{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:57:56Z","timestamp":1791917876187,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T00:00:00Z","timestamp":1597104000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Diabetic Foot Infection (DFI) is a challenging complication of diabetes mellitus with a high burden in the Middle East where there is a marked increase in diabetes prevalence and complications. Early detection of DFI and the infectious organisms could result in the early initiation of appropriate antibiotic therapy and improved outcomes. DFI microbiological profiles differ between countries. In our region, Western guidelines are used when initiating treatment for DFI in the absence of local guidance. The purpose of our study was to determine the microbiologic profile and antimicrobial susceptibility of the DFI admissions at a large tertiary referral centre in Beirut and review other reported series in Lebanon and our region. This is a retrospective observational study of patients with DFI admitted to the American University of Beirut Medical Centre from January 2008 to June 2017. The bacteriologic isolation and antimicrobial susceptibility tests were performed according to standard microbiological methods. Between 2008 and 2017, 319 diabetic patients with DFU were admitted to AUBMC, and deep\u2010tissue cultures were taken for 179 patients. From 179 deep tissue cultures, 314 bacterial isolates were obtained. Fifty\u2010four percent of patients had the polymicrobial infection. Aerobic gram\u2010negative rods (GNR) were more prevalent than gram\u2010positive cocci (GPC) (55%, 39%, respectively). The most common isolate was\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    (15%) followed by\n                    <jats:italic>Enterococcus<\/jats:italic>\n                    (14%) and\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    (11%).\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    isolates accounted for 9% with 50% of them being methicillin\u2010resistant (MRSA). Among Enterobacteriaceae, 37% of isolates were fluoroquinolone\u2010resistant, 25% were ESBL producers, and 2% were carbapenem\u2010resistant. Antibiotic resistance was significantly associated with prior usage of antibiotics. Anaerobes were isolated in 1% and\n                    <jats:italic>Candida<\/jats:italic>\n                    species in 5% of isolates. The sensitivity, specificity, PPV, and NPV of swab culture recovery of pathogens compared with deep tissue culture were (76%, 72%, 76%, 72%) and (94%, 81%, 91%, 86%) for gram\u2010positive and gram\u2010negative organisms, respectively. The microbiological profile of DFI in Lebanon is comparable to other countries in the MENA region with big differences compared with the West. Therefore, it is imperative to develop local guidelines for antimicrobial treatment. The high prevalence of GNR in DFI and the high fluoroquinolone resistance should be taken into consideration when choosing empiric antibiotics. Empiric treatment for MRSA or\n                    <jats:italic>Pseudomonas<\/jats:italic>\n                    does not appear necessary except for patients with specific risk factors.\n                  <\/jats:p>","DOI":"10.1111\/iwj.13465","type":"journal-article","created":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T04:32:20Z","timestamp":1597120340000},"page":"1764-1773","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Microbiological profile and antimicrobial resistance among diabetic foot infections in Lebanon"],"prefix":"10.1111","volume":"17","author":[{"given":"Lamia","family":"Jouhar","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rola F.","family":"Jaafar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakan","family":"Nasreddine","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Itani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fady","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisrine","family":"Rizk","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal J.","family":"Hoballah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,11]]},"reference":[{"issue":"1","key":"e_1_2_7_2_1","first-page":"1","article-title":"Diabetes mellitus and chronic kidney disease in the eastern Mediterranean region: findings from the global burden of disease 2015 study","volume":"63","author":"Mokdad AH","year":"2017","journal-title":"Int J Public Health"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2014.06.005"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.07.048"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-014-0630-5"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/14746514080080020501"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2015.04.007"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.14310\/horm.2002.1245"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-1598"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2011.10.001"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis346"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-014-2047-5"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2253"},{"key":"e_1_2_7_14_1","first-page":"435","article-title":"Emergence of multi drug resistant bacteria in diabetic patients with lower limb wounds","volume":"140","author":"Xavier W","year":"2014","journal-title":"Indian J Med Res"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2011.07.004"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12199"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiac.2015.12.007"},{"issue":"1","key":"e_1_2_7_18_1","first-page":"Doc02","article-title":"Bacterial etiology and antibiotic susceptibility pattern of diabetic foot infections in Tabriz, Iran","volume":"10","author":"Akhi MT","year":"2015","journal-title":"GMS Hyg Infect Control"},{"key":"e_1_2_7_19_1","first-page":"89","article-title":"Diabetic foot infection in Morocco: microbiological profile","volume":"28","author":"Belefquih B","year":"2016","journal-title":"Wounds"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1086\/511036"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12642"},{"key":"e_1_2_7_22_1","first-page":"125","article-title":"A reflection on bacterial resistance to antimicrobial agents at a major tertiary care center in Lebanon over a decade","volume":"60","author":"Araj GF","year":"2012","journal-title":"J Med Liban"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00551-07"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.10063"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.4172\/2332-0877.1000381"},{"key":"e_1_2_7_26_1","first-page":"441","article-title":"The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains","volume":"7","author":"Shanmugam P","year":"2013","journal-title":"J Clin Diagn Res"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1086\/593185"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-5491.2003.00860.x"},{"key":"e_1_2_7_29_1","first-page":"437","article-title":"Diabetic foot infections: a study of microorganisms associated with the different Wagner grades","volume":"41","author":"Pathare N","year":"1998","journal-title":"Indian J Pathol Microbiol"},{"key":"e_1_2_7_30_1","first-page":"1013","article-title":"Prevalence of pathogens in diabetic foot infection in south Indian type 2 diabetic patients","volume":"50","author":"Viswanathan V","year":"2002","journal-title":"J Assoc Physicians India"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2015.12.001"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anaerobe.2015.03.009"},{"key":"e_1_2_7_33_1","first-page":"29","article-title":"Candida infections in diabetic foot ulcers","volume":"34","author":"Mlinari\u00e6\u2010Missoni E","year":"2005","journal-title":"Diabetol Croat"},{"key":"e_1_2_7_34_1","first-page":"344","article-title":"Bacteriology of diabetic foot infections","volume":"21","author":"El\u2010Tahawy AT","year":"2000","journal-title":"Saudi Med J"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2006.08.013"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2005.03.009"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.688"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fiwj.13465","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.13465","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.13465","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.13465","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T09:36:22Z","timestamp":1748338582000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.13465"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,11]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1111\/iwj.13465"],"URL":"https:\/\/doi.org\/10.1111\/iwj.13465","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,11]]},"assertion":[{"value":"2020-05-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}