Occurrence and Antimicrobial Resistance of Extended-Spectrum Beta-Lactamase Producing Bacteria in Diabetic Foot Infections at Korle-Bu Teaching Hospital

Background: Common complications of diabetes mellitus include foot infections, which lead to increased healthcare cost and delayed wound healing. Diabetic foot infections (DFIs) can be caused by Gram-negative, Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria which are resistant to a wide range of antibiotics used in clinical medicine. This presents a significant challenge to the treatment of DFIs. However, identifying the bacterial species involved can be critical for effective management and targeted therapy. Objective: The study investigated the antimicrobial resistance and molecular characteristics of ESBL-producing bacteria from diabetic foot infections at Korle Bu Teaching Hospital (KBTH) using disk diffusion and Polymerase Chain Reaction (PCR). Methods: From January to September 2018, tissue samples, aspirates, or pus were collected from diabetic patients from the ulcer room at the department of surgery, KBTH. Patients’ demographics were gathered using a data collection tool. Bacterial culture, antimicrobial susceptibility testing and PCR detection of ESBL genes were performed. Results: In total, 138 Gram-negative isolates were recovered from the 50 study participants enrolled. Majority of the isolates were resistant to ciprofloxacin (55.79%, n = 77/138) but susceptible to meropenem (97.82%, n = 135/138). Among the isolates, 41 (29.71%) were phenotypically positive for ESBL production using CHROMagar ESBL. The CTX-M gene was predominantly identified in E. coli (9/19) by PCR. Conclusion: ESBL-producing Gram-negative bacteria continue to pose a major challenge in Ghana, with the CTX-M gene identified as the most prevalent among ESBL-positive isolates. Notably, a majority of the isolates remained susceptible to meropenem, suggesting its potential as an effective treatment option. Continued surveillance is crucial to monitor the emergence and dissemination of AMR pathogens in DFIs.