الفهرس 
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Abstract
Diabetes mellitus (DM) is one of the most challenging worldwide health problems. Diabetic foot infection is considered the most common cause of diabetes-related hospitalization. Diabetic foot ulcers are subjected to bacterial colonization, these bacteria are embedded within a self-produced protective extracellular matrix, and together they constitute the biofilm. Biofilms represent a great challenge to physicians because of their diverse properties and clinical recalcitrance despite antimicrobial therapy.
The aim of this study was to identify the spectrum of bacteria associated with diabetic foot infection, to assess the biofilm formation by the clinical isolates from diabetic foot infection, to evaluate differences in antibiotic susceptibility pattern between planktonic and biofilm phases of these clinical isolates, in addition to determine the antibiotics which are active on the organism in the biofilm phase.
The study comprised 50 patients with infected diabetic foot ulcers admitted to the vascular surgery department (vascular ward and diabetic foot unit) in Alexandria Main University Hospital.
A deep swab was collected from each patient. The specimens were cultured on blood, MacConkey’s and Sabouraud’s dextrose agar. All isolates were identified according to the standard microbiological procedures and tested for antimicrobial susceptibility according to CLSI guidelines using Bauer-Kirby disc diffusion technique.
Isolates were screened for biofilm formation by tissue culture plate method. Biofilm forming isolates were further subjected to MIC determination of different antimicrobials using automated Vitek apparatus except for MICs of levofloxacin and cefoperazone/ sulbactam which were detected manually using broth microdilution method.
MBEC assays were performed for selected antibiotic, namely; levofloxacin, gentamycin, cefepime, meropenem, and cefoperazone/sulbactam for Gram negative organisms and levofloxacin, gentamicin, vancomycin, linezolid, doxycycline, and clindamycin for Gram positive organisms.