An assessment on the risk factors of multidrug resistant organism infection in patients with diabetic foot ulcer

Abstract Background This is the first review to analyze the literatures identifying risk factors for multidrug resistant organism (MDRO) infection in patients with diabetic foot ulcers. The purpose of this study was to collect the currently published data to determine the most commonly and consistently identified risk factors for MDRO infection. Methods The PubMed, Medline, BIOSIS, Web of Science, and the Cochrane Library electronic databases were searched. The last search updated was in Sep 2019. The evaluated outcomes included age, male gender, type of diabetes, diabetes duration, level of HbA1c, ulcer type, wound duration, ulcer size, ulcer grade, osteomyelitis, previous antibiotic therapy and previous hospitalization. The standard mean difference (SMD) or the odds ratio (OR) was calculated for continuous or dichotomous data, respectively. The quality of the studies was assessed, and meta-analyses were performed with the Cochrane Collaboration's RevMan 5.0 software. Results A total of 11 studies including 1229 patients provided evidence for six possible risk factors for MDRO infection. Ischemic ulcer (OR 0.50, 95%CI 0.35, 0.71), ulcer size (SMD -0.27, 95%CI-0.46, -0.08), ulcer grade (OR 0.36, 95%CI0.15, 0.83), osteomyelitis (OR 0.33, 95%CI 0.25, 0.45), previous antibiotic therapy (OR 0.08, 95%CI 0.04, 0.14) and previous hospitalization (OR 0.15, 95%CI 0.08, 0.28) were identified as risk factors for MDRO infection in patients with diabetic foot ulcers. Conclusion Our meta-analysis indicated that ischemic ulcer, ulcer size, ulcer grade, osteomyelitis, previous antibiotic therapy and previous hospitalization were associated with MDRO infection in patients with diabetic foot ulcers.