Keyword: Multidrug Resistance

ABSTRACT: The growing pace of antimicrobial resistance (AMR) is a serious threat to modern infectious disease control as it has significantly undermined the clinical value of the traditional antibiotics. Traditional antimicrobial agents, which act by preventing the growth of bacteria or causing cell death, place a lot of selection pressure on the microbial population, therefore, promoting the rapid emergence and spread of resistance determinants. Besides spurring the evolution of resistance, such strategies often destabilize commensal microbiota and help transfer resistance genes between different bacteria of various species. These restrictions have shown that there is an urgent need to establish alternative treatment measures capable of reducing infections and reducing evolutionary pressures that promote resistance. Anti-virulence therapy (AVT) has developed as an exciting paradigm which has sought to lay emphasis on the molecular aspects of bacterial pathogenicity, as opposed to microbial viability. AVTs are designed to disrupt virulence-related processes such as quorum sensing, toxin secretion, host adhesion, immune evasion, and nutrient acquisition by selectively interrupting virulence in endotoxin-producing bacteria with the aim of attenuating virulence and promoting host-mediated clearance without necessarily endangering the survival of bacteria. It is theorized that this mechanistic difference will decrease the selective advantage provided to resistant variants, which may retard the tempo of resistance emergence and dissemination in bacterial populations. In this case, we will analyze the mechanistic foundations of bacterial virulence and will compare the existing anti-virulence therapies used as therapeutic approaches and their application in an evolutionary context. We also evaluate the new preclinical and clinical findings under the effectiveness of AVTs, along with the most important translational obstacles in terms of pharmacological optimization, target specificity, and regulatory validation. Together, these observations provide support to anti-virulence interventions as complementary or alternative therapies to conventional antibiotics in the treatment of multidrug-resistant infections, and highlight the necessity of interdisciplinary collaboration in order to support the adoption of such interventions into new-generation antimicrobial treatment programs.

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