Bacterial isolation and antibiotic susceptibility from diabetic foot ulcers in Kenya using microbiological tests and comparison with RT-PCR in detection of S. aureus and MRSA

• Published in: BMC research notes Vol. 12; no. 1; p. 244
• Main Authors: Mutonga, Daniel M, Mureithi, Marianne W, Ngugi, Nancy N, Otieno, Fredrick C F
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.04.2019; BioMed Central; BMC
• Subjects: Amoxicillin; Ampicillin; Amputation; Antibacterial agents; Antibiotics; Antimicrobial agents; Bacteria; Bacterial genetics; Cefepime; Ceftazidime; Cefuroxime; Clindamycin; Criminal investigations; Deoxyribonucleic acid; Diabetes; Diabetes mellitus; Diabetic foot; Diabetic foot ulcers; Diagnosis; DNA; Drug resistance; Erythromycin; Escherichia coli; Feet; Foot diseases; Fungal infections; Genetic research; Hospital admission and discharge; Hospitals; Kenya; Laboratories; Leg ulcers; Medical research; Methicillin; Methicillin-resistant S. aureus; Methods; Microbial drug resistance; Microbial sensitivity tests; Microbiology; Multi-drug resistant organisms; Multidrug resistance; Oxacillin; Penicillin G; Penicillins; Piperacillin; Pneumonia; Polymerase chain reaction; Pseudomonas aeruginosa; Quality control; Research Note; Staphylococcus aureus; Staphylococcus aureus infections; Staphylococcus infections; Studies; Tazobactam; Teaching hospitals; Testing; Tetracyclines; Thermal cycling; Trimethoprim; Ulcers; Kenya; Germany; Africa; Polymerase chain reaction; Methicillin-resistant S. aureus; Multi-drug resistant organisms; Diabetic foot ulcers; Kenya
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/s13104-019-4278-0

Diabetic foot ulcers (DFUs) often lead to hospital admissions, amputations and deaths; however, there is no up-to-date information on microbial isolates from DFUs and no mention of utilization of molecular techniques in Sub-Saharan Africa. We conducted a cross-sectional study among 83 adult patients at a tertiary hospital in Kenya over 12 months. The study aimed to isolate, identify bacteria, their antibiotic susceptibility patterns in active DFUs, and to compare standard microbiological methods versus a real-time PCR commercial kit in the detection of Staphylococcus aureus DNA and methicillin-resistant S. aureus (MRSA) DNA. Eighty swabs (94%) were culture-positive; 29% were Gram-positive and 65% were Gram-negative. The main organisms isolated were S. aureus (16%), Escherichia coli (15%), Proteus mirabilis (11%), Klebsiella pneumoniae (7%) and Pseudomonas aeruginosa (7%). The bacterial isolates showed resistance to commonly used antibiotics such as ampicillin, amoxicillin, cefepime, ceftazidime, cefuroxime, clindamycin, erythromycin, piperacillin-tazobactam, tetracycline and trimethoprim-sulphamethoxazole (TMPSMX). Thirty-one percent of the S. aureus isolated and 40% of the Gram-negatives were multi-drug resistant organisms (MDROs). There was a high prevalence of nosocomial bacteria. MRSA were not identified using culture methods but were identified using PCR. PCR was more sensitive but less specific than culture-based methods to identify S. aureus.