Microbial Diversity and Antimicrobial Resistance Patterns in ‎Diabetic Foot Infections: A Cross-Sectional Study

Purpose: The study was designed to characterize the microbial diversity, antibiotic susceptibility patterns, and MDRO prevalence among patients with diabetic foot infections in western Libya.

Materials and Methods: We conducted a descriptive, observational study involving 104 patients with clinically confirmed diabetic foot infections attending three healthcare facilities in western Libya. Pus swabs were collected aseptically and processed using conventional culture techniques. Bacterial identification employed Gram staining, biochemical tests, and API 20E strips for Gram-negative organisms. Antimicrobial susceptibility testing followed CLSI guidelines using the Kirby-Bauer disk diffusion method. Fungal elements were identified via direct microscopy, culture on Sabouraud dextrose agar, and germ tube testing. Statistical analyses examined associations between clinical variables and infection characteristics‎.

Results: ‎ The cohort predominantly comprised males (68.3%) with a mean age of 56.5 years. Type 2 diabetes was most common (84.6%), with median disease duration of 6–15 years. Bacterial infections predominated (65.4%), frequently presenting as polymicrobial infections (26.9%). Staphylococcus aureus was the leading Gram-positive isolate (21.2%), while Pseudomonas species and Enterobacter species were most prevalent among Gram-negatives (8.7% each). Candida albicans was identified in 34.6% of cases. In particular, multidrug resistance was significantly higher in Gram-negative bacteria (90.0%) compared with Gram-positive organisms (25.0%) (p < 0.001). Previous amputation, hypertension, and diabetes duration exceeding 15 years emerged as significant risk factors for MDR infections‎.

Conclusion: This study reveals a complex microbial ecology in Libyan diabetic foot infections, characterized by substantial polymicrobial involvement and alarming rates of antibiotic resistance. The pronounced burden of multidrug-resistant Gram-negative organisms underscores the necessity for culture-guided therapy, robust antimicrobial stewardship, and region-specific treatment protocols‎. (Open J Biomed Res 2026;5:78-87)