Risk factors for multidrug-resistant bacterial infections in patients with diabetic foot ulcers: a systematic review and meta-analysis

Abstract

Background: Diabetic foot ulcer (DFU) is one of the main causes of disability and death in diabetic patients, along with the continuous development of relevant research. The purpose of this paper is to study the risk factors of multidrug resistant organisms (MDROs) infection in patients with DFUs by meta-analysis. Methods: We searched the PubMed, EMBASE, Cochrane library, and Web of Science databases for literature related to the risk factors of MDRO infection in patients with DFUs from the date of establishment of the database to September 2021. Duplicate studies were excluded using Endnote X9 software. Stata 15.1 software was used to meta-analyze the data. Random or fixed effects models were used to combine and analyze the odds ratio (OR) and 95% confidence interval (CI) of the included risk factors. Heterogeneity was analyzed by the Q and I2 tests. Egger’s linear regression method was used to evaluate the publication bias of the included articles. Sensitivity analysis was used to analyze the source of heterogeneity. Results: A total of 13 articles were included in the study. Meta-analysis was performed on 15 risk factors. Among them, hospital records before admission (OR =5.18, 95% CI: 1.45–18.51, P=0.011), antibiotic use before admission (OR =2.17, 95% CI: 1.24–3.79, P=0.006), diabetes type (OR =2.44, 95% CI: 1.29–4.64, P=0.006), ulcer type (OR =2.17, 95% CI: 1.06–4.41, P=0.033), ulcer size (OR =2.56, 95% CI: 1.53–4.28, P<0.001), osteomyelitis (OR =3.50, 95% CI: 2.37–5.16, P<0.001), vascular disease (OR =2.37, 95% CI: 1.41– 3.99, P=0.001), surgical treatment (OR =4.80, 95% CI: 2.95–7.83, P<0.001), and these meta-analysis results were statistically different and could be considered as risk factors for MDRO infection. Conclusions: The risk factors of MDRO infection in DFU patients include hospitalization records before admission, antibiotic use before admission, type of diabetes, type of ulcer, size of ulcer, osteomyelitis, vascular lesions, and surgical treatment. This study contributes to the ability of the population of DFU patients infected with MDROs to receive timely treatment at an early stage and delay disease development.