High prevalence of multidrug-resistant bacteria in diabetic patients with foot ulcers: A descriptive analysis of patients referred to a tertiary care hospital in Vietnam.

BACKGROUND: Misuse of antibiotics in diabetic foot infections (DFI) promotes multidrug-resistant (MDR) bacteria. Objectives: To describe antibiotic resistance patterns in patients with prior antibiotic exposure before tertiary hospital admission. METHODS: A descriptive cross-sectional study followed STROBE guidelines from November 2022 to May 2023. Inclusion criteria were DFI patients with ≥ 48-hour prior antibiotic exposure at lower-level facilities. Clinical characteristics, infection severity, and bacterial cultures were assessed. RESULTS: Among 51 patients (64.7% male, mean age 61.1 years), results showed elevated inflammatory markers (WBC: 15.1 k/uL; CRP: 109.2 mg/L) and poor glycemic control (HbA1c: 10.2%). Ulcers were large (mean: 10.1 cm^2) with 85.3% moderate-to-severe infections. Out of 51 samples, 38 (74.5%) yielded positive isolates. Among these isolates, the MDR prevalence was 84.2% (32/38). MDR infection was significantly associated with moderate-to-severe ulcers (OR: 10.8; 95% CI: 1.48-78.8; p=0.007). CONCLUSION: A high prevalence of MDR bacteria was identified among referred DFI patients, indicating a significant resistance burden in this population. These findings suggest a potential link between prior antibiotic exposure and increased resistance risk, underscoring the need for robust antimicrobial stewardship within referral networks.