Bacterial Diversity, Antibiotic Resistance, and the Risk of Lower Limb Amputation in Younger and Older Individuals With Diabetic Foot Infection

Int J Low Extrem Wounds. 2023 Mar;22(1):63-71. doi: 10.1177/1534734621992290. Epub 2021 Mar 20.


Introduction: A diabetic foot infection (DFI) contributes to high mortality and morbidity in diabetics due to its often rapid progressive and intricately treatable infection. DFIs are usually a polymicrobial infection and characterizing the entire bacterial load is still challenging. Prompt and effective treatment of DFI is nevertheless mandatory to safe limbs and lives. It is therefore crucial to know the local pathogen spectrum and its antibiotic susceptibility.

Methods and material: For a 12-month period, we investigated 353 individuals with infected diabetic foot ulcer, their bacterial diversity, and antimicrobial susceptibility at fist-time visit in a Diabetic Foot Care Center in southern Germany.

Results: Cultures yielded 888 species, most of them gram-positive cocci (primary Staphylococcus aureus). The gram-negative sector was mainly formed by Pseudomonas aeruginosa and Enterobacteriacae. Because the prevalence of multiresistant species was surprisingly low (0.9% of isolated strains), we suggest penicillins with β-lactamase inhibitor in case of gram-positive-dominated infection or piperacillin/tazobactam or rather carbapenems with equal efficacy when gram-negative species are involved.

Keywords: antibiotic resistance; diabetic foot infection; diabetic foot ulcer; lower limb amputation; microbiology; microbiota.

MeSH terms

  • Amputation, Surgical
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Diabetes Mellitus*
  • Diabetic Foot* / drug therapy
  • Diabetic Foot* / epidemiology
  • Diabetic Foot* / surgery
  • Drug Resistance, Microbial
  • Humans
  • Lower Extremity
  • Microbial Sensitivity Tests


  • Anti-Bacterial Agents