{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:57:58Z","timestamp":1791917878834,"version":"4.3.4"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T00:00:00Z","timestamp":1609286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Diabetic foot ulcers (DFU) and infection (DFI) are a major diabetes-related problem around the world due to the high prevalence of diabetes in the population. The aim of our study was to determine the microbiological profile of infected ulcers in patients attending Dasman Diabetes Institute (DDI) clinics in Kuwait and to analyze the distribution of microbial isolates according to wound grade, sex, age and diabetes control.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We collected and analyzed clinical data and samples from 513 diabetic patients with foot ulcers referred to our podiatry clinic at DDI from Jan 2011 till Dec 2017.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We show a higher prevalence of DFU in men than in women, and a greater percentage of DFU occurred in men at an earlier age (p&lt;0.05). Only about half of the DFU were clinically infected (49.3%) but 92% of DFU showed bacterial growth in the microbiological lab analysis. In addition, we isolated more monomicrobial (57.3%) than polymicrobial (34.8%) DFI and representing an average of 1.30 pathogens per patient. The presence of Gram-positive and Gram-negative strains was comparable between men and women regardless their age or glucose levels. Interestingly, more Gram-positive strains are present in ulcers without ischemia while more Gram-negative strains are present in ulcers with ischemia (p&lt;0.05). While <jats:italic>Staphylococcus aureus<\/jats:italic> was common in infected ulcers without ischemia, <jats:italic>Pseudomonas aeruginosa<\/jats:italic> was predominant in ulcers with infection and ischemia, regardless of ulcer depth. Finally, a higher percentage of women has controlled HbA1c levels (19.41% versus 11.95% in men) and more women in this group displayed non-infected wounds (60.6% and 43.90% for women and men, respectively).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our results provide an updated picture of the DFI patterns and antibiotics resistance in patients attending Dasman Diabetes Institute (DDI) clinics in Kuwait which might help in adopting the appropriate treatment of infected foot and improving clinical outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244306","type":"journal-article","created":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T18:54:31Z","timestamp":1609354471000},"page":"e0244306","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":39,"title":["Microbiological profile of diabetic foot ulcers in Kuwait"],"prefix":"10.1371","volume":"15","author":[{"given":"Asma","family":"Alhubail","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May","family":"Sewify","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Messenger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Masoetsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imtiaz","family":"Hussain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinu","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3024-5370","authenticated-orcid":true,"given":"Ali","family":"Tiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,30]]},"reference":[{"key":"pone.0244306.ref001","doi-asserted-by":"crossref","first-page":"382","DOI":"10.2337\/diacare.22.3.382","article-title":"Incidence, outcomes, and cost of foot ulcers in patients with diabetes","volume":"22","author":"SD Ramsey","year":"1999","journal-title":"Diabetes Care"},{"key":"pone.0244306.ref002","first-page":"309","article-title":"A comparison of diabetic foot ulcer patients managed in VHA and non-VHA settings","volume":"38","author":"GE Reiber","year":"2001","journal-title":"J Rehabil Res Dev"},{"key":"pone.0244306.ref003","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.2337\/diacare.26.5.1435","article-title":"Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort","volume":"26","author":"LA Lavery","year":"2003","journal-title":"Diabetes Care"},{"key":"pone.0244306.ref004","unstructured":"Epicast: EpiCast Report: Diabetic Foot Ulcers\u2014Epidemiology Forecast to 2025. pp. 1\u201359; 2017:1\u201359."},{"key":"pone.0244306.ref005","first-page":"1","volume-title":"IDF Diabetes Atlas","author":"IDF","year":"2019","edition":"9"},{"key":"pone.0244306.ref006","doi-asserted-by":"crossref","first-page":"1471927","DOI":"10.1080\/2000625X.2018.1471927","article-title":"Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait","volume":"9","author":"G Messenger","year":"2018","journal-title":"Diabet Foot Ankle"},{"key":"pone.0244306.ref007","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s00125-006-0491-1","article-title":"High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. 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