Bacterial Epidemiology and Antimicrobial Resistance of Diabetic Foot Ulcers in Iran: A Systematic Review and Meta-Analysis

Introduction: Foot ulcer, with a prevalence rate of 15-25% is one of the most feared complications in people with diabetes. Since infectious foot ulcers represent one of the major causes of dramatically increased lower-limb amputation, it calls an appropriate action for early detection and sufficient treatment of diabetic foot infection (DFI). The aim of the present study is to investigate the bacterial epidemiology and antibiotic resistance of DFIs in Iran.Methods: We conducted a thorough search in PubMed, Embase, Web of Science, Scopus, Google Scholar, and SID. Two independent reviewers conducted all the steps, including title and abstracts assessment, full-text screening, and data extraction. The following data were extracted: city, language, the date of sample collection, sampling method, the number of patients, mean age, and the related outcomes. The random effects model was applied for the pooled estimation of outcomes with 95% confidence intervals (CIs). Statistical analysis was performed in STATA 13.Results: Of 54 retrieved articles, 15 evaluated the bacterial profile and entered the study. 1987 bacterial isolates were obtained from 1404 patients. The most predominant isolates recovered from DFIs was S. aureus with a frequency of 24% (95% CI: 20, 28%) from which 55% (95% CI: 38, 72%) were methicillin resistant strains (MRSA). Among gram negative strains, the pooled estimate of E. coli isolates was 13% (95% CI: 14, 21%). The highest pooled estimate of resistance against erythromycin and ceftazidime was found in S. aureus 65% (95% CI: 54, 76%) and E.coli isolates 75% (95% CI: 56, 90%), respectively.Conclusion: Since the most prevalent isolated bacteria from DFIs were the most resistant isolates, it is suggested that future studies focus on phenotypic and molecular aspects of antibiotic resistance in these reported isolates.