DFUs showed a high burden of carbapenemase-producing Gram-negative bacilli, driven mainly by blaKPC and blaNDM, and poor glycemic control was strongly associated with these resistant infections, positioning glycemic control as a modifiable driver of antimicrobial resistance in DFUs.
Among 150 patients with infected diabetic foot ulcers, more than half had high-grade ulcers and the cohort was male-predominant.
Klebsiella pneumoniae was the most common Gram-negative isolate in DFU infections.
Phenotypic carbapenem resistance was high, and most isolates produced carbapenemases.
blaKPC and blaNDM were the most prevalent carbapenemase genes and were significantly associated with phenotypic carbapenemase production.
Carbapenemase-producing isolates were associated with worse glycemic control than non-producers.
Carbapenemase production was not significantly associated with Wagner grade.
The authors conclude that glycemic control is a modifiable driver of antimicrobial resistance in DFUs and call for integrated management.
This study looked at 150 people with infected diabetic foot ulcers and tested the bacteria in their deep tissue samples for resistance to carbapenems, a class of powerful last-resort antibiotics. Most infections involved Klebsiella pneumoniae, and about three-quarters of the bacteria were resistant to meropenem and imipenem. Over 80% of the isolates produced carbapenemase enzymes, which break down these drugs. Genetic testing showed that the genes blaKPC and blaNDM were the most common ones behind this resistance. People whose infections involved carbapenemase-producing bacteria had significantly higher fasting blood glucose and HbA1c (a measure of long-term blood sugar) than those whose infections did not. The severity of the ulcer, measured by Wagner grade, was not significantly linked to carbapenemase production. This research suggests that poor blood sugar control may be tied to drug-resistant infections in diabetic foot ulcers, and that managing diabetes, tracking resistance genes, and careful antibiotic use may all matter. Because this was a single cross-sectional study, it shows an association and cannot prove that high blood sugar causes resistant infections.
Othman G, A Badawy A, Hamed Al-Serwi R, El Sayed Zaki M, Tharwat Abou El-Khier N, Alkassaby N, et al.. (2026). Molecular epidemiology of carbapenemase-producing gram-negative bacilli in diabetic foot infections: association with glycemic control.. Frontiers in cellular and infection microbiology. https://doi.org/10.3389/fcimb.2026.1847743