Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2020; 11(3): 78-89
Published online Mar 15, 2020. doi: 10.4239/wjd.v11.i3.78
Prevalence and interrelationships of foot ulcer, risk-factors and antibiotic resistance in foot ulcers in diabetic populations: A systematic review and meta-analysis
Mohammad Zubair
Mohammad Zubair, Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia
Author contributions: Zubair M design the concept, performed the research, analysis and wrote the manuscript.
Conflict-of-interest statement: Author have no conflict of interest related to the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mohammad Zubair, PhD, Assistant Professor, Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, PO Box 71491, Tabuk 71491, Saudi Arabia.
Received: August 21, 2019
Peer-review started: August 21, 2019
First decision: October 13, 2019
Revised: November 21, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: March 15, 2020

Diabetic foot ulceration (DFU) is the prime health concern globally. It accounts for the major burden related to disease mortality and morbidity and economic cost. The timely and early recognition of the DFU can help present its occurrence and improve clinical outcomes.


To evaluate interrelationships between foot ulcers, risk factors, and antibiotic resistance among diabetic patients having ulcers in their foot.


The databases such as PubMed, ERIC, Medline, and Google Scholar were extensively used for the extraction of studies. The selected studies were published within the time-period of 2014-2018. Ten studies were selected, which were found to be completely relevant to the current study.


The prevalence of diabetic foot ulcers among the population was evaluated, and the associated risk factors with its prevalence. Moreover, few studies also reported on the bacteria that are found to be most prevailing among diabetic patients. A narrative discussion was drawn through this analysis, which was used to highlight the specific area of research through selected studies, extraction of the significant information that matched with the topic of research, and analysis of problem through the findings of the selected articles. The results helped in assessing significant knowledge regarding the risk factors of diabetic foot ulcers and the role of antimicrobial resistant in its treatment.


The gram-negative bacteria were found to be the most common reason for diabetic foot ulcers. The study only included 10 studies that are not sufficient to produce generalized results, and no information was reported on the tests required to analyze antimicrobial susceptibility that can guide clinicians to propose better and sound treatment plans. It is evident that most study results depicted that the most common risk factors were found to be hypertension and neuropathy.

Keywords: Amputation, Diabetes mellitus, Drug resistance, Foot ulcer, Gram-negative bacteria

Core tip: The study has investigated relationship between foot ulcer, risk factors and antibiotic resistance among diabetic patients having ulcers in their foot. The results demonstrated that gram-negative bacteria are more responsible for the occurrence of diabetic foot ulcers. Antimicrobial sensitivity needs to be controlled by prescribing effective treatment plans to patients. Whereas, the overuse of antibiotics can negatively influence the health of patients.