Epidemiology, Antimicrobial Resistance Patterns, Management, and Predictors of Mortality in Diabetic Foot Infections in a Lebanese Hospital: A Retrospective Observational Study

Background Diabetic foot infections (DFIs) are a common and serious complication of type II diabetes mellitus, contributing to morbidity and mortality. Their management is often complicated by its etiology, antimicrobial resistance, and treatment practices. In Lebanon, recent epidemiological data and local treatment guidelines remain limited. This study aimed to investigate the antimicrobial susceptibility of DFIs, evaluate the appropriateness of initial therapy, and identify predictors of mortality. Methods This retrospective observational study included hospitalized patients with confirmed DFIs at a tertiary care university hospital in Beirut, Lebanon. Medical records from 2020 to 2025 were reviewed. Kaplan-Meier survival and multivariable logistic regression analyses were conducted to identify predictors of mortality. Results Out of 343 DFI cases, 160 patients were included. Most infections were community-acquired (145, 90.6%), and nearly half were of moderate severity (49.4%). Gram-negative bacteria predominated (70.4%), mainly Pseudomonas aeruginosa . The prevalence of MRSA among Staphylococcus aureus was 43.2%. Nearly one-third received inappropriate initial antimicrobial therapy (32.5%). The 60-day mortality was 11.9%. Higher Charlson Comorbidity Index (CCI) (Adjusted Odds Ratio [AOR] = 1.77, P = 0.001) and severe infection (PEDIS grade 4; AOR = 10.05, P = 0.001) were independently associated with increased mortality, whereas surgical management was associated with significantly reduced odds of death (AOR = 0.13, P = 0.02). Conclusion In Lebanon, DFIs are mainly caused by Gram-negative pathogens, with notable MRSA prevalence, and frequently managed with inappropriate initial antimicrobial therapy. Increased comorbidity burden and severe infection independently predict higher 60-day mortality, whereas timely surgical management is associated with a significant reduction in death. These findings highlight critical gaps in current practice and emphasize the need for strengthened antimicrobial stewardship, early risk stratification, and timely, targeted therapeutic and surgical management to improve patient outcomes.