Microbiological profile of diabetic foot infections in China and worldwide: a 20-year systematic review

Front Endocrinol (Lausanne). 2024 Jun 28:15:1368046. doi: 10.3389/fendo.2024.1368046. eCollection 2024.

Abstract

Introduction: Pathogens causing diabetic foot infections (DFIs) vary by region globally; however, knowledge of the causative organism is essential for effective empirical treatment. We aimed to determine the incidence and antibiotic susceptibility of DFI pathogens worldwide, focusing on Asia and China.

Methods: Through a comprehensive literature search, we identified published studies on organisms isolated from DFI wounds from January 2000 to December 2020.

Results: Based on our inclusion criteria, we analyzed 245 studies that cumulatively reported 38,744 patients and 41,427 isolated microorganisms. DFI pathogens varied according to time and region. Over time, the incidence of Gram-positive and Gram-negative aerobic bacteria have decreased and increased, respectively. America and Asia have the highest (62.74%) and lowest (44.82%) incidence of Gram-negative bacteria, respectively. Africa has the highest incidence (26.90%) of methicillin-resistant Staphylococcus aureus. Asia has the highest incidence (49.36%) of Gram-negative aerobic bacteria with species infection rates as follows: Escherichia coli, 10.77%; Enterobacter spp., 3.95%; and Pseudomonas aeruginosa, 11.08%, with higher local rates in China and Southeast Asia. Linezolid, vancomycin, and teicoplanin were the most active agents against Gram-positive aerobes, while imipenem and cefoperazone-sulbactam were the most active agents against Gram-negative aerobes.

Discussion: This systematic review showed that over 20 years, the pathogens causing DFIs varied considerably over time and region. This data may inform local clinical guidelines on empirical antibiotic therapy for DFI in China and globally. Regular large-scale epidemiological studies are necessary to identify trends in DFI pathogenic bacteria.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023447645.

Keywords: antibiotics; diabetic foot; drug sensitivity test; infection - immunology; pathogenic bacteria.

Publication types

  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents* / therapeutic use
  • Bacterial Infections / drug therapy
  • Bacterial Infections / epidemiology
  • Bacterial Infections / microbiology
  • China / epidemiology
  • Diabetic Foot* / epidemiology
  • Diabetic Foot* / microbiology
  • Humans
  • Incidence

Substances

  • Anti-Bacterial Agents

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by grants from the National Natural Science Foundation of China (grant numbers: 81972083), Science and Technology Planning Project of Guangzhou (grant numbers 202201020303, 202102080052, 202102010057, 201804010226), and Science Foundation of Guangdong Second Provincial General Hospital (grant numbers 3D-A2020004, 3D-A2020002, YQ2019–009, C2020019).