Bacteriological Profile and Antibiotic Resistance Patterns in Diabetic Foot Infections: A Monocentric Tertiary Care Study in Lebanon (2017–2024)

Background Diabetic foot infections (DFIs) are a serious complication of poorly controlled diabetes mellitus (DM), often resulting in significant morbidity, recurrent hospital admissions, and an increased mortality risk. The bacteriological profile and resistance patterns of DFIs vary based on geographical and socio-economic factors, with Gram-negative bacteria more prevalent in humid, lower-income regions, including the Middle East. Data on DFI’s microbiological landscape in Lebanon remain limited, with few studies tracking the evolution of antibiotic resistance over time. This retrospective, monocentric study analyzes the bacteriological trends of DFIs in Lebanon over seven years, comparing findings with previously published research from the same center and other national and regional studies. Results Gram-negative bacteria were identified in 68.23% of all DFIs. However, Staphylococcus species remained the most frequently isolated bacteria, accounting for 20.7% of cases, followed by E. coli (16.3%) and Pseudomonas species (13.8%). A substantial increase in ESBL-producing Enterobacterales was observed compared to earlier data from the same center (36.86% vs 16.3% in 2011). Severe diabetic foot infections were also significantly associated with higher rates of diabetic neuropathy and peripheral arterial disease compared to milder infections. Conclusions DFI-causing bacteria exhibit increasing resistance to standard oral and parenteral antibiotics. As a result, preventing diabetic foot infections through regular foot assessment, strict glycemic control, and long-term follow-up is crucial in minimizing ulcer formation and subsequent infections.