KARACHI: Infections caused by multidrug-resistant (MDR) bacteria are worsening the diabetic foot crisis in Pakistan, driving up treatment costs, leaving patients with fewer therapeutic options and pushing amputation rates to alarming levels.

These concerns were raised at a scientific session on Saturday as part of the international conference titled “Diabetes and Diabetic Foot 2025”, which began on Friday at a local hotel. The three-day event was organised by the Baqai Institute of Diabetology and Endocrinology (BIDE) in collaboration with Baqai Medical University and Diabetic Foot International, and concludes today (Sunday).

Opening the session, BIDE Deputy Director Dr Saif-ul-Haq said around 74 per cent of diabetic foot ulcers were infected with more than one multidrug-resistant bacteria, which were extremely difficult to treat.

“Treatment of these wounds is not only challenging and costly but often leads to amputations if patients fail to report at tertiary-care facilities,” he said.

Three-day international conference on diabetes underway

Dr Saif noted that the incidence of MDR bacteria in infected wounds had been steadily rising, with treatment of a single case now requiring prolonged courses of injectable antibiotics costing between Rs150,000 and Rs200,000

“Most patients cannot afford these medicines, and many discontinue treatment midway. That is when amputations become inevitable,” he regretted, urging both doctors and the public to curb the reckless misuse of antibiotics, which has accelerated resistance.

“Unfortunately, doctors are to blame for overprescribing, while people also self-medicate with antibiotics. Combined with the diabetes crisis, this is becoming one of Pakistan’s most serious health emergencies,” he warned.

‘MDR bacteria a nightmare’

Prof Javed Akram, President of the Pakistan Society of Internal Medicine, described drug-resistant bacteria as “a nightmare” in the country’s hospitals.

“In people with diabetes, neuropathy damages nerves in the feet, so they do not feel minor injuries. These wounds quickly turn into ulcers and, when infected with resistant bacteria, there is often no option left but amputation,” he explained.

Prof Akram stressed that unchecked antibiotic use, weak regulation and limited laboratory testing were fuelling resistance.

“If we do not act now, we will see a generation of diabetics losing limbs because our drugs have stopped working,” he cautioned.

Wound-care specialist Gulnaz Tariq advised doctors to minimise antibiotic use and instead adopt antimicrobial sprays, ointments and dressings for managing diabetic foot ulcers. She also called for major investment in education — not only for doctors but also for patients and families — so wounds could be managed effectively at home.

International speakers highlighted the importance of early diagnosis and innovative detection methods. Prof Zulfiqar G. Abbas from Tanzania discussed new tools to identify diabetic neuropathy in its earliest stages, saying timely screening could help prevent ulcers and reduce infection risk.

BIDE Director Prof Zahid Miyan reiterated that diabetes had become one of Pakistan’s deadliest health challenges, not only because of heart disease, kidney failure and blindness, but also due to the growing burden of diabetic foot complications.

Ali Asghar of Liaquat National Hospital added that diabetes in 50pc of cases in Pakistan remained uncontrolled despite available therapies, underscoring the need for wider insulin use.

“Unless we control blood sugar, no wound-care or antibiotic strategy will succeed,” he emphasised.

Several other leading experts — including Prof Roberto Anichini from Italy, William Akiki from Lebanon, Prof Uzma Khan from the United States, Prof Erid Senneville from France and Prof Willbert Van Laar from the Netherlands — also shared insights on best practices and new technologies for preventing diabetic amputations.

Speakers noted that local studies show resistant bacteria such as Pseudomonas, Klebsiella and MRSA (methicillin-resistant Staphylococcus aureus) are now common in foot infections, with one in three samples failing to respond to standard antibiotics. Poor blood supply to the legs, biofilm-protected bacteria and delayed hospital visits made treatment even more difficult, they said.

Doctors underscored the urgent need for early detection, proper foot care and strict antibiotic stewardship to tackle the crisis. Without these measures, they warned, Pakistan’s already high amputation rates will rise further, devastating families and leaving more people with lifelong disability.

Published in Dawn, August 17th, 2025