Introduction DiabeticFootinfectionsarecommon,complex,expensive and important causes for hospitalization of patients with diabetes. 1-3 About one-in-four patients with diabetes will have an ulcer in their lifetime and approximately half of theseulcerswilldevelopaninfection.Theseinfectionsare the leading cause of patient morbidity and are associated with lower limb amputation if not treated properly. 2,4,5 In developing countries like Pakistan, about 14-20% of patients with diabetes who develop foot ulcers undergo an amputation. 6 Diabetic foot infections are mostly Polymicrobial, 7,8 consisting of both Gram positive and Gram negative aerobic bacteria such as S. aureus, Streptococcus pyogenes, Escherichia coli, Pseudomonas aeruginosa, Proteus and Klebsiella species. 8-11 There are many discrepancies regarding the bacteriology of diabetic foot infections. 12 In some studies Gram positive isolates were found to be the main causative pathogen while in others a predominance of Gram- negative aerobes has been reported. 12 Moreovermanybacterialpathogensimpressivelydevelop the ability to adapt and to overcome the challenges of antibiotics in their environment 10 therefore antimicrobial resistancehasbecomeagrowingproblemindiabeticfoot in developing countries. 13-15 Multiple Drug Resistant (MDR) and Methicillin-Resistant Staphylococcus aureus (MRSA) are two highly challenging situations for a tertiary care Physician. Antimicrobial resistance is also increases morbidity, mortality and cost of treatment and posing a burden on health care system. 13-15 Management of diabetic foot infection is difficult and challenging. The proper management of these infections with the help of culture and antimicrobial susceptibility results may decrease the morbidity and amputation rate. 2,3,5,7 The knowledge regarding frequency and susceptibility pattern of organism are important for the treatment of diabetic foot infections. Therefore the aim of the current study was to determine thetypeoforganismandtheirantimicrobialsusceptibility pattern in Diabetic foot infections at the specialized diabetic foot clinic. Patients and Methods This observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), from January 2013 to March 2014. A total number of 342 patientswithdiabeticfootinfectionswereincludedinthe study.Thedemographicdataofthestudysubjectssuchas J Pak Med Assoc 665 ORIGINAL ARTICLE Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country Zahid Miyan, Asher Fawwad, Rubina Sabir, Abdul Basit Abstract Objective: Todeterminethemicrobiologicalprofileandantibioticsusceptibilitypatternsoforganismsisolatedfrom diabetic foot ulcers in a tertiary care hospital Karachi, Pakistan. Methods: This descriptive study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), fromJanuary2013toMarch2014.Bone,pusandtissuesampleswerecollectedfrom342patientswithdiabeticfoot infections and inoculated on appropriate media. Antibiotic susceptibility tests were done by Kirby Bauer disk diffusion method. Results: A total of 671 aerobic bacteria were isolated from 473 specimens with an average of 1.45 isolates per specimen. Poly-microbial infection was 56.87%. Gram- negative isolates were predominant 76.27%.Staphylococcus aureuswasmostfrequentamongGram-positive20.7%andEscherichiacoli15.72%inGramnegativeisolates.MRSA was found in 26.76% Staphylococcus aureus. About 33.48% of antimicrobial resistant isolates were observed. Conclusions: In our study, Gram negative aerobes were predominant in the diabetic foot infections. A significant numberofMDRisolateswerealsoobservedinthiscohort.Delayedreferralandinappropriateuseofbroadspectrum antibiotics may be the main cause of increase in the frequency of MDR isolates. Keywords: Diabetic foot, Pakistan, Foot ulcer, Antibiotic susceptibility. (JPMA67:665;2017) Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi. Correspondence: Zahid Miyan. Email: drzahidmiyan@yahoo.com