{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:09:28Z","timestamp":1785434968478,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005003","name":"Baskent University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005003","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/02v9bqx10","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Objectives: Diabetic foot infections are a major cause of morbidity and amputation, and increasing antibiotic resistance complicates their management. This study aimed to evaluate longitudinal changes in antibiotic resistance among bacterial pathogens isolated from patients undergoing toe amputation due to diabetic foot infections. Methods: This retrospective, single-center study included patients who underwent toe amputation for diabetic foot infections between 2013 and 2024. Microbiological culture results and antimicrobial susceptibility data were analyzed across three consecutive time periods: 2013\u20132016, 2017\u20132020, and 2021\u20132024. Results: A total of 351 patients were included (mean age, 64.1 years; 64% male). A history of dialysis was present in 30% of patients, and 54% had a history of prior hospitalization. A total of 351 patients were included in the study. A total of 378 bacterial isolates recovered from positive microbiological cultures were included in the antimicrobial susceptibility analysis. The most frequently isolated microorganisms were Escherichia coli, Enterococcus spp., coagulase-negative Staphylococcus, and Staphylococcus aureus. Among Enterobacterales isolates, statistically significant increases in resistance across the three consecutive time periods were observed for amoxicillin\u2013clavulanate (p = 0.009), piperacillin\u2013tazobactam (p = 0.002), trimethoprim\u2013sulfamethoxazole (p = 0.012), and meropenem (p = 0.027), whereas the increase in imipenem resistance did not reach statistical significance (p = 0.054). Within Staphylococcus spp., a statistically significant increase in resistance across the three consecutive time periods was observed only for ciprofloxacin (p = 0.047). Conclusions: Changes in antimicrobial resistance rates were observed among bacterial isolates recovered from diabetic foot infections across the three consecutive time periods, highlighting the importance of regional surveillance and up-to-date local resistance data for guiding empirical antibiotic therapy.<\/jats:p>","DOI":"10.3390\/antibiotics15070681","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T16:30:37Z","timestamp":1783701037000},"page":"681","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in Antibiotic Resistance Patterns in Diabetic Foot Infections Requiring Toe Amputation: A Long-Term Single-Center Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0479-3074","authenticated-orcid":false,"given":"Alaaddin Levent","family":"\u00d6zg\u00f6zen","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Baskent University, Adana Dr. Turgut Noyan Training and Research Center, Adana 01250, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enes","family":"Altunay","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Baskent University, Adana Dr. Turgut Noyan Training and Research Center, Adana 01250, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/ndt\/gfaf177","article-title":"IDF Diabetes Atlas 11th edition 2025: Global prevalence and projections for 2050","volume":"41","author":"Duncan","year":"2026","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"316","DOI":"10.55730\/1300-0144.5587","article-title":"Characteristics of diabetes mellitus patients in Turkey: An analysis of national electronic health records","volume":"53","author":"Zayim","year":"2023","journal-title":"Turk. J. Med. Sci."},{"key":"ref_3","first-page":"335","article-title":"Do diabetic patients who undergo transtibial amputation receive adequate treatment?","volume":"90","author":"Beyaz","year":"2019","journal-title":"Ann. Ital. Chir."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.aott.2017.07.001","article-title":"Factors affecting lifespan following below-knee amputation in diabetic patients","volume":"51","author":"Beyaz","year":"2017","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/15347346241239719","article-title":"Diabetic foot and work outcomes: A review","volume":"25","author":"Panou","year":"2026","journal-title":"Int. J. Low. Extrem. Wounds"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1177\/15347346211004141","article-title":"The effects of antimicrobial resistance and the compatibility of initial antibiotic treatment on clinical outcomes in patients with diabetic foot infection","volume":"22","author":"Saltoglu","year":"2023","journal-title":"Int. J. Low. Extrem. Wounds"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/iwj.13540","article-title":"Clinical and economic burden of diabetic foot ulcers: A 5-year longitudinal multi-ethnic cohort study from the tropics","volume":"18","author":"Lo","year":"2021","journal-title":"Int. Wound J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Macdonald, K.E., Boeckh, S., Stacey, H.J., and Jones, J.D. (2021). The microbiology of diabetic foot infections: A meta-analysis. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06516-7"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"ofad500.172","DOI":"10.1093\/ofid\/ofad500.172","article-title":"2901. Associations between climate and diabetic foot infection microbiology: A systematic review and meta-analysis","volume":"10","author":"Rabin","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Qu, Y.D., Ou, S.J., Zhang, W., Li, J.X., Xia, C.L., Yang, Y., Liu, J.B., Ma, Y.F., Jiang, N., and Wang, Y.Y. (2024). Microbiological profile of diabetic foot infections in China and worldwide: A 20-year systematic review. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1368046"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e3645","DOI":"10.1002\/dmrr.3645","article-title":"Classification of foot ulcers in people with diabetes: A systematic review","volume":"40","author":"Hamilton","year":"2024","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_12","first-page":"475","article-title":"Role of HbA1c as a predictor in healing of diabetic foot ulcer (DFU) at a tertiary care hospital: A prospective observational study","volume":"6","author":"Sharath","year":"2025","journal-title":"Int. J. Med. Pharm. Res."},{"key":"ref_13","unstructured":"Ba\u015fara, B.B., Ayg\u00fcn, A., \u00d6zdemir, T.A., Kulal\u0131, B., \u00c7a\u011flar, \u0130.S., Kara, S., Ate\u015f Peker\u00e7ili, D., Uzun, S.B., Karag\u00f6z, D., and Kay\u0131\u015f, B. (2025). Sa\u011fl\u0131k \u0130statistikleri Y\u0131ll\u0131\u011f\u0131 2023, T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131. Available online: https:\/\/www.tdb.org.tr\/tdb\/v2\/istatistikler\/2023\/2023_SB_SIY.pdf."},{"key":"ref_14","unstructured":"Turkish Society of Microbiology (2026, July 05). Antibiotic Susceptibility Testing Standards (ADTS): Short Notification Tables 2022. Available online: https:\/\/www.tmc-online.org\/userfiles\/file\/TMC-ADTS%20K%C4%B1s%C4%B1tl%C4%B1%20Bildirim%20Tablolar%C4%B1%202022%20(pdf%20dosyas%C4%B1-).pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"29155","DOI":"10.1038\/s41598-024-80790-8","article-title":"Age at type 2 diabetes diagnosis and the risk of mortality among US population","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2150132720957449","DOI":"10.1177\/2150132720957449","article-title":"Peripheral artery disease in type 2 diabetes mellitus: Survival analysis of an Ecuadorian population in primary care","volume":"11","year":"2020","journal-title":"J. Prim. Care Community Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"94","DOI":"10.2337\/dc16-1397","article-title":"Cardiovascular autonomic neuropathy and cardiovascular outcomes in the Diabetes Control and Complications Trial\/Epidemiology of Diabetes Interventions and Complications (DCCT\/EDIC) study","volume":"40","author":"Braffett","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Akhtar, S., Latif, M., Ahmed, O.S., Sarwar, A., Alina, A., and Khan, M.I. (2022). Prevalence of foot ulcers in diabetic patients in Punjab, Pakistan. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.967733"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Vanherwegen, A.-S., Lauwers, P., Lavens, A., Doggen, K., and Dirinck, E. (2023). IQED-Foot Study Group. Sex differences in diabetic foot ulcer severity and outcome in Belgium. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0281886"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"433","DOI":"10.3390\/kidneydial2030038","article-title":"The epidemiology of diabetic kidney disease","volume":"2","author":"Hoogeveen","year":"2022","journal-title":"Kidney Dial."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Schamroth Pravda, M., Maor, Y., Brodsky, K., Katkov, A., Cernes, R., Schamroth Pravda, N., Tocut, M., Zohar, I., Soroksky, A., and Feldman, L. (2024). Bloodstream infections in chronic hemodialysis patients: Characteristics and outcomes. BMC Nephrol., 25.","DOI":"10.1186\/s12882-023-03442-5"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e2462059","DOI":"10.1001\/jamanetworkopen.2024.62059","article-title":"Antimicrobial-resistant infections in hospitalized patients","volume":"8","author":"Wolford","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"14655","DOI":"10.1038\/s41598-023-41882-z","article-title":"Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: A systematic review and meta-analysis","volume":"13","author":"Wada","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Co\u015fkun, B., Ayhan, M., Ulusoy, S., and G\u00fcner, R. (2024). Bacterial profile and antimicrobial resistance patterns of diabetic foot infections in a major research hospital of Turkey. Antibiotics, 13.","DOI":"10.3390\/antibiotics13070599"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103320","DOI":"10.1016\/j.jksus.2024.103320","article-title":"Bacterial spectrum from diabetic foot ulcers: A study of antibiotic resistance patterns and phylogenetic diversity","volume":"36","author":"Idrees","year":"2024","journal-title":"J. King Saud Univ. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Moya-Salazar, J., Chamana, J.M., Porras-Rivera, D., Goicochea-Palomino, E.A., Salazar, C.R., and Contreras-Pulache, H. (2023). Increase in antibiotic resistance in diabetic foot infections among Peruvian patients: A single-center cross-sectional study. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1267699"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Qi, C., Luo, X., Huang, J., Kong, D., Zhang, Y., Zou, M., and Zhou, H. (2024). Prevalence of S. aureus and\/or MRSA in hospitalized patients with diabetic foot and establishment of LAMP methods for rapid detection of the SCCmec gene. BMC Microbiol., 24.","DOI":"10.1186\/s12866-024-03196-6"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Morton, K.E., and Coghill, S.H. (2024). Staphylococcus aureus is the predominant pathogen in hospitalised patients with diabetes-related foot infections: An Australian perspective. Antibiotics, 13.","DOI":"10.3390\/antibiotics13070594"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sta\u0144kowska, M., Garbacz, K., Korzon-Burakowska, A., Bronk, M., Skotarczak, M., and Szyma\u0144ska-Dubowik, A. (2022). Microbiological, Clinical and Radiological Aspects of Diabetic Foot Ulcers Infected with Methicillin-Resistant and -Sensitive Staphylococcus aureus. Pathogens, 11.","DOI":"10.3390\/pathogens11060701"},{"key":"ref_30","unstructured":"The European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2026, July 05). Breakpoint Tables for Interpretation of MICs and Zone Diameters, Version 12.0. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_12.0_Breakpoint_Tables.pdf."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/7\/681\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T04:11:17Z","timestamp":1783829477000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/7\/681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["antibiotics15070681"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15070681","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}