Common Pathogens Associated with Diabetic Charcot Neuroarthropathy in the Indian Population: A Retrospective Observational Study.

BACKGROUND

Diabetic Charcot neuroarthropathy (CN) is a limb-threatening complication of long-standing diabetes mellitus and is frequently complicated by secondary infection. India-specific data on the microbiological spectrum and antimicrobial susceptibility patterns of infections complicating diabetic CN are limited.

MATERIALS AND

METHODS

This retrospective observational study included 82 adult patients with diabetic CN and associated foot ulcers. Deep tissue or ulcer-base samples were collected under aseptic precautions and processed for bacterial culture, organism identification, and antimicrobial susceptibility testing using standard microbiological methods.

RESULTS

Culture positivity was observed in 61 (74.4%) cases, with monomicrobial growth in 39 (47.6%) and polymicrobial growth in 18 (22.0%) cases. A total of 96 microbial isolates were identified. Gram-negative organisms predominated, accounting for 60/96 (62.5%) bacterial isolates, while Gram-positive organisms constituted 34/96 (35.4%). The most frequent isolates were Staphylococcus aureus 24 (25.0%), of which methicillin-resistant S. aureus accounted for 9 isolates, representing 37.5% of all S. aureus isolates, followed by Pseudomonasaeruginosa 18 (18.75%), Escherichiacoli 16 (16.67%), and Klebsiellapneumoniae 11 (11.46%). Fungal isolates were infrequent 2 (2.08%). Gram-positive organisms showed high sensitivity to linezolid (94.1%) and vancomycin (91.2%), whereas Gram-negative organisms were most sensitive to meropenem (80.0%) and piperacillin-tazobactam (73.3%). Detailed characterization of extended-spectrum β-lactamase production and carbapenem resistance was not systematically performed in this retrospective dataset; however, the observed antimicrobial susceptibility patterns suggest the presence of clinically relevant multidrug resistance among Gram-negative organisms.

CONCLUSION

Infected diabetic CN in this Indian cohort demonstrated a predominance of Gram-negative pathogens with substantial polymicrobial infection and antimicrobial resistance. These findings highlight the importance of early, culture-guided, and region-specific antimicrobial strategies to optimize limb salvage outcomes.