Prevalence and Antibiotic Susceptibility Profiles of Staphylococcus aureus Derived from Wound Samples of Diabetic Patients Attending the Moi Teaching and Referral Hospital, Kenya
Staphylococcus aureus is a common cause of delayed wound healing worldwide, especially among diabetic patients, due to the bacterium’s resistance to antibiotics. This study aimed to investigate the prevalence, antimicrobial susceptibility patterns of S. aureus, and potential risk factors for its occurrence in diabetic wound infections at Moi Teaching and Referral Hospital (MTRH). A purposive sampling method was used to select 156 diabetic patients aged 13 years or older attending the diabetic clinic. Wound swabs were collected aseptically, inoculated onto blood agar, and then sub-cultured on Mannitol Salt Agar. The isolates were characterized using biochemical tests, while antimicrobial susceptibility was assessed via the agar disk diffusion technique. Results showed that 19.87% were positive for S. aureus, while 80.13% were negative. Among the positive isolates, 10.48% showed intermediate sensitivity, and 29.03% exhibited resistance to at least one antibiotic. More than half of the isolates were susceptible to the tested antibiotics. The highest susceptibility was observed for Cefoxitin (96.77%) and Clindamycin (80.65%), while Ampicillin demonstrated the lowest susceptibility (25.81%). The study found a 19.87% prevalence of S. aureus in wounds of diabetic patients at the outpatient diabetic clinic of MTRH, with most isolates showing susceptibility to Cefoxitin, Erythromycin, and Clindamycin.
References
[1]
Standl, E., Khunti, K., Hansen, T.B. and Schnell, O. (2019) The Global Epidemics of Diabetes in the 21st Century: Current Situation and Perspectives. European Journal of Preventive Cardiology, 26, 7-14. https://doi.org/10.1177/2047487319881021
[2]
Ogurtsova, K., Guariguata, L., Barengo, N.C., Ruiz, P.L., Sacre, J.W., Karuranga, S., et al. (2022) IDF Diabetes Atlas: Global Estimates of Undiagnosed Diabetes in Adults for 2021. Diabetes Research and Clinical Practice, 183, Article 109118. https://doi.org/10.1016/j.diabres.2021.109118
[3]
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., et al. (2019) Global and Regional Diabetes Prevalence Estimates for 2019 and Projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th Edition. Diabetes Research and Clinical Practice, 157, Article 107843. https://doi.org/10.1016/j.diabres.2019.107843
[4]
Al-Khaledi, M., Al-Dousari, H., Al-Dhufairi, S., Al-Mousawi, T., Al-Azemi, R., Al-Azimi, F., et al. (2018) Diabetes Self-Management: A Key to Better Health-Related Quality of Life in Patients with Diabetes. Medical Principles and Practice, 27, 323-331. https://doi.org/10.1159/000489310
[5]
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., et al. (2014) Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38, 140-149. https://doi.org/10.2337/dc14-2441
[6]
Hurlow, J.J., Humphreys, G.J., Bowling, F.L. and McBain, A.J. (2018) Diabetic Foot Infection: A Critical Complication. International Wound Journal, 15, 814-821. https://doi.org/10.1111/iwj.12932
[7]
Hinojosa, C.A., Boyer-Duck, E., Anaya-Ayala, J.E., Núñez-Salgado, A.E., Laparra-Escareno, H. and Lizola, R. (2018) Impact of Revascularization and Factors Associated with Limb Salvage in Patients with Diabetic Foot. Gaceta Médica de México, 154, 146-152. https://doi.org/10.24875/gmm.18002772
[8]
Anwar, K., Hussein, D. and Salih, J. (2020) Antimicrobial Susceptibility Testing and Phenotypic Detection of MRSA Isolated from Diabetic Foot Infection. International Journal of General Medicine, 13, 1349-1357. https://doi.org/10.2147/ijgm.s278574
[9]
Foster, T.J. (2019) Surface Proteins of Staphylococcus aureus. Microbiology Spectrum, 7, 1-22. https://doi.org/10.1128/microbiolspec.gpp3-0046-2018
[10]
Lister, J.L. and Horswill, A.R. (2014) Staphylococcus aureus Biofilms: Recent Developments in Biofilm Dispersal. Frontiers in Cellular and Infection Microbiology, 4, Article ID: 178. https://doi.org/10.3389/fcimb.2014.00178
[11]
Thomas, S., Liu, W., Arora, S., Ganesh, V., Ko, Y. and Höök, M. (2019) The Complex Fibrinogen Interactions of the Staphylococcus aureus Coagulases. Frontiers in Cellular and Infection Microbiology, 9, Article ID: 106. https://doi.org/10.3389/fcimb.2019.00106
[12]
Visansirikul, S., Kolodziej, S.A. and Demchenko, A.V. (2020) Staphylococcus aureus Capsular Polysaccharides: A Structural and Synthetic Perspective. Organic & Biomolecular Chemistry, 18, 783-798. https://doi.org/10.1039/c9ob02546d
[13]
Bashabsheh, R.H.F., AL-Fawares, O., Natsheh, I., Bdeir, R., Al-Khreshieh, R.O. and Bashabsheh, H.H.F. (2023) Staphylococcus aureus Epidemiology, Pathophysiology, Clinical Manifestations and Application of Nano-Therapeutics as a Promising Approach to Combat Methicillin Resistant Staphylococcus aureus. Pathogens and Global Health, 118, 209-231. https://doi.org/10.1080/20477724.2023.2285187
[14]
Anafo, R.B., Atiase, Y., Dayie, N.T.K.D., Kotey, F.C.N., Tetteh-Quarcoo, P.B., Duodu, S., et al. (2021) Methicillin-Resistant Staphylococcus aureus (MRSA) Infection of Diabetic Foot Ulcers at a Tertiary Care Hospital in Accra, Ghana. Pathogens, 10, Article 937. https://doi.org/10.3390/pathogens10080937
[15]
Tuvei, S.M. (2017) ‘Prevalence and Antimicrobial Susceptibility of Staphylococcus aureus Isolated from Diabetes Mellitus Patients with Foot Ulcers at Vihiga County Referral Hospital, Kenya. Doctoral Dissertation, Maseno University.
[16]
Mutonga, D.M. (2018) Isolation, Sensitivity Patterns, and Molecular Characterization of Bacterial Isolates from Infected Diabetic Foot Ulcers in Patients at Kenyatta National Hospital. Master’s Thesis, University of Nairobi.
[17]
Kisoi, S.K. (2021) The Prevalence and Antimicrobial Susceptibility Patterns of Bacteria That Cause Chronic Wound Infections among Patients at Kenyatta National Hospital. Master’s Thesis, University of Nairobi.
[18]
Fisher, A.A., Laing, J.E., Stoeckel, J.E. and Townsend, J. (1991) Handbook for Family Planning Operations Research Design. 2nd ed. Population Council. https://doi.org/10.31899/rh10.1039
[19]
Jung, S. (2013) Stratified Fisher’s Exact Test and Its Sample Size Calculation. Biometrical Journal, 56, 129-140. https://doi.org/10.1002/bimj.201300048
[20]
Mariam, T.G., Alemayehu, A., Tesfaye, E., Mequannt, W., Temesgen, K., Yetwale, F., et al. (2017) Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study. Journal of Diabetes Research, 2017, Article ID: 2879249. https://doi.org/10.1155/2017/2879249
[21]
Atlaw, A., Kebede, H.B., Abdela, A.A. and Woldeamanuel, Y. (2022) Bacterial Isolates from Diabetic Foot Ulcers and Their Antimicrobial Resistance Profile from Selected Hospitals in Addis Ababa, Ethiopia. Frontiers in Endocrinology, 13, Article ID: 987487. https://doi.org/10.3389/fendo.2022.987487
[22]
Amini, M., Davati, A. and Piri, M. (2013) Determination of the Resistance Pattern of Prevalent Aerobic Bacterial Infections of Diabetic Foot Ulcer. Iranian Journal of Pathology, 8, 21-26. https://ijp.iranpath.org/article_8328.html
[23]
Shettigar, K. and Murali, T.S. (2020) Virulence Factors and Clonal Diversity of Staphylococcus aureus in Colonization and Wound Infection with Emphasis on Diabetic Foot Infection. European Journal of Clinical Microbiology & Infectious Diseases, 39, 2235-2246. https://doi.org/10.1007/s10096-020-03984-8
[24]
Tuchscherr, L., Korpos, È., van de Vyver, H., Findeisen, C., Kherkheulidze, S., Siegmund, A., et al. (2018) Staphylococcus aureus Requires Less Virulence to Establish an Infection in Diabetic Hosts. International Journal of Medical Microbiology, 308, 761-769. https://doi.org/10.1016/j.ijmm.2018.05.004
[25]
Fawad, U. (2022) Bacteriological Spectrum and Antibiotic Susceptibility on Blood Culture in Newly Diagnosed Pediatric Patients with Acute Lymphoblastic Leukemia during the Induction Phase. Cureus, 14, e25470. https://doi.org/10.7759/cureus.25470
[26]
Bhat Y, R., Lewis, L. and KE, V. (2011) Bacterial Isolates of Early-Onset Neonatal Sepsis and Their Antibiotic Susceptibility Pattern between 1998 and 2004: An Audit from a Center in India. Italian Journal of Pediatrics, 37, Article No. 32. https://doi.org/10.1186/1824-7288-37-32
[27]
Owais, D., Al-Groom, R.M., AlRamadneh, T.N., Alsawalha, L., Ahmad Khan, M.S., Yousef, O.H., et al. (2024) Antibiotic Susceptibility and Biofilm Forming Ability of Staphylococcus Aureus Isolated from Jordanian Patients with Diabetic Foot Ulcer. Iranian Journal of Microbiology, 16, 450-458. https://doi.org/10.18502/ijm.v16i4.16303
[28]
Rashid, Z., Farzana, K., Sattar, A. and Murtaza, G. (2012) Prevalence of Nasal Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus in Hospital Personnel and Associated Risk Factors. Acta Poloniae Pharmaceutica, 69, 985-991.
[29]
Amanat, S., Ghahri, S., Dianatinasab, A., Fararouei, M. and Dianatinasab, M. (2020) Exercise and Type 2 Diabetes. Advances in Experimental Medicine and Biology, Springer Nature, 91-105. https://doi.org/10.1007/978-981-15-1792-1_6
[30]
Thorlacius-Ussing, L., Sandholdt, H., Larsen, A.R., Petersen, A. and Benfield, T. (2019) Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008-2015. Emerging Infectious Diseases, 25, 875-882. https://doi.org/10.3201/eid2505.181773
[31]
Kautzky-Willer, A., Leutner, M. and Harreiter, J. (2023) Sex Differences in Type 2 Diabetes. Diabetologia, 66, 986-1002. https://doi.org/10.1007/s00125-023-05891-x
[32]
Gebremedhn, G., Gebremariam, T.T., Wasihun, A.G., Dejene, T.A. and Saravanan, M. (2016) Prevalence and Risk Factors of Methicillin-Resistant Staphylococcus aureus Colonization among HIV Patients in Mekelle, Northern Ethiopia. SpringerPlus, 5, Article No. 877. https://doi.org/10.1186/s40064-016-2613-7
[33]
Simkhada, R. (2013) Urinary Tract Infection and Antibiotic Sensitivity Pattern among Diabetics. Nepal Medical College Journal, 15, 1-4.
[34]
Aedh, A.I. (2016) Methicillin-Resistant Staphylococcus aureus Prevalence, Response and Resistance to Antimicrobial Agents at King Khaled Hospital in Najran (KSA). Journal of Medical and Dental Science Research, 4, 14-20.
[35]
Reveles, K.R., Duhon, B.M., Moore, R.J., Hand, E.O. and Howell, C.K. (2016) Epidemiology of Methicillin-Resistant Staphylococcus aureus Diabetic Foot Infections in a Large Academic Hospital: Implications for Antimicrobial Stewardship. PLOS ONE, 11, e0161658. https://doi.org/10.1371/journal.pone.0161658
[36]
Oguzkaya-Artan, M., Artan, C. and Baykan, Z. (2016) Prevalence and Risk Factors for Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Nasal Carriage Inpatients in a Tertiary Care Hospital’s Chest Clinic in Turkey. Nigerian Journal of Clinical Practice, 19, 313-317. https://doi.org/10.4103/1119-3077.179285
[37]
Sekhar, S., Vyas, N., Unnikrishnan, M., Rodrigues, G. and Mukhopadhyay, C. (2014) Antimicrobial Susceptibility Pattern in Diabetic Foot Ulcer: A Pilot Study. Annals of Medical and Health Sciences Research, 4, 742-745.
[38]
Neubeiser, A., Bonsignore, M., Tafelski, S., Alefelder, C., Schwegmann, K., Rüden, H., et al. (2020) Mortality Attributable to Hospital Acquired Infections with Multidrug-Resistant Bacteria in a Large Group of German Hospitals. Journal of Infection and Public Health, 13, 204-210. https://doi.org/10.1016/j.jiph.2019.07.025
[39]
Liu, X., Ren, Q., Zhai, Y., Kong, Y., Chen, D. and Chang, B. (2022) Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer. Infection and Drug Resistance, 15, 1627-1635. https://doi.org/10.2147/idr.s359157
[40]
Yuan, J., Hu, Y.J., Zheng, J., Kim, J.H., Sumerlin, T., Chen, Y., et al. (2020) Long-Term Use of Antibiotics and Risk of Type 2 Diabetes in Women: A Prospective Cohort Study. International Journal of Epidemiology, 49, 1572-1581. https://doi.org/10.1093/ije/dyaa122
[41]
Karimi, M.A., Binaei, S., Hashemi, S.H., Refahi, P., Olama, E., Olama, E., et al. (2025) Marital Status and Risk of Type 2 Diabetes among Middle-Aged and Elderly Population: A Systematic Review and Meta-analysis. Frontiers in Medicine, 11, Article ID: 1485490. https://doi.org/10.3389/fmed.2024.1485490
[42]
Adeiza, S.S., Ademola Onaolapo, J. and Olalekan Olayinka, B. (2020) Prevalence, Risk Factors and Antimicrobial Susceptibility Profile of Methicillin-Resistant Staphylococcus aureus (MRSA) Obtained from Nares of Patients and Staff of Sokoto State-Owned Hospitals in Nigeria. GMS Hygiene and Infection Control, 15, Doc25.
[43]
Early, G.J. and Seifried, S.E. (2012) Risk Factors for Community-Associated Staphylococcus aureus Skin Infection in Children of Maui. Hawai’i Journal of Medicine and Public Health, 71, 218-223.
