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However, the high prevalence of antibiotic misuse and the growing issue of antibiotic resistance in low- and middle-income countries (LMICs) exacerbate the challenges in managing these ulcers, contributing to the risk of lower-limb amputations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This systematic review reported the bacterial profile and antibiotic resistance patterns associated with DFUs in LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>A comprehensive search was conducted in PubMed, SCOPUS, and Web of Science to retrieve relevant articles, which were screened according to predefined selection criteria. Publication bias was assessed with a funnel plot and Egger\u2019s regression test. A meta-analysis was conducted in RStudio version 4.5.2, using the random-effects model. Meta-regression and sensitivity analysis were conducted to assess the sources of heterogeneity and robustness of the included studies, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The most frequently isolated bacteria were\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      (22.64%),\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      (12.37%),\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      (8.49%),\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      (5.19%),\n                      <jats:italic toggle=\"yes\">P. mirabilis<\/jats:italic>\n                      (4.61%), and Coagulase-negative\n                      <jats:italic toggle=\"yes\">Staphylococci<\/jats:italic>\n                      (4.86%). The prevalence of key antibiotic-resistant bacteria was as follows: Methicillin-resistant\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      (38.65%), Extended-spectrum beta-lactamase (ESBL)-producing\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      (50.74%), and ESBL-producing\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      (41.54%).\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      demonstrated the highest resistance to penicillin (96.87% (93.30; 99.32)), azithromycin (76.42% (64.54; 86.65)), and cefoxitin (68.19% (46.83; 86.67)).\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      showed the highest resistance to ampicillin (86.60% (77.14; 94.18)) and cotrimoxazole (69.27% (57.35; 80.18)).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pathogenic bacteria isolated from DFUs in LMICs exhibit high rates of antibiotic and multidrug resistance. Alternative therapies, such as phage therapy, should be explored as potential treatments for DFUs to mitigate the impact of antibiotic resistance and decrease the rate of diabetes-related amputations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>\n                      Open Science Framework (OSF) registry, available at\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/DPX9F\">https:\/\/doi.org\/10.17605\/OSF.IO\/DPX9F<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20499361261452940","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:29:58Z","timestamp":1789475398000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in low- and middle-income countries: a systematic review and meta\u2011analysis"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6946-4423","authenticated-orcid":false,"given":"Aaron","family":"Awere-Duodu","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6402-5681","authenticated-orcid":false,"given":"Frederick","family":"Kungu","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yacoba","family":"Atiase","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana"},{"name":"National Diabetes Management and Research Centre, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Donkor","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra KB 4236, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.2004"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781119697473.ch3"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0266907"},{"key":"e_1_3_4_5_2","unstructured":"Magliano DJ Boyko EJ. 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