
  • Petra Aboulhosn Lebanese American University, Byblos, Lebanon
  • Rashad Madi Lebanese American University, Byblos, Lebanon
  • Maya Farah Lebanese American University Medical Center, Beirut, Lebanon
  • Jinia Feghali Lebanese American University Medical Center, Beirut, Lebanon
  • Jacques Mokhbat Lebanese American University Medical Center, Beirut, Lebanon
  • Anna Farra Lebanese American University Medical Center, Beirut, Lebanon
  • Rima Moughnieh Makassed Hospital, Beirut, Lebanon
  • Ziad Daoud University of Balamand and Centre Hospitalier du nord Hospital, Beirut, Lebanon
  • Rita Feghaleh Rafik Hariri University Hospital, Beirut, Lebanon
  • Edmond Abboud Middle East Institute of Health, Mount Lebanon, Lebanon
  • Emma Abboud Mount Lebanon Hospital, Beirut, Lebanon
  • Rola Husni-Samaha Lebanese American University Medical Center, Beirut, Lebanon
Keywords: Diabetes, Foot, Infection, Lebanon, Antibiotics

Abstract

Introduction: Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Global studies on the epidemiology of diabetic foot ulcer (DFU) infections and guidelines detailing the most common pathogens and their respective antimicrobial susceptibilities are available. While Gram-positive cocci, mainly Staphylococcus species (spp.), were the most common organisms cultured from DFU in the United States, the Gram-negative Pseudomonas spp. were found to be the most common in some Middle Eastern countries. In Lebanon, however, such studies remain scarce. This study, conducted in Lebanon, investigated the most common organisms in DFU infections and their antimicrobial profiles.

Methodology: We collected data from all documented diabetic foot infections between January 2015 and March 2016, 128 participants total, from 5 different hospitals in various regions of Lebanon.

Results: Among all isolates, Enterobacteriaceae (42%), Pseudomonas spp. (18.6%) and methicillin-sensitive Staphylococcus aureus (MSSA) (15.3%) were the most frequent bacteria. In addition, 72% of Pseudomonas spp. were susceptible to ciprofloxacin and 63.6% of Enterobacteriaceae were susceptible to either amoxicillin/clavulanate or ciprofloxacin, 91% were susceptible to piperacillin/tazobactam. Methicillin-resistant Staphylococcus aureus (MRSA) was only found in hospitalized patients or those who received prior antibiotics. Polymicrobial infections were documented in only 38% of patients.

Conclusion: In Lebanon, the most appropriate empirical oral outpatient treatment would be a combination of amoxicillin/clavulanate and ciprofloxacin. As for admitted patients who have failed the oral regimen, piperacillin/tazobactam would then be the treatment of choice.

Published
2018-05-31
How to Cite
1.
Obeid M, Moughames E, Aboulhosn P, Madi R, Farah M, Feghali J, Mokhbat J, Farra A, Moughnieh R, Daoud Z, Feghaleh R, Abboud E, Abboud E, Husni-Samaha R (2018) Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon. J Infect Dev Ctries 12:347-351. doi: https://doi.org/10.3855/jidc.10063
Section
Original Articles