EPIDEMIOLOGY AND HEALTH DATA INSIGHTS
Review Article
Dec 01, 2025 157 169

Diabetic Foot Ulcers in Africa: A Systematic Review of Microbial Profiles and Clinical Outcomes in the Context of Multidrug Resistance

Patrick Chinazam Nwosu 1,
Emmanuel Cherechi Egwuatu 2 * ,
Alliah Kris-Ann Wright 3,
Fortune Itoje Ebiala 4,
Gloria Ogbeyi Yaro 5,
Precious Esong Sone 6,
Ayodele Blessing Ayo-ige 7,
Esther Uyoyooghene Olokede 8
1 Clinical Lead, Rehabilitation and Quality Department, San Remo Nursing and Rehabilitation Center, Garland, TX, USA2 Clinical Lead, Infection Prevention Specialist, Elizabeth Residence Assisted Living Community, Appleton, WI, USA3 Department of Nursing, Graduate School of Nursing Science, Alverno College, Milwaukee, WI, USA 4 Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria5 Department of Food Science and Technology, Faculty of Agriculture, Prince Abubakar Audu University, Anyigba, Kogi State, Nigeria6 Department of Healthcare Management, College of Business, East Carolina University, Greenville, NC, USA7 Department of Epidemiology of Infectious Diseases, School of Public Health, Yale University, New Haven, CT, USA8 Department of Medical Laboratory Science, University of Benin, Benin City, Edo State, Nigeria* Corresponding Author
Epidemiology and Health Data Insights, 1(6), 2025, ehdi022, https://doi.org/10.63946/ehdi/17471
Publication date: Dec 01, 2025
Full Text (PDF)

ABSTRACT

Diabetic foot ulcers (DFUs) are among the most severe complications of  diabetes mellitus, contributing to infection, limb loss, and premature mortality. In Africa, the rising prevalence of diabetes, combined with limited laboratory capacity and frequent empirical antibiotic use, has intensified the problem of multidrug-resistant (MDR) infections. Understanding the microbial spectrum and associated outcomes is critical for guiding evidence-based management. This review systematically synthesizes data on microbial etiologies, antimicrobial-resistance patterns, and clinical outcomes of DFUs in African populations. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, Embase, Web of Science, African Journals Online, and Google Scholar were searched for studies published between 2000 and 2025. Eligible studies included adults with DFUs in African settings that reported bacterial isolates, resistance profiles, or clinical outcomes. Two reviewers independently screened and extracted data, and study quality was appraised using the Joanna Briggs Institute checklist. Data were synthesized narratively and summarized using descriptive statistics. Sixteen verified studies from ten African countries, encompassing approximately 2,700 participants, were included. Staphylococcus aureus and Pseudomonas aeruginosa were the predominant isolates, followed by Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. MDR prevalence was high, with methicillin-resistant S. aureus (MRSA) detected in 25–45% of isolates and extended-spectrum β-lactamase (ESBL)–producing Enterobacterales in 30–50%. Among studies reporting outcomes, amputation rates ranged from 15% to 38% and mortality from 7% to 16%, with poorer outcomes in MDR infections. Considerable heterogeneity existed in sampling and testing methods across studies. Saureus remains the dominant pathogen in African DFUs, but AMR is pervasive across bacterial species. Strengthening diagnostic laboratory systems, infection-control practices, and antimicrobial stewardship (alongside integrated diabetic foot care) is essential to reduce preventable amputations, mortality, and the continent’s growing burden of drug-resistant infections.
Keywords: Diabetic

KEYWORDS

Diabetic Foot Ulcer Antimicrobial Resistance Africa Staphylococcus Aureus Pseu-domonas Aeruginosa Multidrug Resistance Clinical Outcomes

CITATION (Vancouver)

Nwosu PC, Egwuatu EC, Wright AKA, Ebiala FI, Yaro GO, Sone PE, et al. Diabetic Foot Ulcers in Africa: A Systematic Review of Microbial Profiles and Clinical Outcomes in the Context of Multidrug Resistance. Epidemiology and Health Data Insights. 2025;1(6):ehdi022. https://doi.org/10.63946/ehdi/17471
APA
Nwosu, P. C., Egwuatu, E. C., Wright, A. K.-A., Ebiala, F. I., Yaro, G. O., Sone, P. E., Ayo-ige, A. B., & Olokede, E. U. (2025). Diabetic Foot Ulcers in Africa: A Systematic Review of Microbial Profiles and Clinical Outcomes in the Context of Multidrug Resistance. Epidemiology and Health Data Insights, 1(6), ehdi022. https://doi.org/10.63946/ehdi/17471
Harvard
Nwosu, P. C., Egwuatu, E. C., Wright, A. K.-A., Ebiala, F. I., Yaro, G. O., Sone, P. E., . . . Olokede, E. U. (2025). Diabetic Foot Ulcers in Africa: A Systematic Review of Microbial Profiles and Clinical Outcomes in the Context of Multidrug Resistance. Epidemiology and Health Data Insights, 1(6), ehdi022. https://doi.org/10.63946/ehdi/17471
AMA
Nwosu PC, Egwuatu EC, Wright AKA, et al. Diabetic Foot Ulcers in Africa: A Systematic Review of Microbial Profiles and Clinical Outcomes in the Context of Multidrug Resistance. Epidemiology and Health Data Insights. 2025;1(6), ehdi022. https://doi.org/10.63946/ehdi/17471
Chicago
Nwosu, Patrick Chinazam, Emmanuel Cherechi Egwuatu, Alliah Kris-Ann Wright, Fortune Itoje Ebiala, Gloria Ogbeyi Yaro, Precious Esong Sone, Ayodele Blessing Ayo-ige, and Esther Uyoyooghene Olokede. "Diabetic Foot Ulcers in Africa: A Systematic Review of Microbial Profiles and Clinical Outcomes in the Context of Multidrug Resistance". Epidemiology and Health Data Insights 2025 1 no. 6 (2025): ehdi022. https://doi.org/10.63946/ehdi/17471
MLA
Nwosu, Patrick Chinazam et al. "Diabetic Foot Ulcers in Africa: A Systematic Review of Microbial Profiles and Clinical Outcomes in the Context of Multidrug Resistance". Epidemiology and Health Data Insights, vol. 1, no. 6, 2025, ehdi022. https://doi.org/10.63946/ehdi/17471

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