Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers

Multidrug-resistant organism infections have become important in recent years due to the increased prevalence of diabetic foot ulcers and their possible consequences. This study aimed to systematically review and evaluate ulcer duration, healing time, hospital stay, amputation, and mortality rates in patients with diabetic foot ulcers caused by infection with multidrug-resistant organisms. PubMed, the Cochrane Library, and Web of Science were searched in May 2020 to find observational studies in English about the clinical outcomes of multidrug-resistant organism infection in diabetic foot ulcers. Eight studies met the inclusion criteria, and these studies included 923 patients. The overall methodological quality of the study was moderate. Ulcer duration was described in six studies, and there was no practical association with multidrug-resistant organisms. Two out of three studies reported a longer healing time in multidrug-resistant organism infections than in non-multidrug-resistant organism infections. Clinical outcomes included the duration of hospitalisation, surgeries, amputations, and deaths. Lower limb amputation was the most reported clinical outcome in the included studies, and was more prevalent in the multidrug-resistant organism infections. We concluded that there was not enough evidence that multidrug-resistant organisms hindered the healing of diabetic foot ulcers. In contrast to the clinical outcomes, multidrug-resistant organisms affect both amputation rates and mortality rates.

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SAT-045-Prevalence, type and risk factors of colonization by multidrug-resistant bacteria in a large series of patients with decompensated cirrhosis

Journal of Hepatology ◽

10.1016/s0618-8278(19)31287-3 ◽

2019 ◽

Vol 70 (1) ◽

pp. e646-e647

Author(s):

Maria Hernandez-Tejero ◽

Fatima Aziz ◽

Cristina Pitart ◽

Francesc Marco Reverte ◽

Irene Campo ◽

...

Keyword(s):

Risk Factors ◽

Multidrug Resistant ◽

Large Series ◽

Decompensated Cirrhosis ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria

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Risk Factors Associated with Amputation-Free Survival in Patient with Diabetic Foot Ulcers

Yonsei Medical Journal ◽

10.3349/ymj.2014.55.5.1373 ◽

2014 ◽

Vol 55 (5) ◽

pp. 1373 ◽

Cited By ~ 22

Author(s):

Sung Hun Won ◽

Chin Youb Chung ◽

Moon Seok Park ◽

Taeseung Lee ◽

Ki Hyuk Sung ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Free Survival ◽

Factors Associated

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Risk factors, ulcer grade and management outcome of diabetic foot ulcers in a Tropical Tertiary Care Hospital

Nigerian Medical Journal ◽

10.4103/0300-1652.108900 ◽

2013 ◽

Vol 54 (1) ◽

pp. 59 ◽

Cited By ~ 13

Author(s):

AndrewE Edo ◽

GloriaO Edo ◽

IgnatiusU Ezeani

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Foot Ulcers ◽

Care Hospital ◽

Diabetic Foot Ulcers

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Alternative Approaches for the Management of Diabetic Foot Ulcers

Frontiers in Microbiology ◽

10.3389/fmicb.2021.747618 ◽

2021 ◽

Vol 12 ◽

Author(s):

Cassandra Pouget ◽

Catherine Dunyach-Remy ◽

Alix Pantel ◽

Adeline Boutet-Dubois ◽

Sophie Schuldiner ◽

...

Keyword(s):

Diabetic Foot ◽

Current Knowledge ◽

Healing Process ◽

Public Health Problem ◽

Skin Surface ◽

Multidrug Resistant ◽

Limb Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Alternative Approaches

Diabetic foot ulcers (DFU) represent a growing public health problem. The emergence of multidrug-resistant (MDR) bacteria is a complication due to the difficulties in distinguishing between infection and colonization in DFU. Another problem lies in biofilm formation on the skin surface of DFU. Biofilm is an important pathophysiology step in DFU and may contribute to healing delays. Both MDR bacteria and biofilm producing microorganism create hostile conditions to antibiotic action that lead to chronicity of the wound, followed by infection and, in the worst scenario, lower limb amputation. In this context, alternative approaches to antibiotics for the management of DFU would be very welcome. In this review, we discuss current knowledge on biofilm in DFU and we focus on some new alternative solutions for the management of these wounds, such as antibiofilm approaches that could prevent the establishment of microbial biofilms and wound chronicity. These innovative therapeutic strategies could replace or complement the classical strategy for the management of DFU to improve the healing process.

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Toward Machine-Learning-Based Decision Support in Diabetes Care: A Risk Stratification Study on Diabetic Foot Ulcer and Amputation

Frontiers in Medicine ◽

10.3389/fmed.2020.601602 ◽

2021 ◽

Vol 7 ◽

Author(s):

Zeinab Schäfer ◽

Andreas Mathisen ◽

Katrine Svendsen ◽

Susanne Engberg ◽

Trine Rolighed Thomsen ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Diabetic Foot ◽

National Registry ◽

Registry Data ◽

Data Sources ◽

Machine Learning Techniques ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Patients With Diabetes

Diabetes mellitus is associated with serious complications, with foot ulcers and amputation of limbs among the most debilitating consequences of late diagnosis and treatment of foot ulcers. Thus, prediction and on-time treatment of diabetic foot ulcers (DFU) are of great importance for improving and maintaining patients' quality of life and avoiding the consequent socio-economical burden of amputation. In this study, we use Danish national registry data to understand the risk factors of developing diabetic foot ulcers and amputation among patients with diabetes. We analyze the data of 246,705 patients with diabetes to assess some of the main risk factors for developing DFU/amputation. We study the socioeconomic information and past medical history of the patients. Factors, such as low family disposable income, cardiovascular disorders, peripheral artery, neuropathy, and chronic renal complications are among the important risk factors. Mental disorders and depression, albeit not as pronounced, still pose higher risks in comparison to the group of people without these complications. We further use machine learning techniques to assess the practical usefulness of such risk factors for predicting foot ulcers and amputation. Finally, we outline the limitations of working with registry data sources and explain potentials for combining additional public and private data sources in future applications of artificial intelligence (AI) to improve the prediction of diabetic foot ulcers and amputation.

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