Antimicrobial Photodynamic Therapy in Infected Diabetic Foot Ulcers: A Multicenter Preliminary Experience

2020 ◽  
Vol 110 (1) ◽  
Author(s):  
Matteo Monami ◽  
Alessia Scatena ◽  
Michael Schlecht ◽  
Ralf Lobmann ◽  
Letizia Landi ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Diabetic Foot ◽  
Bacterial Load ◽  
Healing Process ◽  
Red Light ◽  
Wound Management ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Diabetic Foot Infections ◽  
Management Procedure

Background: The increasing resistance of bacteria to antibiotics and the frequency of comorbid conditions of patients make the treatment of diabetic foot infections problematic. In this context, photodynamic therapy could be a useful tool to treat infected wounds. The aim of this study was to evaluate the effect of repeated applications of a phthalocyanine derivative (RLP068) on the bacterial load and on the healing process. Methods: The present analysis was performed on patients with clinically infected ulcers who had been treated with RLP068. A sample for microbiological culture was collected at the first visit before and immediately after the application of RLP068 on the ulcer surface, and the area was illuminated for 8 minutes with a red light. The whole procedure was repeated three times per week at two centers (Florence and Arezzo, Italy) (sample A), and two times per week at the third center (Stuttgart, Germany) (sample B) for 2 weeks. Results: Sample A and sample B were composed of 55 and nine patients, respectively. In sample A, bacterial load decreased significantly after a single treatment, and the benefit persisted for 2 weeks. Similar effects of the first treatment were observed in sample B. In both samples, the ulcer area showed a significant reduction during follow-up, even in patients with ulcers infected with gram-negative germs or with exposed bone. Conclusions: RLP068 seems to be a promising topical wound management procedure for the treatment of infected diabetic foot ulcers.

scholarly journals Wound Fluid Matrix Metalloproteinase-9 as a Potential Predictive Marker for the Poor Healing Outcome in Diabetic Foot Ulcers

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Punyanuch Jindatanmanusan ◽  
Sivat Luanraksa ◽  
Tanit Boonsiri ◽  
Thirayost Nimmanon ◽  
Pasra Arnutti
Keyword(s):  
Wound Healing ◽  
G Protein ◽  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Fluid ◽  
The Poor ◽  
Wound Size

Background and Objective. Evidence for the roles of matrix metalloproteinases-9 (MMP-9) in the healing process of diabetic foot ulcers has remained unclear. We therefore aimed to demonstrate the relationship of MMP-9 with the wound healing process and determine its potential usefulness in predicting the wound healing outcome. Methods. Twenty-two patients with diabetic foot ulcer were recruited. The wound size was determined, and the wound fluid was collected for the measurement of MMP-9 levels using an ELISA during the 12-week follow-up period regularly. The patients were categorized as good healers and poor healers when the wound area reduction was ≥ 50% and < 50% at week 4 when compared to the initial wound size at week 0. Results. Median wound fluid MMP-9 levels in the poor healer group were shown to be significantly higher than those in the good healer group (1.03 pg/µg protein vs. 0.06 pg/µg protein, p = 0.001), and the levels fluctuated throughout the 12-week follow-up period. In contrast to the poor healer group, the MMP-9 levels were demonstrated to be constantly low throughout the follow-up period in the good healer group. ROC analysis showed that the MMP-9 level of 0.38 pg/µg protein was able to predict the wound healing outcome with the sensitivity of 81.8%, the specificity of 64.6%, and the area under the curve of 0.901 (CI 0.78-1.03, p = 0.001). Conclusion. These findings suggested that determination of wound fluid MMP-9 levels might become a promising biomarker predicting wound healing outcomes and a novel potential therapeutic target for diabetic foot ulcers.

scholarly journals EFFECTIVITY OF INDONESIAN HONEY ON DIABETIC FOOT ULCERS HEALING PROCESS: OBSERVATIONAL CASE STUDY

2019 ◽  
Vol 2 (2) ◽  
pp. 20-28
Author(s):  
Anita Sukarno ◽  
Nur Hidayah ◽  
Musdalifah Musdalifah
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Cost Effective ◽  
Tissue Type ◽  
Foot Ulcers ◽  
Wound Healing Process ◽  
Diabetic Foot Ulcers ◽  
Necrotic Tissue

Background: Diabetic foot ulcers were common diabetes complication that progressively growth globally. The effectivity of Manuka honey in wound healing process was huge published currently. Modern dressing and Manuka honey may not affordable and cost effective since these dressings were not produced originally in Indonesia. In addition, the published study of Indonesian honey is still lack. Therefore, we conducted this study to investigate the effectivity of Indonesian honey in diabetic foot ulcers healing process. Method: This study design was observational case study. This study was conducted among type 2 diabetes with diabetic foot ulcers in Griya Afiat Homecare and ETN Center in Makassar City, Indonesia from March to June 2014. The Bates Wound Assessment Tool (BWAT) were used to collect the score of diabetic foot ulcer healing process regarding wound size, depth, edges, undermining, necrotic tissue type, necrotic amount, granulation, epithelization, exudate type and amount, surrounding skin color, edema and induration. Descriptive, Independent t-test, Analysis of Variance (ANOVA) and Wilcoxon signed rank test were conducted appropriately. Results: In total, 10 type 2 diabetes patients with diabetic foot ulcers were participated. The factors associated with wound healing process were diabetes treatment (t= 2.44, p= 0.041) and primary dressing (t= -2.76, p= 0.025). The effect of honey primary dressing was in reducing wound size (p= 0.043), improving necrotic tissue type (p= 0.041), reducing necrotic tissue amount (p= 0.042), increasing granulation (p= 0.038) and epithelization (p= 0.042). In the counterpart, the effect of modern dressing was in improving necrotic tissue type (p= 0.046) and increasing granulation (p= 0.042). Conclusion: Indonesian honey is beneficial on diabetic foot ulcers healing process. Recommendation: Therefore, findings suggest that honey should be considered as the alternative, cost effective and beneficial wound dressing on the diabetic foot ulcers.

scholarly journals Nurse Approach in the Treatment of Piabetic Foot Ulcers with the Management of Negative Pressure Therapy

2021 ◽  
pp. 1-4
Author(s):  
Astasio Picado Álvaro ◽  
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Bacterial Load ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Negative Pressure Therapy ◽  
Novel Therapy ◽  
Pressure Therapy ◽  
Advanced Therapy ◽  
Global Increase

The global increase of Diabetes Mellitus represents serious complications for those who suffer from it, the most frequent complications are diabetic foot ulcers and amputations derived from them. Currently, negative pressure therapy (NPT) is used as an advanced therapy for the treatment of this type of ulcers. This novel therapy promises numerous advantages for the nursing approach to patients with diabetic foot ulcers. Therefore, the objective of this narrative review is to prove the effectiveness of the negative pressure therapy as a treatment for diabetic foot ulcers. The search of the articles was carried out in several scientific databases with the help of a searching chain, which combined the keywords and boolean operators. 16 studies were selected, which indicated that NPT as a treatment for diabetic foot ulcers provides benefits such as promoting the formation of granulation tissue, healing and closing of the ulcer in a shorter time, as well as reducing ulcer depth and area and even decreases the bacterial load, the rate of amputations and reulcerations. Hence, NPT is an effective therapy that should be applied to clinical practice

Treatment with topical nitroglycerine may promote the healing process of diabetic foot ulcers

2014 ◽  
Vol 83 (2) ◽  
pp. 172-174 ◽  
Author(s):  
Peyman Mikaili ◽  
Milad Moloudizargari ◽  
Shahin Aghajanshakeri
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers

Antibiotic Resistance in Diabetic Foot Soft Tissue Infections: A Series From Greece

2017 ◽  
Vol 16 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Maria Demetriou ◽  
Nikolaos Papanas ◽  
Periklis Panagopoulos ◽  
Maria Panopoulou ◽  
Efstratios Maltezos
Keyword(s):  
Antibiotic Resistance ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Initial Choice ◽  
Gram Positive Cocci

Diabetic foot infections are a common and serious problem for all health systems worldwide. The aim of this study was to examine the resistance to antibiotics of microorganisms isolated from infected soft tissues of diabetic foot ulcers, using tissue cultures. We included 113 consecutive patients (70 men, 43 women) with a mean age of 66.4 ± 11.2 years and a mean diabetes duration of 14.4 ± 7.6 years presenting with diabetic foot soft tissue infections. Generally, no high antibiotic resistance was observed. Piperacillin-tazobactam exhibited the lowest resistance in Pseudomonas, as well as in the other Gram-negative pathogens. In methicillin-resistant Staphylococcus aureus isolates, there was no resistance to anti-Staphylococcus agents. Of note, clindamycin, erythromycin, and amoxycillin/clavulanic acid exhibited high resistance in Gram-positive cocci. These results suggest that antibiotic resistance in infected diabetic foot ulcers in our area is not high and they are anticipated to prove potentially useful in the initial choice of antibiotic regimen.

scholarly journals Alternative Approaches for the Management of Diabetic Foot Ulcers

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.

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 Wound Myiasis in Diabetic Foot Ulcer: Calliphoridae and Sar-cophagidae Family

2021 ◽  
Author(s):  
Evren Tileklioğlu ◽  
İbrahim Yildiz ◽  
Fürüzan Bozkurt Kozan ◽  
Erdoğan Malatyali ◽  
Mustafa Bülent Ertuğrul ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Chronic Wound ◽  
Developmental Stages ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Diabetic Foot Infections ◽  
Third Stage ◽  
Wound Myiasis

Background: Myiasis is a parasitic infestation of tissues or body cavities of mammals with dipterous larvae. The patients with diabetic foot ulcers are more vulnerable to acquiring infestation; however, the infestation may be neglected and mistreated in some cases.  Methods: Data were collected of twelve myiasis cases with diabetic foot ulcers in Nazli-Selim Eren Chronic Wound and Infections Care Unit, Aydin, Turkey between 2017 and 2019. Demographic, clinical characteristics of the patients and clinical examination of the wound were recorded. To morphology-based identification method of the agents, the developmental stages of the maggots were examined. Results: The cases aged between 46 and 81 years (10 males, two females). Eight of the larvae collected from wounds had Calliphoridae and four had Sarcophagidae family. The larvae were infested right/left foot sole, thumb, ankle, and mostly left toes. The number of larvae collected from the cases ranged from 2 to 48. Third-stage larvae (L3) were mostly detected. Mixed (L1-L2, L2-L3) larvae were detected in a patient. The infestations were more common in July and August. According to the score of Infectious Diseases Society of America (IDSA), ten (83%) cases had moderate and two (17%) cases were mild diabetic foot infections (DFIs). Conclusion: Diabetic foot ulcers should be evaluated in terms of myiasis. This was the first study in our province indicating that myiasis should not be neglected and different species of flies were responsible for myiasis cases.

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