Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in low- and middle-income countries: a systematic review and meta‑analysis.
Aaron Awere-Duodu, Frederick Kungu, Yacoba Atiase, Eric S Donkor
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引用次数: 0
Abstract
Background: Diabetic foot ulcers (DFUs) are often polymicrobial infections, necessitating antibiotic therapy. However, the high prevalence of antibiotic misuse and the growing issue of antibiotic resistance in low- and middle-income countries (LMICs) exacerbate the challenges in managing these ulcers, contributing to the risk of lower-limb amputations.
Objectives: This systematic review reported the bacterial profile and antibiotic resistance patterns associated with DFUs in LMICs.
Design: A systematic review and meta-analysis.
Data sources and methods: A comprehensive search was conducted in PubMed, SCOPUS, and Web of Science to retrieve relevant articles, which were screened according to predefined selection criteria. Publication bias was assessed with a funnel plot and Egger's regression test. A meta-analysis was conducted in RStudio version 4.5.2, using the random-effects model. Meta-regression and sensitivity analysis were conducted to assess the sources of heterogeneity and robustness of the included studies, respectively.
Results: The most frequently isolated bacteria were Staphylococcus aureus (22.64%), Escherichia coli (12.37%), Pseudomonas aeruginosa (8.49%), Klebsiella pneumoniae (5.19%), P. mirabilis (4.61%), and Coagulase-negative Staphylococci (4.86%). The prevalence of key antibiotic-resistant bacteria was as follows: Methicillin-resistant S. aureus (38.65%), Extended-spectrum beta-lactamase (ESBL)-producing E. coli (50.74%), and ESBL-producing K. pneumoniae (41.54%). S. aureus demonstrated the highest resistance to penicillin (96.87% (93.30; 99.32)), azithromycin (76.42% (64.54; 86.65)), and cefoxitin (68.19% (46.83; 86.67)). E. coli showed the highest resistance to ampicillin (86.60% (77.14; 94.18)) and cotrimoxazole (69.27% (57.35; 80.18)).
Conclusion: Pathogenic bacteria isolated from DFUs in LMICs exhibit high rates of antibiotic and multidrug resistance. Alternative therapies, such as phage therapy, should be explored as potential treatments for DFUs to mitigate the impact of antibiotic resistance and decrease the rate of diabetes-related amputations.
Trial registration: Open Science Framework (OSF) registry, available at https://doi.org/10.17605/OSF.IO/DPX9F.
背景：糖尿病足溃疡（DFUs）通常是多微生物感染，需要抗生素治疗。然而，在低收入和中等收入国家，抗生素滥用的高流行率和抗生素耐药性问题日益严重，加剧了管理这些溃疡的挑战，增加了下肢截肢的风险。目的：本系统综述报道了低收入国家中与DFUs相关的细菌谱和抗生素耐药模式。设计：系统回顾和荟萃分析。数据来源和方法：在PubMed、SCOPUS和Web of Science中进行综合检索，检索相关文章，并根据预先设定的选择标准进行筛选。采用漏斗图和Egger回归检验评估发表偏倚。meta分析采用RStudio 4.5.2版本，采用随机效应模型。分别进行meta回归和敏感性分析来评估纳入研究的异质性来源和稳健性。结果：最常见的分离细菌为金黄色葡萄球菌（22.64%）、大肠杆菌（12.37%）、铜绿假单胞菌（8.49%）、肺炎克雷伯菌（5.19%）、神奇假单胞菌（4.61%）和凝固酶阴性葡萄球菌（4.86%）。主要耐药菌为耐甲氧西林金黄色葡萄球菌（38.65%）、产广谱β -内酰胺酶（ESBL）的大肠杆菌（50.74%）和产ESBL的肺炎克雷伯菌（41.54%）。金黄色葡萄球菌对青霉素（96.87%(93.30;99.32)）、阿奇霉素（76.42%(64.54;86.65)）、头孢西丁（68.19%(46.83;86.67)）的耐药性最高。大肠杆菌对氨苄西林和复方新诺明的耐药性最高，分别为86.60%（77.14;94.18）和69.27%（57.35;80.18）。结论：低收入国家DFUs病原菌具有较高的耐药率和耐多药率。应该探索替代疗法，如噬菌体疗法，作为DFUs的潜在治疗方法，以减轻抗生素耐药性的影响，降低糖尿病相关截肢的发生率。试验注册：开放科学框架（OSF）注册中心，可在https://doi.org/10.17605/OSF.IO/DPX9F上获得。
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