ISSN: 0973-7510

E-ISSN: 2581-690X

Research Article | Open Access

Ahmad ALbeloushi1,2 , Ayman Elbehiry3,4, Eman Marzouk5, Rasha Zahran3 and Husam Edrees4

1Al Bukayriyah General Hospital, Qassim, Kingdom of Saudi Arabia.
2Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia.
3Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, University of Sadat City, Sadat, Egypt.
4Department of Public Health, College of Public Health and Health Informatics, Qassim University, Buraidah, Saudi Arabia.
5Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Saudi Arabia.
J Pure Appl Microbiol, 2019, 13 (1): 481-489 | Article Number: 5346
Received: 06/11/2018| Accepted: 09/12/2018 |Published: 25/01/2019

Diabetic foot infections (DFIs) are a progressively serious health problem worldwide. Enterococcus faecalis (E. faecalis) is one of the most frequent bacteria in DFIs. The antibiotic resistance patterns of this bacterium remain a significant tool for monitoring infection. Therefore, our study aimed to determine the susceptibility of E. faecalis recovered from the wounds of hospitalized diabetic foot patients to various antimicrobial drugs. Fifty-two E. faecalis strains were recovered from 630 diabetic foot patients. All isolates were identified biochemically by a Vitek® 2 system and via a mass spectrometer (MALDI Biotyper). Antimicrobial sensitivity testing used Vitek 2 cards and Kirby-Bauer as the reference method. The findings indicated that the susceptibility of E. faecalis was 100% for ampicillin, ampicillin-sulbactam, benzylpenicillin, norfloxacin, and ofloxacin; 92% for nitrofurantoin, teicoplanin, and vancomycin; 87% for imipenem; 81% for kanamycin (high concentration) and tetracycline; 73% for levofloxacin; and 52% for streptomycin (high concentrations). The resistance was 100% for clindamycin and quinupristin-dalfopristin, 96% for cefuroxime, 90% for ciprofloxacin and erythromycin, 86% for trimethoprim-sulfamethoxazole, 54% for gentamicin (high concentration), and 48% for streptomycin (high concentration). All E. faecalis strains were resistant against numerous antibiotics with a multiple antibiotic resistance (MAR) index of 0.20–0.60. The mean value of MAR indices for all tested E. faecalis species was 0. 373. The high levels of antimicrobial resistance patterns to E. faecalis seen here are important because they restrict treatment possibilities and adversely affect the health of diabetic foot patients. Consequently, our findings should be carefully considered in public health and awareness programs.


Diabetic foot infections; Enterococcus faecalis; Antibiotic resistance.

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