Abstract
Background: Diabetic Foot Ulcer (DFU) bears several problems in clinical practice. The nature of the ulcer is usually polymicrobial, and the common pathogen is the S. aureus. Objective: To study the prevalence of methicillin-resistant S. aureus (MRSA) and antimicrobial resistance dissimilarity among biofilm-producing and non producing microorganisms isolated from DFU patients. Methodology: The current study was on 30 DFU patients admitted in King Fahad Specialist Hospital in Tabuk, KSA during April 2018 and January 2019. Standard methods of sample collection and identification of microorganism were adopted. An antibiotic sensitivity test was investigated using Kirby Bauer discdiffusion method. The colonies of S. aureus were screened for MRSA on Mueller-Hinton agar with oxacillin (1 mu g) and cefoxitin (30 mu g). Identification of biofilm activity was performed by tissue culture plate method. Results: Among the S. aureus isolates screened, the majority of them showed resistance to sparfloxacin and cefotaxime clavulanic acid. MRSA activity was 56.7% using cefoxitin disk and 40 % by oxacillin disk, only 12 isolates were classified as true MRSA based on minimum inhibitory concentration results using oxacillin (>4 mu g/ml)) and cefoxitin (>8 mu g/ml). The overall antibiotic resistance was high in biofilm positive isolates compared to non-biofilm activity. In an univariate analysis, significant factors which were more likely to have a biofilm activity was resistance to Oxacillin [OR 1.14, RR 1.22], resistance cefoxitin [OR1.20, RR1.30] and resistance to both oxacillin & cefoxitin [OR 1.33, RR 1.11]. Conclusion: Based on preliminary data, our recommendation is to shift the approach of treating DFU to biofilm model from classical planktonic model. The model shifting can be done with a new scientific approach in mutual coordination between clinical lab and clinics, continuous education and comprehensive data-based research.