الفهرس 
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Abstract
Diabetes mellitus (DM) is a metabolic syndrome characterized by chronic hyperglycemia with abnormality of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both. It has a global burden on health care costs and it is due to development of chronic complications.These complications affect many organs and these complications are divided into:
• Micro-vascular (diabetic kidney disease, diabetic neuroapathy and diabetic retinopathy) which are the major causes of renal insufficiency, non-traumatic lower limb amputation and blindness respectively.
• Macro-vascular complications (cerebrovascular disease, peripheral vascular disease, and coronary artery disease).
Diabetic foot is a common, severe chronic complication of diabetes which is associated with neuropathy and peripheral vascular disease in the lower limbs. DF incidence has increased due to the worldwide prevalence of DM and the prolonged life expectancy of patients. Ischemia, loss of protective sensation and infection are the main pathological components that cause diabetic foot complications. DFI continue to be a major health problem worldwide and it is one of the most common cause of hospitalization,disease related morbidity and mortality. It may lead to gangrene and lower limb amputation in the end.
The aim of this study was to determine bacterial profile of DFIs and to assess the antimicrobial resistance pattern of isolated bacteria with doing Comparison between swab and tissue biopsy in detecting bacteria of these infections.
Tissue biopsy was known as the most standard method, but our study shows that there is a perfect agreement between swab culture and biopsy culture and this means that there is no differences in bacteria isolated by swab or biopsy. We should use the Levine swabbing technique.This technique is done by rotation of the swab with sufficient pressure to extract fluid from the inner part of the wound. It thus may decrease superficial contamination.
Our cross sectional study of 120 patients, 22 had negative results for both aerobic and anaerobic organisms and about 124 aerobic organisms and 54 anaeobic organisms were isolated from 98 subjects. Monomicrobial infections were the most frequent infections. Mild infection were due to Gram-positive organisms while deep severe life threatening infections were due to Gram-negative organisms.
Our study revealed Gram-negative organisms were the predominant organisms constituting about 98 of the isolates while Gram-positive organisms constituting 26 and anerobes about 54. Ruminococcus spp. was the most common anaerobes isolated in our study followed by bacteroids. Proteus spp. and Pseudomonas spp. were the most common Gram-negative isolates while MRSA were the most common Gram positive isolates.
According to Wagner’s grading and IDSA/IWGDF classification,the majority of the patients (75%) in the current study, had higher gardes of DFU (grade 2-4). The presentation with higher grade ulcers could be explained by the poor educational level of the population, self-medication, and delay in seeking medical advice.
Diabetic foot infections (DFIs) in our patients were commonly associated with MDR and XDR Gram-negative bacterial etiology. The prevelance of MDR/XDR isolates is about 86 among all isolates in our study. The antimicrobial susceptibility revealed that colistin, imipenem, meropenem, or piperacillin-tazobactam may be used as empirical antimicrobial therapy for all DFI grades and Vancomycin may be added only if there are any predisposing factors.