Insight into multidrug-resistant microorganisms from microbial infected 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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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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Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers

Diabetes & Metabolism ◽

10.1016/j.diabet.2008.02.005 ◽

2008 ◽

Vol 34 (4) ◽

pp. 363-369 ◽

Cited By ~ 54

Author(s):

J.-L. Richard ◽

A. Sotto ◽

N. Jourdan ◽

C. Combescure ◽

D. Vannereau ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Multidrug Resistant ◽

Foot Ulcers ◽

Resistant Bacteria ◽

Diabetic Foot Ulcers ◽

Multidrug Resistant Bacteria

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Identification of biofilm-producing microorganism’s and drug susceptibility pattern from diabetic foot ulcer patients at Puducherry

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3916 ◽

2020 ◽

Vol 11 (4) ◽

pp. 7353-7357

Author(s):

Jayarani Manikandan ◽

Jaikumar S ◽

Sandhya Rani T

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Multidrug Resistant ◽

Diffusion Method ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Isolation And Identification ◽

Diabetic Ulcer ◽

Biofilm Production

Diabetes mellitus is a significant health problem worldwide that affects approximately 171 million people; severe complications lead to the development of diabetic foot ulcers. Diabetic ulcer infections are mainly polymicrobial in nature and multidrug-resistant (MDR), which is capable of forming a biofilm, which is the important virulence factor results in treatment failure. The main objectives of this study to investigate the etiologic agents of diabetic foot infections, their antimicrobial resistance and biofilm formation. A total of 200 patient samples were taken from diabetic foot ulcer patients between September 2015 and February 2016. Isolation and identification of microorganism were made according to standard microbiological procedures. Antibiotic Susceptibility testing performed by Kirby Bauer disc diffusion method and the biofilm production was performed by the tube method and Congo Red Method. Out of 200 samples processed, 110 (55%) were polymicrobial, 50 (25%) monomicrobial and 40(20 %)culture Sterile. The most common organism isolated were 82(39%) Pseudomonas aeruginosa,45(21%) Staphylococcus aureus, 48(23%) Candida sp followed by others. Biofilm production was seen in 112 (53%) of the isolates. Antimicrobial drug resistance was higher among 92(82%) biofilm producers than non-biofilm 20(18%) producing microorganisms. Organisms isolated from chronic diabetic foot ulcers cases were multidrug-resistant and biofilm producers. Our study shows the importance of biofilm screening with the usual antibiogram, as a routine technique in diabetic foot ulcers patients for effective treatment.

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Attack of the NETs! NETosis primes IL-1β-mediated inflammation in diabetic foot ulcers

Clinical Science ◽

10.1042/cs20200240 ◽

2020 ◽

Vol 134 (12) ◽

pp. 1399-1401

Author(s):

Man K.S. Lee ◽

Gopalkrishna Sreejit ◽

Prabhakara R. Nagareddy ◽

Andrew J. Murphy

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Healing Process ◽

Foot Ulcers ◽

Wound Healing Process ◽

Inflammasome Activation ◽

Diabetic Foot Ulcers ◽

Nlrp3 Inflammasome Activation ◽

Improve Wound Healing ◽

Insight Into

Abstract In volume 133 issue 4 of Clinical Science, Liu et al. showed that neutrophils release extracellular traps (NETs) in the setting of diabetes which acts as a stimulus for NLRP3 inflammasome activation in macrophages to promote IL1β-dependent exacerbation of inflammation. They also provide evidence to show that degrading NETs improves the wound healing process. These findings provide an insight into how NETs communicate with other cells in the vicinity (e.g. macrophages) to exacerbate the inflammatory response. Most importantly, they provide novel avenues to improve wound healing process such as diabetic foot ulcers (DFUs) by targeting NETs.

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Isolation and Genetic Analysis of Multidrug Resistant Bacteria from Diabetic Foot Ulcers

Frontiers in Microbiology ◽

10.3389/fmicb.2015.01464 ◽

2016 ◽

Vol 6 ◽

Cited By ~ 7

Author(s):

Shailesh K. Shahi ◽

Ashok Kumar

Keyword(s):

Genetic Analysis ◽

Diabetic Foot ◽

Multidrug Resistant ◽

Foot Ulcers ◽

Resistant Bacteria ◽

Diabetic Foot Ulcers ◽

Multidrug Resistant Bacteria

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MON-626 Frequency and Associated Factors with Multidrug-Resistant Organism Infection in Diabetic Foot Ulcers in a Peruvian Public Hospital

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1209 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Marlon Augusto Yovera-Aldana ◽

Liset Paola Sifuentes ◽

Delia Cruz-Estacio ◽

Diana Consuelo Flores ◽

Lucy Nelly Damas-Casani

Keyword(s):

Clinical Practice ◽

Diabetic Foot ◽

Associated Factors ◽

Public Hospital ◽

Multidrug Resistant ◽

Foot Ulcers ◽

Bivariate Analysis ◽

Resistant Organism ◽

Diabetic Foot Ulcers ◽

International Expert

Abstract Objective: To determine the frequency and associated factors with multidrug-resistant organism (MDRO) infection among patients with diabetic foot ulcers in a Peruvian Public Hospital. Materials and methods. Cross-sectional survey was conducted from January 2017 -December 2018 at National Hospital in Lima Perú. Ulcers with clinical signs of infection (erythema, edema, pain, purulent exudate) according Infectious Diseases Society of America clinical practice guideline were included1. Wounds with only skin involvement were excluded. On admission, specimens for culture were obtained after cleansing and debriding of the wound. Samples were promptly sent to the microbiology laboratory for culture using appropriate transport media. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK® 2 automated system (BioMérieux Laboratory, Argentina). Multidrug-resistant organisms were identified according to the recommendations of International Expert Proposal2. Prevalence ratios derived from bivariate analysis are given with their 95% CI, which was performed to study factors associated with the presence of multidrug-resistant bacteria; and a multivariate analysis with a lineal model to associated variables found in the bivariate analysis. This study has the approval of the Research Ethics Committee of the María Auxiliadora Hospital. Results Among 153 selected subjects, 75% were male, with an average age of 59 yo, 70% had ≥10 years of diabetes duration and only 16% had HbA1C <7%. A frequency of 85% of patients with MDRO infection was found and was associated with minor amputation RP 1.18 (95% CI 1.01-1.44) and with hospitalization time of ≥ 28 days RP 1.21 (95% CI 1.03-1.30). Conclusion. 6 of 7 patients have MDRO infection among patients with diabetic foot ulcers and are associated with the occurrence of minor amputation and hospitalization time ≥ 28 days. References 1. Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-73. 2. Magiorakos AP, et al. Multidrug-resistant, extensively drug-resistant and pandrugresistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.

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