Front Biosci (Landmark Ed) 2018 Jan 1;23:310-317. Epub 2018 Jan 1.
Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, China.
Foot ulcers affect 15% of patients with diabetes, resulting in a great health burden. The occurrence and development of diabetic foot ulcers is associated with neuropathy, peripheral arterial disease, and infection. Several growth factors are involved in these processes, including epidermal growth factor, vascular endothelial growth factor, transforming growth factor-beta, fibroblast growth factor, and erythropoietin, which could promote wound healing of patients with diabetes. Read More
Background: The objective of this study was to determine the clinical and surgical characteristics of diabetic foot ulcers in a tertiary level hospital in Mexico. Methods: We performed a longitudinal, descriptive study from July, 2012 to August, 2015 on a sample composed of 100 patients with type 2 diabetes mellitus and infected diabetic foot ulcers. We analyzed socio-demographic variables, comorbidities, characteristics of ulcers, and the applied treatment. Read More
Background: Diagnosis of infection in diabetic foot ulcer (DFU) is not always simple. The analytic precision of procalcitonin (PCT) was evaluated to clarify the use of PCT for distinguish the presence of infection in DFU in comparison to other inflammatory markers.
Materials And Methods: This study comprised 88 subjects distributed into four groups: 16 nondiabetic healthy subjects (group control), 17 patients with type 2 diabetes mellitus without foot Complication (group DM), 25 patients with noninfected diabetic foot (group NIDF), and 30 patients with infected diabetic foot (group IDF). Read More
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
Ceftolozane/tazobactam displays potent activity against gram-negative bacteria that can cause diabetic foot infections (DFI), making it an attractive treatment option when few alternatives exist. The pharmacokinetics and tissue penetration of ceftolozane/tazobactam 1.5g q8h in patients (n=10) with DFI were compared with healthy volunteers (n=6) using in vivo microdialysis. Read More
Background: Healthcare events related to diabetic foot disease carry a burden of morbidity, mortality and economic cost. Prompt identification of clinical infection with appropriate tissue sampling limits use of broad spectrum empirical antibiotics and improves antibiotic stewardship. Staphylococcus aureus remains the commonest infecting organism and high-dose flucloxacillin remains the empirical antibiotic of choice for antibiotic naïve patients. Read More
Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, 576104, India.
The genes encoding aminoglycoside resistance in Enterococcus faecalis may promote collateral aminoglycoside resistance in polymicrobial wounds. We studied a total of 100 diabetic foot ulcer samples for infection and found 60 samples to be polymicrobial, 5 to be monomicrobial, and 35 samples to be culture negative. A total of 65 E. Read More
Background: Infection is a common cause for the admission of surgical patients who were initially seen and managed at the primary health care level. Delay to care significantly increases the health care burden of surgical sepsis on affected individuals, the health system and society.
Method: A prospective descriptive study was performed by means of a confidential questionnaire presented to qualifying patients between February 2014 and October 2016. Read More
To the Editor, Diabetic foot syndrome (DFS) is defined by the WHO as ulceration or destruction of foot tissue in diabetic patients associated with neuropathy, with different degrees of the disease existing and frequently also with infection. The statistics are frightening: more than million amputations are annually carried out worldwide due to diabetic foot (Foster and Lauver 2014) and these amputations represent as far as 70% of all non-traumatic amputations. In 2013, 861 647 patients were treated for diabetes mellitus in Czech Republic, including 44 657 patients with diabetic foot syndrome and 11 168 patients had to experience the amputation of lower limb due to this condition. Read More
Aims/hypothesis: Diabetic foot osteomyelitis is a major risk factor for amputation. Medical treatment allows remission in 53-82% of cases. However, the optimal duration of antibiotic therapy remains controversial as a validated marker of osteomyelitis remission is lacking. Read More
In this study, we aimed to investigate the relationship between osteomyelitis complications and drug-resistant infection risk in diabetic foot ulcer. Searches of MEDLINE and ISI databases were performed for the studies. Odds ratios (ORs) for drug-resistant infection incidence were calculated for diabetic foot ulcer patients with or without osteomyelitis complications. Read More
Natural antimicrobial peptides (AMPs), a family of small polypeptides that are produced by constitutive or inducible expression in organisms, are integral components of the host innate immune system. In addition to their broad-spectrum antibacterial activity, natural AMPs also have many biological activities against fungi, viruses and parasites. Natural AMPs exert multiple immunomodulatory roles that may predominate under physiological conditions where they lose their microbicidal properties in serum and tissue environments. Read More
Background: Soft tissue defects in the foot and ankle region are challenging conditions particularly in diabetic patients. We evaluated the reliability of the sural flap in treating such defects among a diabetic population.
Material And Methods: This is a continuous retrospective series of 14 patients with type 2 diabetes treated with an ipsilateral sural flap for soft tissue defects around the rear foot (11 cases) and over the malleolar areas (3 cases). Read More
Diabetic foot and subsequent diabetic ulcer infections are the most devastating complication of diabetes. This study was conducted to explore the bacterial spectrum, sensitivity of microbials, and analysis of the empirical antibiotic regimens in our health center. The study included patients with diabetic foot ulcer infection (DFI) seen from 2009 to 2014. Read More
Background: The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology.
Methods: We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. Read More
Foot (Edinb) 2017 May 3;32:44-48. Epub 2017 May 3.
Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N. Medical College, Aligarh Muslim University, Aligarh, India; Department of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, India; Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, India. Electronic address:
Background: Diabetic foot ulcers (DFUs), a dreadful microvascular complication of diabetes is responsible for substantial increase in morbidity and mortality. Infection, not a cause, but a consequence in DFUs that accounts for minor or major limb loss. The current study aimed to evaluate the microbial etiology of infected diabetic foot ulcers in northern tertiary care hospital, assessment of risk factors and role of inflammatory markers involved in colonization of multidrug-resistant organisms (MDROs) and their impact on the outcome. Read More
In the present study, we aimed to identify the comorbidities that would be predictive of requiring lower extremity amputation or reamputation for diabetic foot wounds. We performed a retrospective review of 132 consecutive patients who had undergone lower extremity amputations (110 patients) or reamputations (22 patients) for diabetic wounds from January 2013 to March 2016. We used multivariate logistic regression to calculate the odds ratios (ORs) for amputation and reamputation for various comorbidities. Read More
Objective: In addition to their lipid-lowering abilities, statins have anti-inflammatory and immunomodulatory properties. Increasing recent evidence suggests the possible role of pretreatment with statins in preventing or decreasing morbidity and mortality from infection. Diabetic foot infection (DFI) is a common complication of diabetes mellitus. Read More
Background: Type II diabetes is a chronic health condition which is associated with skin conditions including chronic foot ulcers and an increased incidence of skin infections. The skin microbiome is thought to play important roles in skin defence and immune functioning. Diabetes affects the skin environment, and this may perturb skin microbiome with possible implications for skin infections and wound healing. Read More
Objective: Diabetic foot ulcer (DFU), the major complication associated with diabetes mellitus, has been shown to precede amputation in up to 90% of cases. Recent data reveal that procalcitonin (PCT) is a valid marker for the diagnosis of bacterial infections compared with traditional markers like white blood cell count, C-reactive protein levels, and erythrocyte sedimentation rate in DFU patients. Furthermore, cytokines are proposed to act as modulators and mediators for the expression and release of PCT into the circulation. Read More
Aims: Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Four inflammatory biomarkers were investigated to develop a composite algorithm for mildly infected diabetic foot ulcers: venous white cell count, C-reactive protein (CRP) and procalcitonin, and a novel wound exudate calprotectin assay. Calprotectin is a marker of neutrophilic inflammation. Read More
Objective: Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with (99m)Tc-hexamethylpropyleneamineoxime [HMPAO] or (111)In-oxine), and [(18)F]fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET)/computed tomography.
Research Design And Methods: We searched Medline and Embase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. Read More
There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. Read More
Background: Diabetic foot being one of the frequent and disabling complications of diabetes. In view of widespread regional variation in causative organisms and antimicrobial susceptibility, the current study aimed to determine frequency of causative organisms, their antimicrobial susceptibility and associated risk factors.
Methods: This descriptive cross-sectional study was conducted in 6 months' duration at dept. Read More
Diabetics may encounter different foot problems, which easily lead to infection, ulcers, and increased risk of amputation due to nerve or vascular injury. In order to reduce the risk of amputation, Buerger's exercise is one of the frequently used rehabilitation to improve the blood circulation in the lower limbs. However, it is difficult to evaluate the rehabilitation efficiency of Buerger's exercise objectively. Read More
Background: Foot ulcers are one of the most important complications of diabetes mellitus and often lead to lower limb amputation. Diabetic foot ulcers are susceptible to infection. The objective of this study was to determine the frequency of common bacteria infecting these ulcers and their antibiotic sensitivity pattern. Read More
Objective: Although hyperbaric oxygen therapy (HBOT) has long been used for diabetic foot ulcers (DFUs), its effectiveness is still controversial. The aim of this study was to investigate the efficacy of HBOT in the management of DFUs and identify amputation predictors.
Method: Patients with chronic DFUs (Wanger grade 2-5) were included in the study, which took place between January 2010 and December 2012. Read More
Purpose: To report the initial clinical experience with percutaneous deep vein arterialization (PDVA) to treat critical limb ischemia (CLI) via the creation of an arteriovenous fistula.
Methods: Seven patients (median age 85 years; 5 women) with CLI and no traditional endovascular or surgical revascularization options (no-option CLI) were recruited in a pilot study to determine the safety of PDVA. All patients were diabetic; 4 had Rutherford category 6 ischemia. Read More
From the MRI Section, Department of Radiology, SERCOSA, Health Time, Calle Carmelo Torres 2, 23007 Jaén, Spain (T.M.N., A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, NYU Langone Medical Center, New York, NY (L.S.B.); MRI Section, Department of Radiology, DADISA, Health Time, Cádiz, Spain (M.G.C.); MRI Section, Department of Radiology, RESSALTA, Health Time, Córdoba, Spain (J.B.C.); and Department of Radiology, Clínica Girona, Catalan Institute of Health (IDI), University of Girona, Girona, Spain (J.C.V.).
Diagnosis and treatment of foot disease in patients with diabetes is a common clinical-radiologic challenge, particularly the differentiation of neuropathic arthropathy from osteomyelitis. Conventional clinical tests and imaging techniques have limited accuracy for evaluation of the diabetic foot. The introduction of morphologic magnetic resonance (MR) imaging in these patients has provided a qualitative leap in diagnosis. Read More
Off-loadinga diabetic foot ulcer is a cornerstone of quality wound care for diabetic patients to allow cellular growth in the wound bed. While total contact casts (TCC) have been described as the gold standard for off-loading the wound, the complexity of application and the time commitment for both application and drying have discouraged health professionals from using them. This retrospective case series, conducted in a podiatric practice, evaluated using a TCC system that helps address the three components in which guidelines should be addressed when caring for a diabetic foot: V - vascular management, I - infection management and prevention, and P - pressure relief. Read More
The aim of this study was to evaluate the impact of end-stage renal disease (ESRD) on health-related quality of life (QOL) in patients with diabetic foot disease. We compared a group of 30 diabetic patients with ESRD requiring dialysis to a group of 60 diabetic patients without ESRD. Both groups consisted of patients with active diabetic foot disease (ulcer, Charcot, infection) and were matched with regard to age and gender. Read More
Diabetic foot ulcers (DFUs) are a serious and common problem in patients with diabetes mellitus and constitute one of the major causes of lower extremity amputation. The microbiological profile of DFUs depends on the acute or chronic character of the wound. Aerobic gram-positive cocci are the predominant organisms isolated from DFUs. Read More
To assess the severity of inflammation associated with diabetic foot infection (DFI), values of inflammatory markers such as white blood count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR) are often measured and tracked over time. It remains unclear if these markers can aid the clinician in the diagnosis and management of DFI, and ensure more rational use of antibiotics. Hospitalized adult patients (n = 379) with DFI were retrospectively assessed for abnormal inflammatory markers, correlation between values of inflammatory markers, and clinical diagnosis on initial admission and on last follow-up. Read More
A high matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 (MMP9/TIMP1) ratio is associated with poor ulcer healing, yet how the ratio of MMP9/TIMP1 changes in diabetic foot ulcers (DFUs) with infection and how these changes may affect wound healing remain unclear. Therefore, the objective of this investigation was to explore relationships among the MMP9/TIMP1 ratio, infection, and DFUs. After being informed of the details of this study, 32 patients signed consent forms. Read More
J Infect 2017 Oct 1;75(4):309-314. Epub 2017 Jul 1.
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland; Service of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland.
Diabetic foot ulcers (DFUs) are the chronic, non-healing complications of diabetic mellitus which compels a significant burden to the patients and the healthcare system. Peripheral vascular disease, diabetic neuropathy, and abnormal cellular and cytokine/chemokine activity are among the prime players which exacerbate the severity and prevent wound reapir. Unlike acute wounds, DFUs impose a substantial challenge to the conventional wound dressings and demand the development of novel and advanced wound healing modalities. Read More
We used next generation DNA sequencing to profile the microbiome of infected Diabetic Foot Ulcers (DFUs). The microbiota was correlated to clinical parameters and treatment outcomes to determine if directed antimicrobial therapy based on conventional microbiological cultures are relevant based on genomic analysis. Patients≥18years presenting with a new Diabetic Foot Infection (DFI) who had not received topical or oral antimicrobials in the two weeks prior to presentation, were eligible for enrolment. Read More
Background: Mortality in patients with type 2 diabetes and diabetic foot osteomyelitis (DFO) have been explored in few small studies with a short follow-up. Aim of the present study is to assess all-cause and cardiovascular mortality and predictors of mortality in a consecutive series of patients with DFO.
Research Design And Methods: Patients with a diagnosis of DFO, attending the Diabetic Foot Unit of San Donato Hospital in Arezzo between January 1st, 2012 and December 31st, 2013, were included in this retrospective study. Read More
Background: Ceftaroline fosamil is US Food and Drug Administration-approved for acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia, but it is not known how ceftaroline is being used in real-world settings or how adverse effects (AEs) and mortality compare to clinical trials.
Objective: This study describes ceftaroline use, AEs, and mortality in US Veterans Health Administration (VHA) hospital patients.
Methods: This phase IV, population-based, epidemiologic study analyzed patients ≥18 years old who received one or more ceftaroline doses within 14 days of admission to 69 VHA hospitals in 41 US states/territories from 1 October 2010 to 30 September 2014. Read More
The risk of adverse events (AEs) such as infection and amputation related to diabetic foot ulcers (DFUs) has been studied, but less is known about rate of other AEs such as falls. As part of a quality improvement project, AEs in veterans with diabetes mellitus (DM) with and without a DFU were examined. Demographic data including ICD-9 codes, AEs, and comorbidities for all patients with a diagnosis of DM and/or DFU treated between 2009 and 2014 at the James A. Read More
From the *Department of Plastic and Reconstructive Surgery, PLA Hospital of No. 117, Hangzhou; and †Department of Plastic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.
Diabetic foot ulcers (DFUs) are associated with an increased risk of secondary infection and amputation. Platelet-rich fibrin (PRF), a platelet and leukocyte concentrate containing several cytokines and growth factors, is known to promote wound healing. However, the effect of PRF on diabetic wound healing has not been adequately investigated. Read More
Background: This study attempted to determine the disease burden in terms of clinical profile and outcome of diabetic foot ulcer (DFU) admissions at a tertiary care hospital in a developing country. Methods: In this descriptive study, the data were collected from the medical record of diabetic patients with foot ulcer who were treated in Dr. Kariadi General Hospital during a 3-year period. Read More
Increasing evidence within the literature has identified the presence of biofilms in chronic wounds and proposed that they contribute to delayed wound healing. This research aimed to investigate the presence of biofilm in diabetic foot ulcers (DFUs) using microscopy and molecular approaches and define if these are predominantly mono- or multi-species. Secondary objectives were to correlate wound observations against microscopy results in ascertaining if clinical cues are useful in detecting wound biofilm. Read More
Aim: To develop pathogenetically justified surgical treatment of diabetic neuroosteoarthropathy (DNOAP).
Material And Methods: 52 patients were operated and long-term results were studied in 36 of them. 2 groups were assessed depending on completeness of surgical treatment including changed synovial structures removal. Read More
Delayed identification of patients requiring admission to extended care facilities (ECFs) can lead to greater healthcare costs through an increased length of hospital stay (LOHS). Previous studies of hip and knee arthroplasty identified factors associated with a likely discharge to an ECF. These issues have not been extensively studied for major hindfoot procedures. Read More