Characteristics of microbial drug resistance and its correlates in chronic diabetic foot ulcer infections

While virulence factors and the biofilm-forming capabilities of microbes are the key regulators of the wound healing process, the host immune response may also contribute in the events following wound closure or exacerbation of non-closure. We examined samples from diabetic and non-diabetic foot ulcers/wounds for microbial association and tested the microbes for their antibiotic susceptibility and ability to produce biofilms. A total of 1074 bacterial strains were obtained with staphylococci, Pseudomonas, Citrobacter and enterococci as major colonizers in diabetic samples. Though non-diabetic samples had a similar assemblage, the frequency of occurrence of different groups of bacteria was different. Gram-negative bacteria were found to be more prevalent in the diabetic wound environment while Gram-positive bacteria were predominant in non-diabetic ulcers. A higher frequency of monomicrobial infection was observed in samples from non-diabetic individuals when compared to samples from diabetic patients. The prevalence of different groups of bacteria varied when the samples were stratified according to age and sex of the individuals. Several multidrug-resistant strains were observed among the samples tested and most of these strains produced moderate to high levels of biofilms. The weakened immune response in diabetic individuals and synergism among pathogenic micro-organisms may be the critical factors that determine the delicate balance of the wound healing process.

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Efek Terapi Oksigen Hiperbarik (TOHB) pada Penyembuhan Ulkus Kaki DM Tipe 2 Berdasarkan Skor PEDIS

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.11.2.2019.23323 ◽

2019 ◽

Vol 11 (2) ◽

pp. 110

Author(s):

Ekanova R. N. Sumarauw ◽

Mendy J. Hatibie ◽

Djony E. Tjandra ◽

Fredrik G. Langi

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Controlled Trial ◽

Healing Process ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Control Group ◽

Wound Healing Process ◽

Holistic Treatment ◽

The Third

Abstract: Diabetic foot ulcer (DFU) is still a health problem related to the extent amount of time in wound healing process hence increasing the treatment cost. Given any methods that are not sat-isfying, encourage the search of other methods that would increase the wound healing rate, in which hyperbaric oxygen therapy (HBOT) is amongst them. The DFU patient that receives HBOT shows a significant increase in angiogenesis process markedly by faster epithelialization and granulation process. This study was aimed to prove that HBOT could accelerate the wound healing process among DFU patients measured by wound size and depth of PEDIS score. This was a ran-domized controlled trial study, conducted at Surgery Department of Prof. Dr. R. D. Kandou Gen-eral Hospital from September 2018 to March 2019. There were 20 DFU patients divided into two groups, each of 10 patients. The control group received a holistic treatment, meanwhile the HBOT group received a holistic treatment added with the inclusion of HBOT. PEDIS score assessment of DFU in HBOT group was measured before and after the third HBOT session, meanwhile the con-trol group was measured on the first and the third day. The results showed that the difference in PEDIS score value was markedly found in HBOT group compared to the control group (2 vs. 0, P=0.001). Conclusion: HBOT could enhance the wound healing process in DFU patients based on the declined PEDIS score.Keywords: HBOT, PEDIS score, diabetic foot ulcerAbstrak: Ulkus kaki diabetik (UKD) masih merupakan masalah kesehatan terkait proses penyembuhan lama sehingga biaya pengobatan meningkat. Belum adanya metode penanganan yang memuaskan, mendorong pencarian metode percepatan penyembuhan luka, salah satunya ialah terapi oksigen hiperbarik (TOHB). Penderita UKD yang menjalani tambahan TOHB diketahui mengalami peningkatan proses angiogenesis yang menghasilkan proses epitelialisasi dan granulasi yang lebih cepat. Tujuan penelitian ialah untuk membuktikan bahwa TOHB dapat mempercepat proses penyembuhan UKD, dinilai berdasarkan ukuran dan kedalaman luka melalui skor PEDIS. Penelitian ini menggunakan randomized controlled trial dan dilaksanakan di Bagian Bedah RSUP Prof. Dr. R.D. Kandou Manado sejak September 2018 sampai dengan Maret 2019. Subyek penelitian sebanyak 20 penderita UKD, dibagi dalam dua kelompok, masing-masing 10 penderita. Kelompok kontrol menjalani penanganan holistik UKD, sedangkan kelompok TOHB menjalani penanganan holistik UKD dengan TOHB. Penilaian skor PEDIS terhadap UKD pada kelompok TOHB dilakukan sebelum dan sesudah TOHB sesi ke-3, sedangkan pada kelompok kontrol dilakukan penilaian pada hari ke-1 dan hari ke-3 sesudahnya. Hasil penelitian mendapatkan bahwa perubahan skor PEDIS yang terjadi antara kedua pengukuran terlihat lebih besar pada kelompok TOHB dibandingkan kelompok kontrol (2 vs 0, P=0,001). Simpulan. TOHB mempercepat proses penyembuhan UKD dinilai dari penurunan skor PEDIS.Kata kunci: TOHB, skor PEDIS, ulkus kaki diabetik

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Micronutrients and Natural Compounds Status and Their Effects on Wound Healing in the Diabetic Foot Ulcer

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734617737659 ◽

2017 ◽

Vol 16 (4) ◽

pp. 244-250 ◽

Cited By ~ 15

Author(s):

Kanokwan Kulprachakarn ◽

Sakaewan Ounjaijean ◽

Jukkrit Wungrath ◽

Raj Mani ◽

Kittipan Rerkasem

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Healing Process ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Herbal Remedies ◽

Current Evidence ◽

Wound Healing Process ◽

Impaired Wound Healing ◽

Wide Range

The diabetic foot ulcer (DFU) is an invariably common complication of diabetes mellitus, it is also a significant cause of amputation as well as extended hospitalization. As most patients with DFU suffer from malnutrition, which has been related to improper metabolic micronutrients status, alterations can affect impaired wound healing process. Micronutrients and herbal remedies applications present a wide range of health advantages to patients with DFU. The purpose of this review is to provide current evidence on the potential effect of dietary supplementations such as vitamins A, C, D, E, magnesium, zinc, copper, iron, boron, and such naturally occurring compounds as Aloe vera, Naringin, and Radix Astragali (RA) and Radix Rehmanniae (RR) in the administration of lower extremity wounds, especially in DFU, and to present some insights for applications in the treatment of DFU patients in the future.

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Topical Application of Teucrium polium Can Improve Wound Healing in Diabetic Rats

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619868629 ◽

2019 ◽

Vol 19 (2) ◽

pp. 132-138 ◽

Cited By ~ 3

Author(s):

Hasan Fallah Huseini ◽

Amir Hossein Abdolghaffari ◽

Maryam Ahwazi ◽

Eghbal Jasemi ◽

Maryam Yaghoobi ◽

...

Keyword(s):

Wound Healing ◽

Healing Process ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Rats ◽

Control Group ◽

Wound Healing Process ◽

Diabetic Patients ◽

Significant Difference ◽

Teucrium Polium

Diabetic foot ulcer is one of the major complications among diabetic patients. Several studies have shown that the extract of Teucrium polium (T. polium) is effective in the treatment of diabetic and non-diabetic wounds, as well as burn wounds. The aim of current study was to assess the wound healing activity of T. polium extract ointment in diabetic rats. Sixty-four male Wistar rats were induced diabetes with alloxan injection (125 mg/kg) and surgical wound induced. The rats were divided into 8 groups of eight rats each: control group, eucerin group, phenytoin group, 2%, 3%, 4%, 5% and 10% T. polium groups. The ointment was dressed on the wound twice a day. The process of wound healing was screened by macroscopy and digitalization on days 14 and 21 and until complete wound healing. There was no infection in the wounds of rats in any groups. The process of wounds healing of the 2%, 3%, 4%, 5%, and 10% T. polium ointments, with phenytoin ointment and base ointment (eucerin) on day 14 and 21, showed that the significant difference between the treatment groups with 4% (P = 0.003), 5% (P = 0.001), 10% (P = 0.001) T. polium ointment and phenytoin ointment group (P = 0.001) compared to eucerin group. The results of this study showed that T. polium extract ointment with a 10% ointment accelerates the wound healing process in diabetic rats and is comparable to the phenytoin group.

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The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

Journal of Clinical Medicine ◽

10.3390/jcm10071495 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1495

Author(s):

Yu-Chi Wang ◽

Hsiao-Chen Lee ◽

Chien-Lin Chen ◽

Ming-Chun Kuo ◽

Savitha Ramachandran ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Healing Rate ◽

Early Period ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Wound Management ◽

Control Group ◽

Diabetic Patients ◽

High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

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Effectiveness of Topical Insulin Dressing in Healing of Diabetic Foot Ulcer among Diabetic Patients

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.3761 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 158-161

Author(s):

Meena P ◽

Monisha V

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Sampling Technique ◽

Diabetic Patients ◽

Chronic Hyperglycemia ◽

Post Test ◽

Quasi Experimental ◽

The Rich

Diabetes is previously known as the disease of the rich people, but now there is no partiality between the rich and poor and it has become the third leading cause of death. Diabetic Mellitus (DM) is a metabolic issue that is characteristics by chronic hyperglycemia; it is a typical and conceivably persistent disease. The aims of the present study to assess the effectiveness of insulin dressing of the diabetic foot ulcer among diabetic patients. A quasi-experimental research design with purposive sampling technique was adopted to conduct a study among 30 diabetic foot ulcer patients. Demography data was collected and wound was measured and insulin dressing was done. After one week the wound was measured. Confidentiality was maintained throughout the procedure. The collected data were analyzed by using descriptive and inferential statistics. Among 30 samples pretest mean score of wound healing among patients with diabetic foot ulcer in the topical insulin dressing was 2.67±0.66 and the post test mean score was 1.43±0.57. The calculated paired ‘t’ test value of t = 15.703 was found to be statistically highly significant at p<0.001 level. The above finding clearly infers that topical insulin dressing to patients with diabetic foot ulcer had significant effect which resulted in the improvement in the level of wound healing among patients with diabetic foot ulcer.

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Rationale of Orthosiphon aristatus for Healing Diabetic Foot Ulcer

Natural Product Communications ◽

10.1177/1934578x20953308 ◽

2020 ◽

Vol 15 (9) ◽

pp. 1934578X2095330

Author(s):

Farah Izana Abdullah ◽

Lee Suan Chua ◽

Siti Pauliena Mohd Bohari ◽

Eka Sari

Keyword(s):

Wound Healing ◽

Plant Extract ◽

Diabetic Foot ◽

Healing Process ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

South East Asia ◽

Diabetic Wound Healing ◽

Preclinical And Clinical Studies ◽

Significant Concentration

Orthosiphon aristatus (Blume) Miq. is traditionally used for wound healing in South East Asia and scientifically proven for its antidiabetic potential. Wounds due to diabetes, especially diabetic foot ulcer (DFU), always involve a complicated healing process. The present work aims to review the information on the rationale of the phytochemicals from O. aristatus in promoting DFU healing. The findings showed that the DFU healing potential of O. aristatus was characterized by a reduction in the blood glucose level, mainly attributed to the significant concentration of constituents such as caffeic acid, rosmarinic acid, and sinensetin in the plant extract. These phytochemicals possibly induce insulin secretion and sensitivity, improve the lipid profile, and stimulate glucose uptake. Furthermore, the healing effect may also be contributed to the antioxidant, anti-inflammatory, and antihyperglycemic properties of the plant. The roles of phytochemicals have been systematically postulated in the 4 phases of the healing process. Moreover, no adverse toxic sign or abnormality has been reported upon oral administration of the plant extract. This suggests that O. aristatus extract could be a potential diabetic wound healing phytomedicine for further preclinical and clinical studies.

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Low level red laser therapy using wavelength 635nm for diabetic foot ulcers: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20190397 ◽

2019 ◽

Vol 6 (2) ◽

pp. 527

Author(s):

Madhavakumaran Pakkiriappan ◽

Manivannan Velayutham ◽

Santhana Mariappan Karthikeyan ◽

Madhavakumaran Pakkiriappan

Keyword(s):

Wound Healing ◽

Laser Therapy ◽

Diabetic Foot ◽

Healing Process ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Laser Wavelength ◽

Contact Method ◽

Initiation Of Therapy ◽

A Prospective Study

Background: Diabetic foot ulcer is one of the important complications of diabetes. After effective debridement and antibiotic therapy, lasers are used to hasten the healing process. Red laser of wavelength 635nm promotes wound healing. This study will aid us to find out the efficacy of red laser wavelength 635nm in healing of diabetic foot ulcers.Methods: After obtaining informed consent, diabetic foot ulcer patients admitted to Rajiv Gandhi government hospital were selected based on non-probability convenience sampling. Necessary history obtained, clinical examination of the ulcer done, investigations done. Cases are given 30minutes of laser therapy by non-contact method before regular ulcer dressing. Controls are given saline dressing. Ulcer area measured before initiation of therapy and measured at 1st week, 2nd week and 3rd week after initiation of therapy.Results: Wound contraction rate was 39.65% with laser and 11.26% with saline dressing alone (p<0.001). The data were statistically significant; thus, laser have wound healing property.Conclusions: Cases have more mean contraction percentage than controls (37.99% versus 11.68%, p<0.001). So LLLT is an effective therapy to heal diabetic ulcers. Need for additional surgeries can be avoided by using LLLT.

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Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

Endocrine Regulations ◽

10.2478/enr-2020-0023 ◽

2020 ◽

Vol 54 (3) ◽

pp. 207-216

Author(s):

Ignatius U. Ezeani ◽

Ejiofor T. Ugwu ◽

Funmi O. Adeleye ◽

Ibrahim D. Gezawa ◽

Innocent O. Okpe ◽

...

Keyword(s):

Wound Healing ◽

Renal Impairment ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Adverse Outcomes ◽

Diabetic Patients ◽

Chi Square ◽

Grade 3

AbstractObjective. The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU.Methods. The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing.Results. The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004–0.332). This was followed by PAD (OR 0.093; 95% CI 0.028–0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030–0.395), anemia (OR 0.179; 95% CI 0.056–0.571).Conclusion. Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.

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Advance-Platelet Rich Fibrin and Hyaluronic Acid Combination Improves Interleukin-6 and Granulation Index in Diabetic Foot Ulcer Patients

The Indonesian Biomedical Journal ◽

10.18585/inabj.v13i2.1501 ◽

2021 ◽

Vol 13 (2) ◽

pp. 170-7

Author(s):

Ronald Winardi Kartika ◽

Idrus Alwi ◽

Franciscus Dhyanagiri Suyatna ◽

Em Yunir ◽

Sarwono Waspadji ◽

...

Keyword(s):

Wound Healing ◽

Hyaluronic Acid ◽

Interleukin 6 ◽

Diabetic Foot ◽

Healing Process ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Fibrin Gel ◽

Platelet Rich Fibrin ◽

Wound Protection

BACKGROUND: Diabetic foot ulcer (DFU) is the most common and threatening complication of Diabetes Mellitus (DM). Ideal wound dressing for DFU management should relieve symptoms, provide wound protection, and encourage healing. Advanced-Platelet Rich Fibrin (A-PRF) and Hyaluronic Acid (HA) have been proven to improve wound healing process. This study was aimed to demonstrate the ability of combination of A-PRF and HA in reducing inflammation and improving DFU tissue healing.METHODS: Twenty DFU subjects were involved in this study, and divided into two groups based on the topical fibrin gel treatment: A-PRF + HA group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. A-PRF + HA was prepared by homogening A-PRF and AH with a ratio of 1:0.6. Interleukin-6 (IL-6) level, granulation index (GI), numeric pain score (NPS), and inflammation clinical symptoms (ICS) were assessed on day-0, 3, 7 and 14.RESULTS: Wound swabs’ IL-6 level on day-7 was found to be significantly lower in A-PRF + HA compared to A-PRF alone (p=0.041). The IL-6 level reduction also found to be significant higher either in wound swabs (day 0-7, p=0.015) or fibrin gel (day 0-3, p=0.049; day 0-7, p=0.034). A-PRF + HA treatment significantly increased the GI even since day-3 (p=0.043), with lower NPS (p<0.001), and ICS score.CONCLUSION: The combination of A-PRF and HA increases the GI in DFU healing by reducing the inflammation state which will induce the angiogenesis process, as well as reducing pain in DFU subjects better than A-PRF alone.KEYWORDS: inflammation, interleukin-6, wound healing, angiogenesis, proliferation

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Quantitative Studies of Diabetic Foot Ulcer Evolution Under Treatment by Digital Stereotactic Photography

Journal of Diabetes Science and Technology ◽

10.1177/1932296819853843 ◽

2019 ◽

Vol 13 (5) ◽

pp. 821-826

Author(s):

Carlos Alberto Cabal Mirabal ◽

Jorge Berlanga Acosta ◽

José Fernández Montequín ◽

Leonardo Oramas Díaz ◽

Evelio González Dalmau ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Healing Process ◽

Main Idea ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Digital Photography ◽

Tissue Loss ◽

Color Changes ◽

Relative Contribution

Background: Imaging the lower extremity reproducibly and accurately remains an elusive goal. This is particularly true in the high risk diabetic foot, where tissue loss, edema, and color changes are often concomitant. The purpose of this study was to evaluate the reproducibility of a novel and inexpensive stereotaxic frame in assessment of wound healing. Methods: The main idea is to keep constant and reproducible the relative position of extremities related to the sensor used for the examination during a serial studies by stereotaxic digital photographic sequence. Ten healthy volunteers were evaluated at 10 different time moments to estimate the foot position variations in the stereotaxic frame. The evolution of 40 of DFU patients under treatment was evaluated before and during the epidemical grow factor intralesional treatment. Results: The wound closing and granulation speeds, the relative contribution of the contraction and tissue restauration mechanism were evaluated by stereotaxic digital photography. Conclusions: The results of this study suggest that the stereotaxic frame is a robust platform for serial study of the evolution of wound healing which allow to obtain consistent information from a variety of visible and hyperspectral measurement technologies. New stereotaxic digital photography evidences related to the diabetic foot ulcer healing process under treatment has been presented.

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