MRSA in diabetic foot ulcers

NewsBot · Jul 20, 2025

Innovative Non-antibiotic Strategies for Combating Methicillin-Resistant Staphylococcus aureus in Diabetic Foot Infections
Mohsen Nazari, Ali Bahrami & Faezeh Jahanian
Current Microbiology

Diabetic foot infections (DFIs) are a common and serious complication of diabetes mellitus (DM), often caused by methicillin-resistant Staphylococcus aureus (MRSA), which is challenging to treat due to its antibiotic resistance. The ability of MRSA to form biofilms and its resistance to commonly used antibiotics, such as beta-lactams, clindamycin, and trimethoprim–sulfamethoxazole, complicate treatment strategies. The pathophysiology of MRSA in DFIs involves bacterial virulence factors, including adhesion proteins, exotoxins, and immune evasion mechanisms, which allow MRSA to persist in infected wounds despite compromised immune responses in diabetic patients. Diabetes-related conditions such as neuropathy, poor glycemic control, and ischemia further exacerbate the susceptibility to and severity of these infections. With conventional antibiotic therapies facing increasing resistance, alternative non-antibiotic treatment options, including antimicrobial peptides, bacteriophage therapy, and nanotechnology-based interventions, are emerging as promising strategies. This review evaluates these alternative approaches, examining their potential to improve patient outcomes and combat antibiotic-resistant MRSA in DFIs.
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NewsBot · Sep 4, 2025

Epidemiology, Risk Factors, and External Validation of Predictive Models for Multidrug-Resistant Bacterial Infections in Diabetic Foot Ulcers
Xiangheng Dai et al
Infect Drug Resist. 2025 Aug 28:18:4471-4483.

Objective: This study aimed to investigate the epidemiological characteristics and risk factors of multidrug-resistant bacterial (MDRB) infections in diabetic foot ulcer (DFU) and externally validate existing predictive models for MDRB, Pseudomonas aeruginosa (PSA), and methicillin-resistant Staphylococcus aureus (MRSA) infections.

Methods: A retrospective analysis of 344 patients diagnosed with DFU identified key clinical and laboratory variables associated with outcomes. Univariate and multivariate logistic regression identified risk factors, while receiver operating characteristic (ROC) curves and calibration analyses assessed model validity.

Results: MDRB infections were linked to longer hospitalization, lower hemoglobin, higher hs-CRP, and higher osteoporosis prevalence. Significant risk factors included prolonged hospitalization, osteomyelitis, osteoporosis, prior antimicrobial use, and respiratory rate. PSA infections correlated with myocardial infarction and peripheral vascular disease, while no significant risk factors were identified for MRSA. External validation showed poor discriminatory ability (AUC: 0.501 for MDRB, 0.505 for PSA, 0.569 for MRSA) and calibration performance, indicating poor generalizability of existing models in our cohort.

Conclusion: MDRB infections in DFUs are associated with specific clinical characteristics and risk factors. However, existing predictive models demonstrated limited utility in our dataset, emphasizing the need for model refinement and inclusion of additional risk factors. Future research should focus on improving predictive models and developing targeted antimicrobial strategies to enhance clinical outcomes in diabetic foot infections.
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NewsBot · Sep 19, 2025

Complete genome sequence of a methicillin-resistant Staphylococcus aureus strain 63-2498, isolated from a diabetic foot infection
Felise G Adams et al
Microbiol Resour Announc. 2025 Sep 19:e0057225.

Here, we report the complete genome sequence of methicillin-resistant Staphylococcus aureus 63-2498, isolated from an outpatient with a diabetic foot infection. The 2.82 Mbp genome with 2,663 predicted coding sequences was assembled using a hybrid approach combining PacBio HiFi long-read and Illumina short-read sequencing, resulting in one chromosome and three plasmids.
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NewsBot · Sep 28, 2025

Risk factors and clinical outcomes of multidrug-resistant and biofilm-producing infections in diabetic foot ulcers: a two-year cohort study
Mohd Shahid Khan et al
World J Microbiol Biotechnol. 2025 Sep 26;41(10):346.

This two-year prospective study analysed 124 diabetic foot ulcer (DFU) patients admitted to the Department of Surgery to identify clinical and microbiological predictors of multidrug-resistant (MDR) and biofilm-producing infections. The cohort was predominantly male (82.3%), with a mean age of 54.3 ± 11.6 years and a high prevalence of tobacco use (63%) and illiteracy (48.4%). Most patients (91.1%) exhibited poor glycaemic control (mean HbA1c 8.3 ± 1.3%), with neuropathy (79%) and retinopathy (72.6%) as the most common comorbidities. Ulcer severity ranged from Wagner grade 1 to 4, with 60.5% persisting for over one month. Microbiological analysis revealed 59.7% monomicrobial and 33.9% polymicrobial infections, with biofilm formation detected in 60.5% of isolates. Multivariable logistic regression showed significant associations between MDR isolates and tobacco use (OR: 4.06, P = 0.049), polymicrobial infections (OR: 20.75, P < 0.001), and biofilm formation (OR: 3.84, P = 0.033). Predictors of biofilm production included male sex (OR: 7.89, P = 0.023), neuropathy (OR: 4.44, P = 0.040), prolonged ulcer duration (OR: 0.09, P = 0.001), non-necrotic ulcers (OR: 0.16, P = 0.014), and MDR organisms (OR: 3.64, P = 0.034). Clinical outcomes included a 30.6% amputation rate (22.6% minor, 8.1% major) and an 8.9% mortality rate, with a mean hospital stay of 22.9 ± 9.2 days. These findings highlight the multifactorial nature of MDR development and biofilm-associated infections, emphasizing the critical roles of biofilm formation, polymicrobial infections, and tobacco use in DFU management. Early intervention and tailored therapies are essential to mitigate these risks and improve patient outcomes.
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NewsBot · Dec 13, 2025

Characterization of Methicillin-Resistant Staphylococcus Aureus Resistance and Hematological Profiles in Diabetic Foot Infections
Tian Chen, Tengteng Li, Jianhua Yu, Wenqing He, Qi Mu, Chao Qian
Clin Lab. 2025 Dec 1;71(12).

Background: This study aimed to analyze the infection rate, drug-resistant phenotypes, and hematological index profiles of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in patients with diabetic foot ulcers (DFUs). This study sought to provide insights for the early identification of MRSA infections and the optimization of antimicrobial strategies in patients with DFU.

Methods: The clinical data of patients with DFUs hospitalized from January 2022 through June 2023 were retrospectively reviewed. The detection rate and drug resistance profile of S. aureus were analyzed using bacterial culture and drug sensitivity testing. Additionally, the differences in hematological indices between the MRSA and MSSA infection groups were compared.

Results: A total of 1,385 patients with DFU underwent bacterial culture of secretions, with a positive rate of 50.25% (696/1,385) for pathogenic bacteria. The detection rate of S. aureus was 14.58% (202/1,385), out of which MRSA accounted for 38.12% (77/202). The MRSA group exhibited resistance to macrolides (clarithromycin: 64.94% vs. 36.00%; erythromycin: 70.13% vs. 39.20%; azithromycin: 66.23% vs. 38.40%), lincosamides (clindamycin: 68.83% vs. 31.20%), and quinolones (levofloxacin: 28.57% vs. 15.20%; moxifloxacin: 15.58% vs. 5.60%). These differences were statistically significant (all p < 0.05). Furthermore, hematological analysis revealed significant disparities between the two groups in erythrocyte mean corpuscular hemoglobin concentration (MCHC), D-dimer, albumin (ALB), alkaline phosphatase (ALP), and electrolytes (Na+, Cl-, Ca2+) (all p < 0.05).

Conclusions: This study examined the characteristics of DFU-associated MRSA infection, particularly its multidrug resistance features. MRSA infection demonstrated 100% sensitivity to vancomycin and linezolid. The findings suggest that combined detection of MCHC, D-dimer, ALB, ALP, Na+, Cl-, and Ca2+ may serve as a valuable reference for the early identification of DFU-associated MRSA infection in clinical settings. Clinicians should be mindful of MRSA infection risks in patients with DFU and develop individualized anti-infection regimens based on drug sensitivity profiles to improve prognosis.
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NewsBot · Dec 29, 2025

Development and validation of a risk prediction model for multidrug-resistant organisms infection in diabetic foot ulcer patients
Jinghang Zhang et al
Front Endocrinol (Lausanne). 2025 Dec 11:16:1609128.

Objective: To develop and validate a nomogram for predicting the risk of multidrug-resistant organisms (MDROs) infection in diabetic foot ulcer (DFU) patients.

Methods: 701 DFU patients were divided into training (491 cases) and validation (210 cases) sets (7:3 ratio). Multivariate logistic regression analysis was performed to identify the independent risk factors for MDRO infection in DFU patients. Two nomogram prediction models were developed based on the independent risk factors. The predictive efficacy of the prediction models was evaluated using the receiver operating characteristic (ROC) curve and calibration curve analysis. The decision curve analysis (DCA) was performed to evaluate the prediction model's performance during clinical application.

Results: Multivariate logistic regression analysis identified previous antibiotic therapy, surgical therapy, ulcer size>4cm2, and CRP as independent risk factors. Two models were developed and validated based on the analysis. Model 1 included previous antibiotic therapy, surgical therapy, and ulcer size>4cm2. Model 2 added a further laboratory indicator to Model 1, such as CRP. In the training set, the AUC of the nomogram for Model 1and Model 2 was 0.763(95% CI 0.711-0.815) and 0.789 (95% CI 0.740-0.838), respectively, and 0.837 (95% CI 0.744-0.900) and 0.845 (95% CI 0.785-0.905) in the validation set. The Youden indexes for Models 1and 2 were 0.416 and 0.470 in the training set and 0.558 and 0.588 in the validation set, respectively. Notably, Model 2 showed higher sensitivity and specificity. The calibration plot and Hosmer-Lemeshow test for Model 1 and Model 2 indicated that the predicted probability had good consistency with the actual probability in both the training set (P = 0.689 for Model 1 and P = 0.139 for Model 2) and validation set (P = 0.607 for Model 1and P = 0.635 for Model 2). The DCA curve indicated that the models had good clinical utility. All models performed well for both discrimination and calibration.

Conclusion: This study developed two nomogram models for predicting MDRO infection risk in DFU patients. Model 2, with superior predictive performance, enables early identification of high-risk patients. These models facilitate targeted interventions, potentially reducing MDRO complications and healthcare burdens.
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NewsBot · Apr 17, 2026

Risk Factors Associated With Methicillin-Resistant Staphylococcus aureus Infections in Patients With Diabetic Foot Ulcers in Tehran
Haniyeh Khalili et al
Can J Infect Dis Med Microbiol. 2026 Apr 12:2026:5695498.

Background: Foot ulcer is a common complication of diabetes mellitus, which is associated with high morbidity and mortality rates among diabetic patients. This study aimed to identify risk factors associated with methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA) infections and their epidemiology among patients with diabetic foot ulcers (DFUs).

Methods: A total of 211 wound samples were collected from patients with DFUs in five educational hospitals in Tehran during 2017-2019. The presence of certain virulence markers (α-haemolysin (hlα), phenol-soluble modulins (psmα), accessory gene regulator (agr), exfoliative toxin A, B (eta etb) and toxic shock syndrome toxin-1 (tsst-1)) was investigated by polymerase chain reaction (PCR), and a multiplex PCR assay was used to screen for staphylococcal cassette chromosome (SCCmec) types. Antibiotic susceptibility testing (AST) was performed by the Kirby-Bauer disk diffusion method.

Results: A significant proportion of patients with DFUs had Type 2 diabetes. Grading of DFUs revealed that Grade 4 was the most common grade among patients. The majority of patients were infected with S. aureus (45.3%) and Escherichia coli (E. coli) (29.4%). A total of 59 S. aureus isolates were identified, of which 37 (62.7%) were MRSA, and 22 (37.2%) were methicillin-susceptible S. aureus (MSSA). MRSA isolates were mostly positive for the hlα (57.6%) and psmα (50.8%) genes. The tsst-1 gene was detected in 8.5% of MRSA strains, while the eta (3.4%) and etb (5.1%) genes had the lowest prevalence in MRSA isolates. According to the results, SCCmec Type III (48.6%) was the most common subtype among MRSA isolates, followed by SCCmec II (16.2%). The antimicrobial susceptibility testing results revealed that linezolid (66.1%), gentamycin (66.1%) and mupirocin (62.7%) were the most effective antibiotics against MRSA isolates, respectively. In contrast, MRSA strains showed the highest resistance to cefoxitin and penicillin. Finally, the risk factors in patients with DFU in this study were diastolic hypertension, cardiovascular diseases, renal failure, neuropathy disease and hospitalization history.

Conclusions: The findings underscore the critical importance of a comprehensive understanding of patients' medical records and underlying conditions. In addition, accurate assessment of microbial prevalence and antibiotic susceptibility is essential for the effective management of DFUs.
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NewsBot · Jul 1, 2026

Multidrug resistance and inappropriate empiric therapy as predictors of hospital stay in diabetic foot infections
Lana Zuriegat et al
PLoS One. 2026 Jun 8;21(6):e0350837.

Objectives: This study explored the causative pathogens, resistance patterns, and treatment appropriateness for diabetic foot infections (DFI) at a tertiary care center in Jordan.

Methods: A retrospective review was conducted on 234 patients diagnosed with DFIs at a tertiary care center in Jordan. Data collected included patient demographics, diabetes history, infection severity, culture results, and antibiotic treatment details. Bacterial isolates were classified as multidrug-resistant (MDR) or non-MDR based on standard definitions. Therapy was considered appropriate if at least one antibiotic given within the first 48 hours of admission covered all identified pathogens and was administered with the correct dosage, formulation, and route. Statistical analyses examined the relationship between resistance patterns, treatment adequacy, and hospital stay duration.

Results: The most frequently isolated bacterium was Staphylococcus aureus, identified in 117 cases (50.0%), including MRSA (n = 46, 19.6%) and MSSA (n = 71, 30.3%). This was followed by Escherichia coli in 33 cases (14.1%) and Pseudomonas aeruginosa in 32 cases (13.7%). MDR organisms accounted for 152 infections (65%). Empiric therapy was deemed appropriate in 111 patients (47.4%), inappropriate in 74 (31.6%), and not assessable due to missing data in 49 (20.9%). Following culture and susceptibility results, antibiotics in 87 cases (37.2%) remained unchanged. In multivariate analysis, only infection severity was significantly associated with prolonged hospitalization (β = -0.161, P = 0.034).

Conclusion: MDR organisms were common in DFIs but not significantly associated with prolonged hospitalization. Infection severity was the key predictor of length of stay. These findings highlight the importance of early infection assessment, appropriate empirical therapy based on local resistance patterns, and robust antibiotic stewardship.
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NewsBot · Jul 5, 2026

Clinical, phenotypic and genotypic antimicrobial resistance profile of diabetic foot ulcer-associated bacterial isolates
Awal Ayaz Khan et al
Sci Rep. 2026 Jul 4.

Diabetic foot ulcers (DFUs) are a leading cause of morbidity in patients with diabetes mellitus and a major driver of multidrug-resistant (MDR) bacterial infection in low- and middle-income countries. This cross-sectional study characterised the clinical profile, microbial spectrum and phenotypic/genotypic resistance patterns of DFU-associated bacteria in 224 patients recruited from six tertiary hospitals in Islamabad, Pakistan, between November 2023 and December 2024. Wound swabs, pus aspirates and deep tissue biopsies were collected aseptically and processed on selective and non-selective media; isolates were identified by colony morphology, Gram staining and standard biochemical tests with ATCC reference strains as controls. Antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion against 15 antibiotics following CLSI M100 (2023) guidelines. Plasmid DNA was extracted from all phenotypically β-lactam- or aminoglycoside-resistant isolates and screened by PCR for β-lactamase genes (blaTEM, blaCTX-M, blaSHV) and aminoglycoside-modifying enzyme genes (aac(6')-Ib, ant(4')-Ia, aph(3')-IIIa). Bacterial growth was obtained from 208/224 (92.9%) samples; six species were recovered: Staphylococcus aureus 41.3% (86/208), Escherichia coli 20.2% (42/208), Staphylococcus epidermidis 12.5% (26/208), Proteus vulgaris 10.6% (22/208), Proteus mirabilis 7.7% (16/208) and Pseudomonas aeruginosa 7.7% (16/208). Resistance to gentamicin was uniformly high (S. aureus 91.9%; E. coli 90.5%; S. epidermidis 84.6%); cefoperazone-sulbactam was the most active β-lactam against S. aureus (43.0% resistance) and colistin retained activity against E. coli (35.7% resistance). PCR detected aac(6')-Ib in 114/208 (54.8%), blaTEM in 91/208 (43.8%), blaCTX-M in 83/208 (39.9%), blaSHV in 82/208 (39.4%), ant(4')-Ia in 78/208 (37.5%) and aph(3')-IIIa in 76/208 (36.5%) of isolates. Fisher's exact test confirmed strong, statistically significant associations between aminoglycoside-modifying enzyme genes and gentamicin resistance, and between β-lactamase genes and cefotaxime resistance (specificity and positive predictive value = 100% at the reference antibiotic). DFUs in this Pakistani cohort were predominantly polymicrobial with a high burden of plasmid-mediated β-lactam and aminoglycoside resistance determinants. Strengthened antimicrobial stewardship, expanded molecular surveillance and patient-centred foot-care education are critical to reduce amputation risk and the public-health burden of DFU.
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MRSA in diabetic foot ulcers

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MRSA AND DIABETIC ULCERS

foot pain following MRSA infection

Nail surgery and MRSA screening

Medihoney, MRSA and venous ulcers

Maggots used to cure MRSA

Stop wearing neck ties to help combat MRSA

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MRSA in diabetic foot ulcers

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MRSA AND DIABETIC ULCERS

foot pain following MRSA infection

Nail surgery and MRSA screening

Medihoney, MRSA and venous ulcers

Maggots used to cure MRSA

Stop wearing neck ties to help combat MRSA

MRSA

Share This Page

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