scholarly journals Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Apoorva Jnana ◽  
Vigneshwaran Muthuraman ◽  
Vinay Koshy Varghese ◽  
Sanjiban Chakrabarty ◽  
Thokur Sreepathy Murali ◽  
...  
Keyword(s):  
Community Structure ◽  
Microbial Community ◽  
Diabetic Foot ◽  
Antibiotic Susceptibility ◽  
Morbidity And Mortality ◽  
Wound Management ◽  
Foot Ulcers ◽  
High Morbidity ◽  
Diabetic Foot Ulcers ◽  
Core Microbiome

ABSTRACT Diabetic foot ulcer (DFU) is a major complication of diabetes with high morbidity and mortality rates. The pathogenesis of DFUs is governed by a complex milieu of environmental and host factors. The empirical treatment is initially based on wound severity since culturing and profiling the antibiotic sensitivity of wound-associated microbes is time-consuming. Hence, a thorough and rapid analysis of the microbial landscape is a major requirement toward devising evidence-based interventions. Toward this, 122 wound (100 diabetic and 22 nondiabetic) samples were sampled for their bacterial community structure using both culture-based and next-generation 16S rRNA-based metagenomics approach. Both the approaches showed that the Gram-negative microbes were more abundant in the wound microbiome. The core microbiome consisted of bacterial genera, including Alcaligenes, Pseudomonas, Burkholderia, and Corynebacterium in decreasing order of average relative abundance. Despite the heterogenous nature and extensive sharing of microbes, an inherent community structure was apparent, as revealed by a cluster analysis based on Euclidean distances. Facultative anaerobes (26.5%) were predominant in Wagner grade 5, while strict anaerobes were abundant in Wagner grade 1 (26%). A nonmetric dimensional scaling analysis could not clearly discriminate samples based on HbA1c levels. Sequencing approach revealed the presence of major culturable species even in samples with no bacterial growth in culture-based approach. Our study indicates that (i) the composition of core microbial community varies with wound severity, (ii) polymicrobial species distribution is individual specific, and (iii) antibiotic susceptibility varies with individuals. Our study suggests the need to evolve better-personalized care for better wound management therapies. IMPORTANCE Chronic nonhealing diabetic foot ulcers (DFUs) are a serious complication of diabetes and are further exacerbated by bacterial colonization. The microbial burden in the wound of each individual displays diverse morphological and physiological characteristics with unique patterns of host-pathogen interactions, antibiotic resistance, and virulence. Treatment involves empirical decisions until definitive results on the causative wound pathogens and their antibiotic susceptibility profiles are available. Hence, there is a need for rapid and accurate detection of these polymicrobial communities for effective wound management. Deciphering microbial communities will aid clinicians to tailor their treatment specifically to the microbes prevalent in the DFU at the time of assessment. This may reduce DFUs associated morbidity and mortality while impeding the rise of multidrug-resistant microbes.

scholarly journals Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

2020 ◽  
Author(s):  
Olufunmilayo O Adeleye ◽  
Ejiofor T Ugwu ◽  
Ibrahim D Gezawa ◽  
Innocent Okpe ◽  
Ignatius Ezeani ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Hospital Mortality ◽  
Cardiac Failure ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Diabetic Foot Ulcers ◽  
Grade 3

Abstract Background: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria.Methods:The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number.Results: Three hundred and twenty three type 2 DM subjects with mean age and mean duration of DM of 57.2 11.4 years and 8.7± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > one month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p <0.001), positive blood cultures (p<0.001), low HDL (p <0.001), shock at presentation (p<0.001), cardiac failure (p 0.027),and renal impairment (p <0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349 – 5.971) were significantly predictive of mortality independent of other variables.Conclusions: This study showed high intra-hospital mortality among patients with DFU, with majority of deaths occurring among those with advanced ulcers, bacteremia, cardiac failure and renal impairment. Prompt attention to these factors might be helpful in improving survival from DFU in Nigeria.

scholarly journals Combination Therapy Revives Hope for Patients with Diabetic Foot Ulcer: A Case Report

2021 ◽  
Author(s):  
Naser Parizad ◽  
Kazem Hajimohammadi ◽  
Rasoul Goli
Keyword(s):  
Case Report ◽  
Combination Therapy ◽  
Diabetic Foot ◽  
Wound Care ◽  
Stable Condition ◽  
Foot Ulcer ◽  
Wound Management ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Present Case Report

Abstract BackgroundDiabetic foot ulcers, as one of the most debilitating complications of diabetes, can lead to amputation. Treatment and management of diabetic foot ulcers are among the most critical challenges for the patients and their families. Case presentationThe present case report is of a 63-year-old man with a 5-year history of uncontrolled type 2 diabetes who has had diabetic foot ulcers for the past three years on three sites of the left external ankle in the form of two deep circular ulcers with sizes of 6×4 cm and 6×8 cm, the sole as a superficial ulcer with a size of 6×3 cm, and the left heel as a deep skin groove. Moreover, the left hallux was completely gangrenous. The patient's ulcers were infected with Staphylococcus aureus and multidrug-resistant Pseudomonas aeruginosa. Despite antibiotic therapy and routine dressing changes, the patient showed no improvement during the hospital stay. Accordingly, the patient was transferred to our service after consulting with the wound management team. Diabetic foot ulcers were treated and managed using a combination of maggot therapy, the Negative Pressure Wound Therapy (NPWT), and silver foam dressing. After three months and ten days, the patient's ulcers completely healed, and he was discharged from our service with the excellent and stable condition. ConclusionsBased on the present case report study's clinical results, wound-care teams can use the combination therapy applied in this study to treat refractory diabetic foot ulcers.

scholarly journals Application of 3D Bioprinting Technologies to the Management and Treatment of Diabetic Foot Ulcers

Biomedicines ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. 441
Author(s):  
Chew Teng Tan ◽  
Kun Liang ◽  
Zong Heng Ngo ◽  
Christabel Thembela Dube ◽  
Chin Yan Lim
Keyword(s):  
Diabetic Foot ◽  
Skin Grafting ◽  
Current Treatment ◽  
Wound Dressings ◽  
Wound Management ◽  
Healthcare Sector ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
3D Bioprinting ◽  
Skin Substitutes

Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. Diabetic foot ulcers (DFUs) are a serious complication of DM. It is estimated that 15–25% of DM patients develop DFU at least once in their lifetime. The lack of effective wound dressings and targeted therapy for DFUs often results in prolonged hospitalization and amputations. As the incidence of DM is projected to rise, the demand for specialized DFU wound management will continue to increase. Hence, it is of great interest to improve and develop effective DFU-specific wound dressings and therapies. In the last decade, 3D bioprinting technology has made a great contribution to the healthcare sector, with the development of personalized prosthetics, implants, and bioengineered tissues. In this review, we discuss the challenges faced in DFU wound management and how 3D bioprinting technology can be applied to advance current treatment methods, such as biomanufacturing of composite 3D human skin substitutes for skin grafting and the development of DFU-appropriate wound dressings. Future co-development of 3D bioprinting technologies with novel treatment approaches to mitigate DFU-specific pathophysiological challenges will be key to limiting the healthcare burden associated with the increasing prevalence of DM.

scholarly journals Bacterial Diversity of Diabetic Foot Ulcers: Current Status and Future Prospectives

2019 ◽  
Vol 8 (11) ◽  
pp. 1935 ◽  
Author(s):  
Fatemah Sadeghpour Heravi ◽  
Martha Zakrzewski ◽  
Karen Vickery ◽  
David G. Armstrong ◽  
Honghua Hu
Keyword(s):  
Diabetic Foot ◽  
Bacterial Communities ◽  
High Sensitivity ◽  
Current Status ◽  
Foot Ulcers ◽  
High Morbidity ◽  
Diabetic Foot Ulcers ◽  
Bacterial Identification ◽  
Molecular Approaches ◽  
The Impact

Diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs) are associated with reduced patient quality of life, lower-extremity amputation, hospitalization, and high morbidity and mortality. Diverse bacterial communities have been identified in DFUs/DFIs, playing a significant role in infection prognosis. However, due to the high heterogeneity of bacterial communities colonized in DFUs/DFIs, culture-based methods may not isolate all of the bacterial population or unexpected microorganisms. Recently, high sensitivity and specificity of DNA (metagenomics) and RNA (metatranscriptomics) technologies have addressed limitations of culture-based methods and have taken a step beyond bacterial identification. As a consequence, new advances obtained from DNA- and RNA-based techniques for bacterial identification can improve therapeutic approaches. This review evaluated the current state of play in aetiology of DFUs/DFIs on culture and molecular approaches, and discussed the impact of metagenomic and metatranscriptomic methods in bacterial identification approaches.

Assessment of diabetic foot ulcers based on pictorial material: an interobserver study

2020 ◽  
Vol 29 (11) ◽  
pp. 658-663
Author(s):  
Tue Smith Jørgensen ◽  
Ylva Hellsten ◽  
Hans Gottlieb ◽  
Stig Brorson
Keyword(s):  
Diabetic Foot ◽  
Interobserver Agreement ◽  
Wound Care ◽  
Wound Management ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Pictorial Material ◽  
Frequent Change ◽  
Level Of Education ◽  
Care Training

Objective: The frequent change in clinicians, and the emerging use of photographic documentation in wound management, could require a more diverse treatment of patients due to poor interobserver agreement. The aim of this study was to assess the interobserver agreement of a commonly used classification system for diabetic foot ulcers (DFUs), the Meggitt–Wagner classification, and to compare the agreement on classification with the agreement in treatment recommendations. Method: An interobserver study was conducted based on a questionnaire linked to 30 photographs of DFUs. Different groups of observers were tested to investigate whether there was a difference between professions or level of education: experienced orthopaedic wound care doctors (n=7); nurses specialised in wound care (n=8) and untrained nurses assigned to a diabetic wound care training course (n=23). Krippendorff's alpha was used to calculate interobserver agreement, and an agreement of >0.67 was defined as substantial. Results: The Krippendorff's alpha value for interobserver agreement on the Meggitt–Wagner classification was 0.52 for the doctors group, 0.67 for the specialised nurses and 0.61 for the untrained nurses. The corresponding values regarding agreement on recommendation of surgical revision of the wound were 0.35, 0.22 and 0.15, respectively. The choice of dressing type or antibiotic treatment had even lower interobserver agreement. Conclusions: The interobserver agreement on the Meggitt–Wagner classification was substantial in the specialised nurse group, but the evaluation and treatment of DFUs should not be exclusively based on pictorial materials.

scholarly journals The dynamic wound microbiome

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Chunan Liu ◽  
Alise J. Ponsero ◽  
David G. Armstrong ◽  
Benjamin A. Lipsky ◽  
Bonnie L. Hurwitz
Keyword(s):  
Diabetic Foot ◽  
Postoperative Mortality ◽  
High Rate ◽  
Wound Management ◽  
Taxonomic Resolution ◽  
Foot Ulcers ◽  
Main Body ◽  
Diabetic Foot Ulcers ◽  
Accurate Identification ◽  
Sequencing Technologies

Abstract Background Diabetic foot ulcers (DFUs) account for the majority of all limb amputations and hospitalizations due to diabetes complications. With 30 million cases of diabetes in the USA and 500,000 new diagnoses each year, DFUs are a growing health problem. Diabetes patients with limb amputations have high postoperative mortality, a high rate of secondary amputation, prolonged inpatient hospital stays, and a high incidence of re-hospitalization. DFU-associated amputations constitute a significant burden on healthcare resources that cost more than 10 billion dollars per year. Currently, there is no way to identify wounds that will heal versus those that will become severely infected and require amputation. Main body Accurate identification of causative pathogens in diabetic foot ulcers is a critical component of effective treatment. Compared to traditional culture-based methods, advanced sequencing technologies provide more comprehensive and unbiased profiling on wound microbiome with a higher taxonomic resolution, as well as functional annotation such as virulence and antibiotic resistance. In this review, we summarize the latest developments in defining the microbiology of diabetic foot ulcers that have been unveiled by sequencing technologies and discuss both the future promises and current limitations of these approaches. In particular, we highlight the temporal patterns and system dynamics in the diabetic foot microbiome monitored and measured during wound progression and medical intervention, and explore the feasibility of molecular diagnostics in clinics. Conclusion Molecular tests conducted during weekly office visits to clean and examine DFUs would allow clinicians to offer personalized treatment and antibiotic therapy. Personalized wound management could reduce healthcare costs, improve quality of life for patients, and recoup lost productivity that is important not only to the patient, but also to healthcare payers and providers. These efforts could also improve antibiotic stewardship and control the rise of “superbugs” vital to global health.

scholarly journals The Profile of Microbiological Pathogens in Diabetic Foot Ulcers

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei Chai ◽  
Yuqing Wang ◽  
Huancheng Zheng ◽  
Song Yue ◽  
Yan Liu ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Antibiotic Resistant ◽  
Resistant Strains ◽  
Pathogen Spectrum ◽  
Main Complication

Diabetic foot, a main complication of diabetes mellitus, renders the foot susceptible to infection, and may eventually lead to non-traumatic limb amputation due to the deterioration of diabetic foot ulcers (DFUs). Characterizing the pathogen spectrum and antibiotic susceptibility is critical for the effective treatment of DFUs. In the current study, the characteristics and antibiotic susceptibility of the pathogen spectrum were analyzed. Secretions from the DFUs of 102 patients were cultured, and dominant pathogens were identified by using test cards. Antibiotic susceptibility of dominant pathogens was assayed by the Kirby–Bauer assay. We found that the dominant pathogens varied with age, duration of diabetes, blood sugar control, and the initial cause of ulcers. Moreover, the dominant pathogens were susceptible to at least one antibiotic. However, the antibacterial efficacy of several commonly used antibiotics decreased from 2016 to 2019. Our study indicates that the identification of dominant pathogens and antibiotic susceptibility testing is essential for the treatment of DFUs with effective antibiotics, while the abuse of antibiotics should be strictly restrained to reduce the generation of antibiotic-resistant strains.

scholarly journals DIABETIC FOOT SYNDROME AS A POSSIBLE CARDIOVASCULAR MARKER IN TYPE 2 DIABETIC PATIENTS

2021 ◽  
Author(s):  
Mohd Riyaz Beg ◽  
Vidhi Gupta
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Diabetic Foot ◽  
Plasma Levels ◽  
Vascular Complications ◽  
Morbidity And Mortality ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
High Morbidity

Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality; in fact, some studies showed a higher prevalence of major, previous and new-onset, cardiovascular, and cerebrovascular events in diabetic patients with foot ulcers than in those without these complications. This is consistent with the fact that in diabetes there is a complex interplay of several variables with inflammatory metabolic disorders and their effect on the cardiovascular system that could explain previous reports of high morbidity and mortality rates in diabetic patients with amputations. Involvement of inflammatory markers such as IL-6 plasma levels in diabetic subjects confirmed the pathogenetic issue of the “adipovascular” axis that may contribute to cardiovascular risk in patients with type 2 diabetes. In patients with diabetic foot, this “adipovascular axis” expression in lower plasma levels of adiponectin and higher plasma levels of IL-6 could be linked to foot ulcers pathogenesis by microvascular and inflammatory mechanisms. The purpose of this review is to focus on the immune inflammatory features of DFS and its possible role as a marker of cardiovascular risk in type 2 diabetes patients.

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