Background: Diabetic foot ulcers (DFUs) are a significant complication of diabetes and are frequently associated with bacterial infections that hinder healing and increase the risk of antimicrobial resistance (AMR). However, local data on pathogen distribution and resistance patterns remain limited in many resource-constrained settings. Methods: A cross-sectional study was conducted from March to June 2025 across three referral hospitals in Kisumu County, Kenya. A total of 471 patients with DFUs were recruited using a stratified sampling approach. Specimens were processed in accordance with the Clinical and Laboratory Standards Institute (CLSI) 2025 guidelines. Bacterial identification was performed using standard biochemical methods, and antimicrobial susceptibility testing was conducted using the Kirby–Bauer disk diffusion technique. Results: Out of 471 participants, 202 had culture-positive infections, yielding 221 bacterial isolates. Gram-negative organisms predominated, accounting for the majority of isolates. Escherichia coli and Acinetobacter baumannii were the most frequently isolated Gram-negative pathogens. Among Gram-positive bacteria, Staphylococcus aureus was the leading isolate and exhibited multidrug resistance (MDR). Conclusion: The predominance of Gram-negative pathogens and the presence of multidrug resistance highlight the limitations of empirical therapy in DFU management. These findings underscore the importance of routine microbiological testing and targeted antimicrobial stewardship strategies.
- Open Access
- Article
Bacteriological Profile and Antimicrobial Resistance Patterns of Pathogens Isolated from Patients with Infected Diabetic Foot Ulcers in Kisumu County, Kenya
Author Information
Received: 19 Feb 2026 | Revised: 17 Jul 2026 | Accepted: 11 Aug 2026 | Published: 14 Sep 2026
Abstract
Keywords
diabetic foot ulcers | antimicrobial resistance | multidrug resistance | ESKAPE pathogens | clinical microbiology
References
- 1.
World Health Organization. Antimicrobial Resistance; World Health Organization: Geneva, Switzerland, 2021.
- 2.
Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States; CDC: Atlanta, GA, USA, 2019.
- 3.
World Health Organization. Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics; WHO: Geneva, Switzerland, 2017.
- 4.
World Health Organization. Priorities of the Global Leaders Group on Antimicrobial Resistance for 2021–2022; WHO: Geneva, Switzerland, 2021.
- 5.
Senneville, É.; Albalawi, Z.; van Asten, S.A.; Abbas, Z.G.; Allison, G.; Aragón-Sánchez, J.; Embil, J.M.; Lavery, L.A.; Alhasan, M.; Oz, O.; et al. IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023). Clin. Infect. Dis. 2023, 79, 286. https://doi.org/10.1093/cid/ciad527.
- 6.
Xie, X.; Bao, Y.; Ni, L.; Liu, D.; Niu, S.; Lin, H.; Li, H.; Duan, C.; Yan, L.; Huang, S.; et al. Bacterial Profile and Antibiotic Resistance in Patients with Diabetic Foot Ulcer in Guangzhou, Southern China: Focus on the Differences among Different Wagner’s Grades, IDSA/IWGDF Grades, and Ulcer Types. Int. J. Endocrinol. 2017, 2017, 8694903. https://doi.org/10.1155/2017/8694903.
- 7.
Taki, E.; Jabalameli, F.; Mohajeri Tehrani, M.; Feizabadi, M.; Beigverdi, R.; Emaneini, M. Microbial profile and antibiotic susceptibility pattern in diabetic patients with mild, moderate, and severe foot infections in Tehran. Arch. Razi Inst. 2022, 77, 1925–1933. https://doi.org/10.22092/ari.2022.359759.2476.
- 8.
Wang, A.; Lv, G.; Cheng, X.; Ma, X.; Wang, W.; Gui, J.; Hu, J.; Lu, M.; Chu, G.; Chen, J.A.; et al. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition). Burns Trauma. 2020, 8, tkaa017. https://doi.org/10.1093/burnst/tkaa017.
- 9.
Awuor, S.; Omwenga, E.; Wafula, E.; Daud, I.; Mariita, R. Prevalence of infected diabetic foot ulcers in Kisumu County, Kenya: Identifying risk factors. J. Emerg. Med. Surg. 2026, 1, 2.
- 10.
Pitocco, D.; Spanu, T.; Di Leo, M.; Vitiello, R.; Rizzi, A.; Tartaglione, L. Diabetic foot infections: A comprehensive overview. Eur. Rev. Med. Pharmacol. Sci. 2019, 23 (Suppl. S2), 26–37. https://doi.org/10.26355/eurrev_201904_17471.
- 11.
Walsh, J.; Hoffstad, O.; Sullivan, M.; Margolis, D. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet. Med. 2016, 33, 1493–1498. https://doi.org/10.1111/dme.13054.
- 12.
Nigi, L.; Fondelli, C.; de Donato, G.; Palasciano, G.; Setacci, C.; Dotta, F. Fighting diabetic foot ulcers—The diabetologist: A king maker of the fight. Semin. Vasc. Surg. 2018, 31, 49–55. https://doi.org/10.1053/j.semvascsurg.2018.12.003.
- 13.
Israel, G.D. Sampling the Evidence of Extension Program Impact; University of Florida IFAS: Gainesville, FL, USA, 2009.
- 14.
Benson, H. Microbiological Applications: Laboratory Manual in General Microbiology, 8th ed.; McGraw-Hill: New York, NY, USA, 2002.
- 15.
Cappuccino, J.G.; Sherman, N. Microbiology: A Laboratory Manual, 10th ed.; Pearson: Boston, MA, USA, 2014.
- 16.
Halebian, S.; Harris, B.; Finegold, S.M.; Rolfe, R.D. Rapid method that aids in distinguishing Gram-positive from Gram-negative anaerobic bacteria. J. Clin. Microbiol. 1981, 13, 444–448. https://doi.org/10.1128/jcm.13.3.444-448.1981.
- 17.
Armstrong, D.G.; Boulton, A.J.M.; Bus, S.A. Diabetic Foot Ulcers and Their Recurrence. N. Engl. J. Med. 2017, 376, 2367–2375. https://doi.org/10.1056/nejmra1615439.
- 18.
Zhang, P.; Lu, J.; Jing, Y.; Tang, S.; Zhu, D.; Bi, Y. Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Ann. Med. 2017, 49, 106–116. https://doi.org/10.1080/07853890.2016.1231932.
- 19.
Wada, F.W.; Mekonnen, M.F.; Sawiso, E.D.; Kolato, S.; Woldegiorgis, L.; Kera, G.K.; El-Khatib, Z.; Ashuro, A.A.; Biru, M.; Boltena, M.T. Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: A systematic review and meta-analysis. Sci. Rep. 2023, 13, 14655. https://doi.org/10.1038/s41598-023-41882-z.
- 20.
Dwedar, R.; Ismail, D.K.; Abdulbaky, A. Diabetic foot infection: Microbiological causes with special reference to their antibiotic resistance pattern. Egypt. J. Med. Microbiol. 2015, 24, 95–102. https://doi.org/10.12816/0024935.
- 21.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing, 35th ed.; CLSI supplement M100; Clinical and Laboratory Standards Institute: Wayne, PA, USA, 2025.
- 22.
Oates, P.J. Polyol pathway and diabetic peripheral neuropathy. Int. Rev. Neurobiol. 2002, 50, 325–392. https://doi.org/10.1016/s0074-7742(02)50082-9.
- 23.
Kwon, K.T.; Armstrong, D.G. Microbiology and Antimicrobial Therapy for Diabetic Foot Infections. Infect. Chemother. 2018, 50, 11–20. https://doi.org/10.3947/ic.2018.50.1.11.
- 24.
Awuor, S.O.; Omwenga, E.O.; Mariita, R.M.; Musila, J.M.; Musyoki, S. Monitoring the battleground: Exploring antimicrobial resistance and virulence factors in wound bacterial isolates. Access Microbiol. 2023, 5, 000613.v6. https://doi.org/10.1099/acmi.0.000613.v6.
- 25.
Thanganadar Appapalam, S.; Muniyan, A.; Vasanthi Mohan, K.; Panchamoorthy, R. A study on isolation, characterization, and exploration of multiantibiotic-resistant bacteria in the wound site of diabetic foot ulcer patients. Int. J. Low. Extrem. Wounds 2021, 20, 6–14. https://doi.org/10.1177/1534734619884430.
- 26.
Al Ayed, M.Y.; Ababneh, M.; Alwin Robert, A.; Alzaid, A.; Ahmed, R.A.; Salman, A.; Musallam, M.A.; Al Dawish, M.A. Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia. Int. J. Low. Extrem. Wounds 2018, 17, 161–168. https://doi.org/10.1177/1534734618793557.
- 27.
Mutonga, D.M.; Mureithi, M.W.; Ngugi, N.N.; Otieno, F.C.F. Bacterial isolation and antibiotic susceptibility from diabetic foot ulcers in Kenya using microbiological tests and comparison with RT-PCR in detection of S. aureus and MRSA. BMC Res. Notes 2019, 12, 244. https://doi.org/10.1186/s13104-019-4278-0.
- 28.
Ogba, O.M.; Nsan, E.; Eyam, E.S. Aerobic bacteria associated with diabetic foot ulcers and their susceptibility pattern. Biomed. Dermatol. 2019, 3, 1. https://doi.org/10.1186/s41702-019-0039-x.
- 29.
Omwenga, E.O.; Awuor, S.O. The Bacterial Biofilms: Formation, Impacts, and Possible Management Targets in the Healthcare System. Can. J. Infect. Dis. Med. Microbiol. 2024, 2024, 1542576. https://doi.org/10.1155/cjid/1542576.
- 30.
Baral, P.; Afnan, N.; Ahmad Zahra, M.; Akter, B.; Rabia Prapti, S.; Muazzam Hossan, M.; Haque, F.K.M. Bacteriological analysis and antibiotic resistance in patients with diabetic foot ulcers in Dhaka. PLoS ONE 2024, 19, e0301767. https://doi.org/10.1371/journal.pone.0301767.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Suite 4002 Level 4, 447 Collins Street, Melbourne, Victoria 3000, Australia
General Inquiries: info@sciltp.com