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Ergin M, Budin M, Canbaz SB, Ciloglu O, Gehrke T, Citak M. Microbiological profiles in periprosthetic joint infections after total knee arthroplasty: a comparative analysis of diabetic and non-diabetic patients. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06275-5. [PMID: 39180538 DOI: 10.1007/s00264-024-06275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/10/2024] [Indexed: 08/26/2024]
Abstract
AIM OF THE STUDY The purpose of this study is to conduct a comparative analysis of the microbiological profiles in periprosthetic joint infections (PJIs) after total knee arthroplasty (TKA) between diabetic and non-diabetic patients. The study aims to address what are the variations in microbial colonization and infection patterns between diabetic and non-diabetic patients undergoing total knee arthroplasty. METHODS A retrospective analysis of 2,569 culture-positive cases of PJIs post-TKA was conducted, comparing outcomes between diabetic (n = 321) and non-diabetic (n = 2,248) patients. Demographic, clinical, and microbiological data were collected and analyzed using descriptive statistics, chi-squared tests, logistic regression, and other statistical tests. RESULTS Diabetic patients exhibited distinct microbial colonization patterns, with a higher prevalence of pathogens such as Staphylococcus aureus (p = 0.033), Pseudomonas aeruginosa (p < 0.001), Streptococcus spp. (Streptococcus agalactiae and Streptococcus dysgalactiae; p = 0.010, 0.016 respectively), Candida spp. (p = 0.010), and Corynebacterium spp. (p = 0.024). Additionally, diabetic patients were at increased risk of polymicrobial infections. Comorbidities associated with diabetes, including chronic pulmonary disease, renal insufficiency, and peripheral artery disease, were significantly more prevalent in diabetic patients and further complicated PJI outcomes. CONCLUSION This study underscores the importance of tailored perioperative antimicrobial strategies and vigilant infection control measures in diabetic patients undergoing TKA. Understanding the differential microbial profiles and associated comorbidities can inform targeted interventions to mitigate the risk of PJIs and improve outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and optimize management strategies for diabetic patients undergoing TKA.
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Affiliation(s)
- Musa Ergin
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
- Department of Orthopedics and Traumatology, Cihanbeyli State Hospital, Konya, Turkey
| | - Maximilian Budin
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Sebati Başer Canbaz
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Osman Ciloglu
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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Deng LE, Qiu Y, Zeng Y, Zou J, Kumar A, Pan Y, Nezamzadeh-Ejhieh A, Liu J, Liu X. Current and promising applications of MOF composites in the healing of diabetes wounds. RSC Med Chem 2024; 15:2601-2621. [PMID: 39149100 PMCID: PMC11324049 DOI: 10.1039/d4md00232f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/16/2024] [Indexed: 08/17/2024] Open
Abstract
Diabetes mellitus is an exponentially growing chronic metabolic disease identified by prolonged hyperglycemia that leads to a plethora of health problems. It is well established that the skin of diabetic patients is more prone to injury, and hence, wound healing is an utmost critical restorative process for injured skin and other tissues. Diabetes patients have problems with wound healing at all stages, which ultimately results in delays in the healing process. Therefore, it is vital to find new medications or techniques to hasten the healing of wounds. Metal-organic frameworks (MOFs), an assorted class of porous hybrid materials comprising metal ions coordinated to organic ligands, can display great potential in accelerating diabetic wound healing due to their good physicochemical properties. The release of metal ions during the degradation of MOFs can promote the differentiation of fibroblasts into myofibroblasts and subsequently angiogenesis. Secondly, similar to enzyme-like active substances, they can eliminate reactive oxygen species (ROS) overproduction (secondary to the bio-load of wound bacteria), which is conducive to accelerating diabetic wound healing. Subsequently, MOFs can support the slow release of drugs (molecular or gas therapeutics) in diabetic wounds and promote wound healing by regulating pathological signaling pathways in the wound microenvironment or inhibiting the expression of inflammatory factors. In addition, the combination of photodynamic and photothermal therapies using photo-stimulated porphyrin-based MOF nanosystems has brought up a new idea for treating complicated diabetic wound microenvironments. In this review, recent advances affecting diabetic wound healing, current means of rapid diabetic wound healing, and the limitations of traditional approaches are discussed. Further, the diabetic wound healing applications of MOFs have been discussed followed by the future challenges and directions of MOF materials in diabetic wound healing.
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Affiliation(s)
- Li-Er Deng
- Department of Nephrology, Dongguan Traditional Chinese Medicine Hospital, Dongguan Hospital of Guangzhou University of Traditional Chinese Medicine Dongguan Guangdong 523000 China
| | - Yuzhi Qiu
- Dongguan Key Laboratory of Drug Design and Formulation Technology, Guangdong Medical University 523808 China
| | - Yana Zeng
- Dongguan Key Laboratory of Drug Design and Formulation Technology, Guangdong Medical University 523808 China
| | - Jiafeng Zou
- Dongguan Key Laboratory of Drug Design and Formulation Technology, Guangdong Medical University 523808 China
| | - Abhinav Kumar
- Department of Chemistry, Faculty of Science, University of Lucknow Lucknow 226007 India
| | - Ying Pan
- Dongguan Key Laboratory of Drug Design and Formulation Technology, Guangdong Medical University 523808 China
| | | | - Jianqiang Liu
- Dongguan Key Laboratory of Drug Design and Formulation Technology, Guangdong Medical University 523808 China
| | - Xingyan Liu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University Dongguan 523808 China
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Gonçalves J, Guimarães AR, Ferreira HU, Ribeiro S, Moreno T, Borges-Canha M, Meira I, Menino J, Silva F, Pedro J, Neves N, Simão RS, Santos L, Queirós J. Microbiological characterization of neuropathic diabetic foot infection: a retrospective study at a Portuguese tertiary hospital. BMC Infect Dis 2024; 24:791. [PMID: 39107703 PMCID: PMC11305078 DOI: 10.1186/s12879-024-09677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
Diabetic foot infection imposes a significant burden and is the major cause of nontraumatic limb amputation. Adequate patient management with effective antibiotic therapy is crucial.This retrospective cohort study aimed to characterize the microbiology and resistance patterns of moderate to severe neuropathic diabetic foot infection in patients hospitalized at a tertiary referral hospital between January 2020 and June 2023. Deep tissue specimens from ulcers were collected for culture.Sixty inpatients were included (62% male, mean age 59.1 ± 11.5 years). Osteomyelitis was present in 90% of the patients. Among 102 microorganisms (average of 1.91 ± 1.25 pathogens per patient), 60.8% were gram-positive bacteria, 31.4% were gram-negative, 3.92% were anaerobic bacteria, and 3.92% were fungi. Staphylococcus aureus (19%) and Enterococcus faecium (17%) were the most common. Pseudomonas aeruginosa (8%) and bacteria of the Enterobacterales family (24%) accounted for all the isolated gram-negative bacteria. Sixteen percent of Staphylococcus aureus and 67% of coagulase-negative Staphylococci were resistant to methicillin. Resistance to ampicillin was found in 11% of Enterococci. All Pseudomonas aeruginosa isolates were sensitive to piperacillin-tazobactam, ceftazidime, or cefepime. Among the Enterobacterales, resistance rates were 35% for piperacillin-tazobactam, 38% for ceftazidime, 21% for cefepime, and 13% for carbapenems.Although the prevalence of methicillin-resistant staphylococci was lower than that in other studies, carbapenem resistance among gram-negative bacteria warrants attention. This study highlights the importance of understanding local epidemiology for effective diabetic foot infection management and resistance mitigation.
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Affiliation(s)
- Juliana Gonçalves
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - André Rodrigues Guimarães
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
- Department of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Helena Urbano Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Sara Ribeiro
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Telma Moreno
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Marta Borges-Canha
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Inês Meira
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - João Menino
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Fábia Silva
- Department of Orthopedic and Traumatology, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Nélia Neves
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
- Department of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Ricardo São Simão
- Department of Orthopedic and Traumatology, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Lurdes Santos
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
- Department of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Intensive Care Unit of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Joana Queirós
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
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Luo Y, Mai L, Liu X, Yang C. Effectiveness of continuous home wound care on patients with diabetic foot ulcers. J Adv Nurs 2024; 80:3395-3413. [PMID: 38156736 DOI: 10.1111/jan.16039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
AIMS To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). DESIGN A non-randomized parallel controlled non-inferiority trial. METHODS Patients with Wagner grade I-III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per-protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self-management behaviour and medical expenses of the two groups. RESULTS Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self-management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. CONCLUSION The continuous home wound care enhanced self-management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. IMPACT This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non-inferiority in ulcer healing, and supported its superiority in improving self-management behaviour and saving medical expenses. REPORTING METHOD We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. PATIENT OR PUBLIC CONTRIBUTION The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self-management behaviours to develop intervention strategies.
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Affiliation(s)
- YiXin Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - LiFang Mai
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - XingZhou Liu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Teran N, Buckley V, Britt RS, Ikwuagwu J, Thomas JL, Zaki A, Olson K, Stramel S. Significant Publications on Infectious Diseases Pharmacotherapy in 2022. J Pharm Pract 2024; 37:995-1007. [PMID: 37709274 DOI: 10.1177/08971900231194200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Purpose: To provide summarization of the most significant infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2022. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated notable articles providing significant contributions to ID pharmacotherapy in 2022. Article nominations included those pertaining to general ID, as well as those including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 71 articles were nominated by HIDN. Members: 68 articles pertaining to general ID pharmacotherapy and 3 articles focusing on HIV/AIDS. To aid selection of the most these most notable articles of 2022, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 153 SIDP members who participated in the survey, there were 128 recorded votes for the top 10 general ID pharmacotherapy articles and 30 votes recorded for the top HIV/AIDS article. The most notable publications are summarized. Conclusion: Post pandemic significant advances in antimicrobial stewardship and infectious disease states continues to occur in a world recently focused on the coronavirus disease 2019 (COVID-19) global pandemic. Continuous growth in publication of ID-related articles over the past year lends towards the aims of this review to aid clinicians in remaining current on key practice-changing ID pharmacotherapy publications from 2022.
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Affiliation(s)
- Nicholas Teran
- Department of Pharmacy, CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Valerie Buckley
- Department of Pharmacy, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rachel S Britt
- Department of Pharmacy, The University of Texas Medical Branch, Galveston, TX, USA
| | - Judy Ikwuagwu
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Jamie L Thomas
- Department of Pharmacy, Memorial Hermann Southwest, Houston, TX, USA
| | - Amir Zaki
- Department of Pharmacy, Memorial Hermann Katy Hospital, Katy, TX, USA
| | - Kelsey Olson
- Department of Pharmacy, HCA Houston Healthcare Clear Lake, Webster, TX, USA
| | - Stefanie Stramel
- Department of Pharmacy, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
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Jin Y, Lu Y, Jiang X, Wang M, Yuan Y, Zeng Y, Guo L, Li W. Accelerated infected wound healing by probiotic-based living microneedles with long-acting antibacterial effect. Bioact Mater 2024; 38:292-304. [PMID: 38745591 PMCID: PMC11091528 DOI: 10.1016/j.bioactmat.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
Delays in infected wound healing are usually a result of bacterial infection and local inflammation, which imposes a significant and often underappreciated burden on patients and society. Current therapies for chronic wound infection generally suffer from limited drug permeability and frequent drug administration, owing to the existence of a wound biofilm that acts as a barrier restricting the entry of various antibacterial drugs. Here, we report the design of a biocompatible probiotic-based microneedle (MN) patch that can rapidly deliver beneficial bacteria to wound tissues with improved delivery efficiency. The probiotic is capable of continuously producing antimicrobial substances by metabolizing introduced glycerol, thereby facilitating infected wound healing through long-acting antibacterial and anti-inflammatory effects. Additionally, the beneficial bacteria can remain highly viable (>80 %) inside MNs for as long as 60 days at 4 °C. In a mouse model of Staphylococcus aureus-infected wounds, a single administration of the MN patch exhibited superior antimicrobial efficiency and wound healing performance in comparison with the control groups, indicating great potential for accelerating infected wound closure. Further development of live probiotic-based MN patches may enable patients to better manage chronically infected wounds.
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Affiliation(s)
- Yinli Jin
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Yun Lu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xue Jiang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Min Wang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yaqi Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Yongnian Zeng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Li
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
- TaiKang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
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Guo P, Tu Y, Liu R, Gao Z, Du M, Fu Y, Wang Y, Yan S, Shang X. Performance of risk prediction models for diabetic foot ulcer: a meta-analysis. PeerJ 2024; 12:e17770. [PMID: 39035162 PMCID: PMC11260075 DOI: 10.7717/peerj.17770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
Background The number of prediction models for diabetic foot ulcer (DFU) risk is increasing, but their methodological quality and clinical applicability are uncertain. We conducted a systematic review to assess their performance. Methods We searched PubMed, Cochrane Library, and Embase databases up to 10 February 2024 and extracted relevant information from selected prediction models. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) checklist was used to assess bias risk and applicability. All statistical analyses were conducted in Stata 14.0. Results Initially, 13,562 studies were retrieved, leading to the inclusion of five development and five validation models from eight studies. DFU incidence ranged from 6% to 16.8%, with age and hemoglobin A1C (HbA1c) commonly used as predictive factors. All included studies had a high risk of bias, mainly due to disparities in population characteristics and methodology. In the meta-analysis, we observed area under the curve (AUC) values of 0.78 (95% CI [0.69-0.89]) for development models and 0.84 (95% CI [0.79-0.90]) for validation models. Conclusion DFU risk prediction models show good overall accuracy, but there is a risk of bias. Adherence to the PROBAST checklist is crucial for improving their clinical applicability.
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Affiliation(s)
- Panpan Guo
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yujie Tu
- The 154th Hospital, Xinyang, Henan, China
| | - Ruiyan Liu
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Zihui Gao
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Mengyu Du
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yu Fu
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Ying Wang
- Department of Geriatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuxun Yan
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xin Shang
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
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8
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Fernández-Grajera M, Pacha-Olivenza MA, Fernández-Calderón MC, González-Martín ML, Gallardo-Moreno AM. Dynamic Adhesive Behavior and Biofilm Formation of Staphylococcus aureus on Polylactic Acid Surfaces in Diabetic Environments. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3349. [PMID: 38998429 PMCID: PMC11243244 DOI: 10.3390/ma17133349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024]
Abstract
Interest in biodegradable implants has focused attention on the resorbable polymer polylactic acid. However, the risk of these materials promoting infection, especially in patients with existing pathologies, needs to be monitored. The enrichment of a bacterial adhesion medium with compounds that are associated with human pathologies can help in understanding how these components affect the development of infectious processes. Specifically, this work evaluates the influence of glucose and ketone bodies (in a diabetic context) on the adhesion dynamics of S. aureus to the biomaterial polylactic acid, employing different approaches and discussing the results based on the physical properties of the bacterial surface and its metabolic activity. The combination of ketoacidosis and hyperglycemia (GK2) appears to be the worst scenario: this system promotes a state of continuous bacterial colonization over time, suppressing the stationary phase of adhesion and strengthening the attachment of bacteria to the surface. In addition, these supplements cause a significant increase in the metabolic activity of the bacteria. Compared to non-enriched media, biofilm formation doubles under ketoacidosis conditions, while in the planktonic state, it is glucose that triggers metabolic activity, which is practically suppressed when only ketone components are present. Both information must be complementary to understand what can happen in a real system, where planktonic bacteria are the ones that initially colonize a surface, and, subsequently, these attached bacteria end up forming a biofilm. This information highlights the need for good monitoring of diabetic patients, especially if they use an implanted device made of PLA.
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Affiliation(s)
- María Fernández-Grajera
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 06006 Badajoz, Spain; (M.F.-G.); (M.A.P.-O.); (M.C.F.-C.); (A.M.G.-M.)
- University Institute of Extremadura Sanity Research (INUBE), 06006 Badajoz, Spain
| | - Miguel A. Pacha-Olivenza
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 06006 Badajoz, Spain; (M.F.-G.); (M.A.P.-O.); (M.C.F.-C.); (A.M.G.-M.)
- University Institute of Extremadura Sanity Research (INUBE), 06006 Badajoz, Spain
- Department of Biomedical Science, University of Extremadura, 06006 Badajoz, Spain
| | - María Coronada Fernández-Calderón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 06006 Badajoz, Spain; (M.F.-G.); (M.A.P.-O.); (M.C.F.-C.); (A.M.G.-M.)
- University Institute of Extremadura Sanity Research (INUBE), 06006 Badajoz, Spain
- Department of Biomedical Science, University of Extremadura, 06006 Badajoz, Spain
| | - María Luisa González-Martín
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 06006 Badajoz, Spain; (M.F.-G.); (M.A.P.-O.); (M.C.F.-C.); (A.M.G.-M.)
- University Institute of Extremadura Sanity Research (INUBE), 06006 Badajoz, Spain
- Department of Applied Physics, University of Extremadura, 06006 Badajoz, Spain
| | - Amparo M. Gallardo-Moreno
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 06006 Badajoz, Spain; (M.F.-G.); (M.A.P.-O.); (M.C.F.-C.); (A.M.G.-M.)
- University Institute of Extremadura Sanity Research (INUBE), 06006 Badajoz, Spain
- Department of Applied Physics, University of Extremadura, 06006 Badajoz, Spain
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Lauri C, Noriega-Álvarez E, Chakravartty RM, Gheysens O, Glaudemans AWJM, Slart RHJA, Kwee TC, Lecouvet F, Panagiotidis E, Zhang-Yin J, Martinez JLL, Lipsky BA, Uccioli L, Signore A. Diagnostic imaging of the diabetic foot: an EANM evidence-based guidance. Eur J Nucl Med Mol Imaging 2024; 51:2229-2246. [PMID: 38532027 PMCID: PMC11178575 DOI: 10.1007/s00259-024-06693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Consensus on the choice of the most accurate imaging strategy in diabetic foot infective and non-infective complications is still lacking. This document provides evidence-based recommendations, aiming at defining which imaging modality should be preferred in different clinical settings. METHODS This working group includes 8 nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), 3 radiologists and 3 clinicians (one diabetologist, one podiatrist and one infectious diseases specialist) selected for their expertise in diabetic foot. The latter members formulated some clinical questions that are not completely covered by current guidelines. These questions were converted into statements and addressed through a systematic analysis of available literature by using the PICO (Population/Problem-Intervention/Indicator-Comparator-Outcome) strategy. Each consensus statement was scored for level of evidence and for recommendation grade, according to the Oxford Centre for Evidence-Based Medicine (OCEBM) criteria. RESULTS Nine clinical questions were formulated by clinicians and used to provide 7 evidence-based recommendations: (1) A patient with a positive probe-to-bone test, positive plain X-rays and elevated ESR should be treated for presumptive osteomyelitis (OM). (2) Advanced imaging with MRI and WBC scintigraphy, or [18F]FDG PET/CT, should be considered when it is needed to better evaluate the location, extent or severity of the infection, in order to plan more tailored treatment. (3) In a patient with suspected OM, positive PTB test but negative plain X-rays, advanced imaging with MRI or WBC scintigraphy + SPECT/CT, or with [18F]FDG PET/CT, is needed to accurately assess the extent of the infection. (4) There are no evidence-based data to definitively prefer one imaging modality over the others for detecting OM or STI in fore- mid- and hind-foot. MRI is generally the first advanced imaging modality to be performed. In case of equivocal results, radiolabelled WBC imaging or [18F]FDG PET/CT should be used to detect OM or STI. (5) MRI is the method of choice for diagnosing or excluding Charcot neuro-osteoarthropathy; [18F]FDG PET/CT can be used as an alternative. (6) If assessing whether a patient with a Charcot foot has a superimposed infection, however, WBC scintigraphy may be more accurate than [18F]FDG PET/CT in differentiating OM from Charcot arthropathy. (7) Whenever possible, microbiological or histological assessment should be performed to confirm the diagnosis. (8) Consider appealing to an additional imaging modality in a patient with persisting clinical suspicion of infection, but negative imaging. CONCLUSION These practical recommendations highlight, and should assist clinicians in understanding, the role of imaging in the diagnostic workup of diabetic foot complications.
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Affiliation(s)
- Chiara Lauri
- Inflammation and Infection Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Edel Noriega-Álvarez
- Inflammation and Infection Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Guadalajara, Guadalajara, Spain
| | - Riddhika M Chakravartty
- Inflammation and Infection Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria
- Radiology Department, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Olivier Gheysens
- Inflammation and Infection Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria
- Department of Nuclear Medicine and Molecular imaging, University Hospitals Leuven, Leuven, Belgium
| | - Andor W J M Glaudemans
- Inflammation and Infection Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frédéric Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique Cliniques, Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Emmanouil Panagiotidis
- Bone & Joint Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria
- Nuclear Medicine Department/PET CT, Theagenio Cancer Center, Thessaloniki, Greece
| | - Jules Zhang-Yin
- Bone & Joint Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria
- Department of Nuclear Medicine, Clinique Sud Luxembourg, Vivalia, Arlon, Belgium
| | | | - Benjamin A Lipsky
- Emeritus Professor of Medicine, University of Washington, Seattle, USA
- Green Templeton College, University of Oxford, Oxford, UK
| | - Luigi Uccioli
- Diabetes and Endocrinology Section, CTO Hospital of Rome, Rome, Italy
- Department of Biomedicine and prevention, Tor Vergata University, Rome, Italy
| | - Alberto Signore
- Inflammation and Infection Committee of the European Association of Nuclear Medicine (EANM), Vienna, Austria
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
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10
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Arfaoui A, Rojo-Bezares B, Fethi M, López M, Toledano P, Sayem N, Ben Khelifa Melki S, Ouzari HI, Klibi N, Sáenz Y. Molecular characterization of Pseudomonas aeruginosa from diabetic foot infections in Tunisia. J Med Microbiol 2024; 73. [PMID: 38963417 DOI: 10.1099/jmm.0.001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background. Pseudomonas aeruginosa is an invasive organism that frequently causes severe tissue damage in diabetic foot ulcers.Gap statement. The characterisation of P. aeruginosa strains isolated from diabetic foot infections has not been carried out in Tunisia.Purpose. The aim was to determine the prevalence of P. aeruginosa isolated from patients with diabetic foot infections (DFIs) in Tunisia and to characterize their resistance, virulence and molecular typing.Methods. Patients with DFIs admitted to the diabetes department of the International Hospital Centre of Tunisia, from September 2019 to April 2021, were included in this prospective study. P. aeruginosa were obtained from the wound swabs, aspiration and soft tissue biopsies during routine clinical care and were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antimicrobial susceptibility testing, serotyping, integron and OprD characterization, virulence, biofilm production, pigment quantification, elastase activity and molecular typing were analysed in all recovered P. aeruginosa isolates by phenotypic tests, specific PCRs, sequencing, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing.Results. Sixteen P. aeruginosa isolates (16.3 %) were recovered from 98 samples of 78 diabetic patients and were classified into 6 serotypes (O:11 the most frequent), 11 different PFGE patterns and 10 sequence types (three of them new ones). The high-risk clone ST235 was found in two isolates. The highest resistance percentages were observed to netilmicin (69 %) and cefepime (43.8 %). Four multidrug-resistant (MDR) isolates (25 %) were detected, three of them being carbapenem-resistant. The ST235-MDR strain harboured the In51 class 1 integron (intI1 +aadA6+orfD+qacED1-sul1). According to the detection of 14 genes involved in virulence or quorum sensing, 5 virulotypes were observed, including 5 exoU-positive, 9 exoS-positive and 2 exoU/exoS-positive strains. The lasR gene was truncated by ISPpu21 insertion sequence in one isolate, and a deletion of 64 bp in the rhlR gene was detected in the ST235-MDR strain. Low biofilm, pyoverdine and elastase production were detected in all P. aeruginosa; however, the lasR-truncated strain showed a chronic infection phenotype characterized by loss of serotype-specific antigenicity, high production of phenazines and high biofilm formation.Conclusions. Our study demonstrated for the first time the prevalence and the molecular characterization of P. aeruginosa strains from DFIs in Tunisia, showing a high genetic diversity, moderate antimicrobial resistance, but a high number of virulence-related traits, highlighting their pathological importance.
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Affiliation(s)
- Ameni Arfaoui
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Beatriz Rojo-Bezares
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Meha Fethi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Maria López
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Paula Toledano
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Noureddine Sayem
- Service of Biology, Carthagene International Hospital of Tunisia, Tunis, Tunisia
| | | | - Hadda-Imene Ouzari
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Naouel Klibi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yolanda Sáenz
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
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11
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Yammine K, Mouawad J, Abou Orm G, Assi C, Hayek F. The diabetic sausage toe: Prevalence, presentation and outcomes. Int Wound J 2024; 21:e70002. [PMID: 39041186 PMCID: PMC11263806 DOI: 10.1111/iwj.70002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024] Open
Abstract
Osteomyelitis (OM) in diabetic foot infection could have many presentations such as an infected ulcer spreading to the bone or superimposed to Charcot neuroarthropathy. However, the sausage toe as a diabetic OM presentation was very rarely investigated; therefore, this study aims to assess the prevalence and signs of this presentation along with treatment modalities and outcomes. This is a retrospective series of patients presenting a sausage toe on admission. Several methods were conducted to diagnose OM, and three treatment modalities were applied. Two groups were compared: acute and chronic sausage toes. Outcomes were defined as sausage toe prevalence, ulcer location, OM prevalence, and comparative treatment results. Out of 82 diabetic toe infection cases, 24 (30%) presented as 'sausage toe'. The side of the proximal interphalangeal joint of the lateral toes was the most frequent ulcer location (50%), mostly on the dorsal aspect followed by the side aspect. There were 15 (62.5%) acute cases and 9 (37.5%) chronic cases. MRI showed signs of OM in 21 (87.5%) cases and signs of septic arthritis in 3 (12.5%) cases. At the final follow-up, a successful treatment was recorded in five (20%) cases with antibiotics alone. Out of the 19 (42%) procedures, conservative surgery was performed successfully in 8 (58%) cases while amputation was needed in 11 (45.8%) cases. There was no significant difference in amputation frequency between acute and chronic groups. This is the first study documenting the sausage toe as a prevalent presentation of diabetic toe infection. The deformity is conclusive of deep infection with a very high osteomyelitis frequency. Surgery is often required for infection control and healing, mainly for chronic cases, and treatment outcomes did not differ between acute and chronic sausage toe groups. It could be beneficial to include this entity in the diabetic wound classification systems.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center‐Rizk HospitalLebanese American University School of MedicineBeirutLebanon
- Diabetic Foot Clinic, Lebanese American University Medical Center‐Rizk HospitalBeirutLebanon
- Center for Evidence‐Based Anatomy, Sport & Orthopedics ResearchBeirutLebanon
| | - Joseph Mouawad
- Department of Orthopedic Surgery, Lebanese American University Medical Center‐Rizk HospitalLebanese American University School of MedicineBeirutLebanon
| | - Ghadi Abou Orm
- Department of Orthopedic Surgery, Lebanese American University Medical Center‐Rizk HospitalLebanese American University School of MedicineBeirutLebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center‐Rizk HospitalLebanese American University School of MedicineBeirutLebanon
- Center for Evidence‐Based Anatomy, Sport & Orthopedics ResearchBeirutLebanon
| | - Fady Hayek
- Division of Vascular Surgery, Department of General Surgery, Lebanese American University Medical Center‐Rizk HospitalLebanese American University School of MedicineBeirutLebanon
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12
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Kipp JA, LeSavage LK, Evans JK, Denmeade TA, Blazek CD. Diabetic Osteomyelitis: Oral versus Intravenous Antibiotics at a Single Level 1 Academic Medical Trauma Center. J Foot Ankle Surg 2024; 63:490-494. [PMID: 38588891 DOI: 10.1053/j.jfas.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/14/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
Residual osteomyelitis is a frequent problem following surgical intervention for diabetic foot infection. The Infectious Disease Society of America guidelines recommend a prolonged course of antibiotics for treatment of residual osteomyelitis. Recent literature suggests oral antibiotic therapy is not inferior to IV therapy. The primary aim of this study was to evaluate treatment success in 128 patients receiving oral versus IV antibiotics for residual osteomyelitis in the diabetic foot after amputation at a Level 1 academic medical trauma center. Treatment success was defined as completion of at least 4 weeks of antibiotic therapy, complete surgical wound healing, and no residual infection requiring further debridement or amputation within 1 year of the initial surgery. Patients with peripheral arterial disease were excluded. A retrospective chart review was performed, and we found no statistically significant difference in treatment success between these two groups (p = .2766). The median time to healing for oral antibiotic treatment was 3.17 months compared to 4.06 months for IV treatment (p = .1045). Furthermore, there was no significant difference in group demographics or comorbidities, aside from more patients in the IV group having coronary artery disease (p = .0416). The type of closure and whether the infection was single or polymicrobial were also not associated with a difference in outcomes between the two treatment arms. The results of the present study suggest oral antibiotics for treatment of residual osteomyelitis are not inferior to IV therapy and may be more efficacious for certain patients regarding cost and ease of administration.
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Affiliation(s)
- Jennifer A Kipp
- Atrium Health Wake Forest Baptist, Podiatric Medicine and Surgery Resident, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.
| | - Lindsay K LeSavage
- Atrium Health Wake Forest Baptist, Podiatric Medicine and Surgery Resident, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Joni K Evans
- Biostatistician, Atrium Health Wake Forest Baptist, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Travis A Denmeade
- Department of Infectious Disease - Atrium Health Wake Forest Baptist, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Cody D Blazek
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest Baptist Medical Center, Winston-Salem, NC
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13
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Kipp J, Vesely BD, Fram M, Russell G, Kim-Shapiro JW, Medda AW, Gangopadhyay P. Comparison of Two Techniques for Proximal Margin Analysis of Toe Amputations: A Retrospective Review. J Foot Ankle Surg 2024; 63:464-467. [PMID: 38438099 DOI: 10.1053/j.jfas.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 09/26/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024]
Abstract
Toe amputations are a common podiatric procedure for treatment of osteomyelitis. Whether or not the surgeon obtains a surgical cure, thus resolving the infection, can be difficult to assess. Obtaining a proximal bone margin can assist the treatment team in deciding the duration of postoperative antibiotics, need for reoperation, and postoperative care. The two senior surgeons use different methods to analyze proximal bone margins. The first surgeon obtains a microbiologic culture from the remaining bone, either at the proximal phalanx or metatarsal head, following the removal of the toe to be reviewed for osteomyelitis. Per the second surgeon's technique, the pathologist only analyzes the proximal aspect of the amputated toe for presence of osteomyelitis. Our goal is to analyze the reoperation and reamputation rates between the techniques in which the proximal margin specimens are obtained. A retrospective chart review was performed on all isolated toe or partial toe amputations from March 2017 to September 2022. There were 115 patients who met inclusion criteria. Reoperation and reamputation rates were analyzed for positive and negative infection margins from intraoperative cultures. Our study found an overall 28% reoperation rate and 26% reamputation rate for the negative margins group. In the positive proximal margin group, there was an overall 48% reoperation rate and 44% reamputation rate. Our analysis did not find a statistically significant difference between the reamputation rate in the negative margins group and the reamputation rate in the positive margins group. In conclusion, our study found that a positive proximal margin for osteomyelitis exhibited a nearly double reoperation and reamputation rate compared to patients with a negative margin, and that one margin analysis technique was not inferior to the other in regards to the need for additional surgeries.
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Affiliation(s)
- Jennifer Kipp
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Bryanna D Vesely
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC.
| | - Madeline Fram
- Medical Student, Wake Forest University School of Medicine, Winston Salem, NC
| | - Greg Russell
- Senior Biostatistician, Wake Forest University School of Medicine, Winston Salem, NC
| | - Jung Wha Kim-Shapiro
- Assistant Professor, Pathology Department, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Ashleigh W Medda
- Attending Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Paula Gangopadhyay
- Attending Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
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14
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Zhao Z, Pang J, Zhao D, Guo N, Guo Y, Kong F, Yang H, Zhao J. Exploring the efficacy of photodynamic antimicrobial chemotherapy on diabetic foot ulcers in rats. JOURNAL OF BIOPHOTONICS 2024; 17:e202300568. [PMID: 38651324 DOI: 10.1002/jbio.202300568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
We investigate the efficacy of photodynamic antimicrobial chemotherapy (PACT) and its combination with an antibiotic in the treatment of diabetic foot ulcers (DFUs) in rats using a novel cationic amino acid porphyrin-based photosensitizer. The research findings demonstrate that the combination of novel cationic photosensitizer-mediated PACT and an antibiotic exhibits significant therapeutic efficacy in treating deep ulcers in a rat model of DFUs. Moreover, the PACT + Antibiotic group displays enhanced angiogenesis, improved tissue maturation, and superior wound healing effect. Micro-computed tomography examination showed that the periosteal reaction was most obvious in the PACT + Antibiotic group. The cortical bone volume ratio (BV/TV), the bone mineral density, and trabecular thickness were significantly higher in the PACT + Antibiotic group than in the model group (p < 0.05). The combination of PACT and antibiotic plays a sensitizing therapeutic role, which provides a new idea for the clinical treatment of DFUs.
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Affiliation(s)
- Zhanjuan Zhao
- College of Basic Medicine, Hebei University, Baoding, China
| | - Jinwen Pang
- Department of Medical Imaging, Cangzhou Hospital of Integrated TCM-WM Hebei, Cangzhou, China
| | - Di Zhao
- School of Foreign Languages, Tianjin University of Commerce, Tianjin, China
| | - Ning Guo
- College of Basic Medicine, Hebei University, Baoding, China
| | - Yiman Guo
- College of Clinical Medicine, Hebei University, Baoding, China
| | - Feiyan Kong
- College of Basic Medicine, Hebei University, Baoding, China
| | - Huizhong Yang
- College of Clinical Medicine, Hebei University, Baoding, China
| | - Jianxi Zhao
- Department of Radiology, Affiliated Hospital of Hebei University, Baoding, China
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15
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Wang F, Zhang X, Zhang J, Xu Q, Yu X, Xu A, Yi C, Bian X, Shao S. Recent advances in the adjunctive management of diabetic foot ulcer: Focus on noninvasive technologies. Med Res Rev 2024; 44:1501-1544. [PMID: 38279968 DOI: 10.1002/med.22020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
Diabetic foot ulcer (DFU) is one of the most costly and serious complications of diabetes. Treatment of DFU is usually challenging and new approaches are required to improve the therapeutic efficiencies. This review aims to update new and upcoming adjunctive therapies with noninvasive characterization for DFU, focusing on bioactive dressings, bioengineered tissues, mesenchymal stem cell (MSC) based therapy, platelet and cytokine-based therapy, topical oxygen therapy, and some repurposed drugs such as hypoglycemic agents, blood pressure medications, phenytoin, vitamins, and magnesium. Although the mentioned therapies may contribute to the improvement of DFU to a certain extent, most of the evidence come from clinical trials with small sample size and inconsistent selections of DFU patients. Further studies with high design quality and adequate sample sizes are necessitated. In addition, no single approach would completely correct the complex pathogenesis of DFU. Reasonable selection and combination of these techniques should be considered.
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Affiliation(s)
- Fen Wang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xiaoling Zhang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Jing Zhang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Qinqin Xu
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xuefeng Yu
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Anhui Xu
- Division of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengla Yi
- Division of Trauma Surgery, Tongji Hospital, Tongji Medical College, Wuhan, China
| | - Xuna Bian
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Shiying Shao
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
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16
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Winkler WL, George IA, Gandra S, Baker JC, Tomasian A, Northrup B, Velde TLV, Hillen TJ, Luo C, Imaoka R, Dettorre GM, Jennings JW. Diagnostic efficacy and clinical impact of image-guided core needle biopsy of suspected vertebral osteomyelitis. Int J Infect Dis 2024; 144:107027. [PMID: 38670483 DOI: 10.1016/j.ijid.2024.107027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected vertebral osteomyelitis in adults is heterogenous in published studies owing to small sample sizes, indicating the need for large cohort studies. METHODS A retrospective analysis of ICNBs was performed from 2010 to 2021 for patients with imaging findings consistent with vertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. In addition, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. A multivariate statistical analysis was performed to evaluate the factors associated with yield. RESULTS A total of 570 biopsies performed on 527 patients were included. A histopathologic diagnosis of osteomyelitis was made in 68.4% (359 of 525) of biopsies, and microbiological cultures were positive in 29.6% (169 of 570). Elevated erythrocyte sedimentation rate was positively associated with a histopathologic diagnosis of osteomyelitis (odds ratio [OR] =1.96, P = 0.007) and positive cultures from bone cores (OR = 1.02, P ≤0.001) and aspirate (OR = 1.02, P ≤0.001). Increased total core length was positively associated with a histopathologic diagnosis of osteomyelitis (OR = 1.81, P = 0.013) and positive cultures from bone cores (OR = 1.65, P = 0.049). Clinical management was affected by ICNB in 37.5% (214 of 570) of cases. CONCLUSIONS In this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-third of the patients.
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Affiliation(s)
- Winston L Winkler
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA.
| | - Ige A George
- John T. Milliken Department of Internal Medicine, Division of Infectious Disease, St. Louis, USA
| | - Sumanth Gandra
- John T. Milliken Department of Internal Medicine, Division of Infectious Disease, St. Louis, USA
| | - Jonathan C Baker
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Anderanik Tomasian
- Department of Radiology, Section of Musculoskeletal Radiology, University of Southern California, Los Angeles, USA
| | - Benjamin Northrup
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Theodore L Vander Velde
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Travis J Hillen
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Resten Imaoka
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Gino M Dettorre
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Jack W Jennings
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
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17
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Abbas Z, Gangji R, Uçkay I. Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries. Endocrinol Diabetes Metab 2024; 7:e00503. [PMID: 38924696 PMCID: PMC11199192 DOI: 10.1002/edm2.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/25/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Diabetic foot ulcers in developing countries often become infected. The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI). METHODS We evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource-poor settings such as in Africa. RESULTS The management of DFI very often is adapted to the financial and practical realities of the resource-poor regions. The application of the point-of-care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi-quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs. CONCLUSIONS In the practical and resource-saving management of DFI, the 'therapeutic' use of Gram stains is not common in resource-rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.
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Affiliation(s)
- Zulfiqarali G. Abbas
- Muhimbili University of Health and Allied SciencesDar es SalaamTanzania
- Abbas Medical CenterDar es SalaamTanzania
| | - Raidah R. Gangji
- Muhimbili University of Health and Allied SciencesDar es SalaamTanzania
- Hubert Kairuki Memorial UniversityDar es SalaamTanzania
| | - Ilker Uçkay
- InfectiologyBalgrist University HospitalZurichSwitzerland
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Baek YJ, Lee E, Jung J, Won SH, An CY, Kang EM, Park SY, Baek SL, Chun DI, Kim TH. Diabetic Foot Osteomyelitis Undergoing Amputation: Epidemiology and Prognostic Factors for Treatment Failure. Open Forum Infect Dis 2024; 11:ofae236. [PMID: 38983712 PMCID: PMC11232692 DOI: 10.1093/ofid/ofae236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Indexed: 07/11/2024] Open
Abstract
Background When treating diabetic foot osteomyelitis (DFO), it remains difficult to determine the presence of residual infection and the optimal treatment after bone resection. In this study, we aimed to investigate the clinical characteristics of and prognostic factors in patients with DFO undergoing amputation. Methods This retrospective study involved 101 patients with DFO who underwent amputation. Data on their demographics, clinical characteristics, tissue culture, and surgery type were collected. Patients were grouped according to primary closure status and clinical outcome postamputation. A good outcome was defined as a successful complete remission, characterized by the maintenance of complete wound healing with no sign of infection at 6 months postamputation. Multivariate logistic regression analysis was performed. Outcomes according to surgery type were also analyzed. Results Staphylococcus aureus (17%) and Pseudomonas species (14%) were the most prevalent pathogens. Gram-negative bacteria were isolated from 62% of patients. In patients with primary closure, hemodialysis and ankle brachial index (ABI) <0.6 were associated with poor outcomes. In patients with DFO, ABI <0.6 was the only prognostic factor associated with treatment failure. Antimicrobial stewardship allows patients who underwent major amputation to reduce the duration of antibiotic therapy compared to those after minor amputation, although it did not contribute to reducing mortality. Conclusions Peripheral artery disease and hemodialysis were associated with poor outcomes despite radical resection of the infected bone. Vigilant monitoring after amputation and antimicrobial stewardship implemented based on microbiological epidemiology, prognostic factors, and the type of surgery are important. A multidisciplinary team could assist in these activities to ensure treatment success.
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Affiliation(s)
- Yae Jee Baek
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jongtak Jung
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sung Hun Won
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Chi Young An
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Myeong Kang
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seung Lim Baek
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Dong-Il Chun
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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19
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White EK, Uberoi A, Pan JTC, Ort JT, Campbell AE, Murga-Garrido SM, Harris JC, Bhanap P, Wei M, Robles NY, Gardner SE, Grice EA. Alcaligenes faecalis corrects aberrant matrix metalloproteinase expression to promote reepithelialization of diabetic wounds. SCIENCE ADVANCES 2024; 10:eadj2020. [PMID: 38924411 PMCID: PMC11204295 DOI: 10.1126/sciadv.adj2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Chronic wounds are a common and costly complication of diabetes, where multifactorial defects contribute to dysregulated skin repair, inflammation, tissue damage, and infection. We previously showed that aspects of the diabetic foot ulcer microbiota were correlated with poor healing outcomes, but many microbial species recovered remain uninvestigated with respect to wound healing. Here, we focused on Alcaligenes faecalis, a Gram-negative bacterium that is frequently recovered from chronic wounds but rarely causes infection. Treatment of diabetic wounds with A. faecalis accelerated healing during early stages. We investigated the underlying mechanisms and found that A. faecalis treatment promotes reepithelialization of diabetic keratinocytes, a process that is necessary for healing but deficient in chronic wounds. Overexpression of matrix metalloproteinases in diabetes contributes to failed epithelialization, and we found that A. faecalis treatment balances this overexpression to allow proper healing. This work uncovers a mechanism of bacterial-driven wound repair and provides a foundation for the development of microbiota-based wound interventions.
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Affiliation(s)
- Ellen K. White
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aayushi Uberoi
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jamie Ting-Chun Pan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jordan T. Ort
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Amy E. Campbell
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sofia M. Murga-Garrido
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jordan C. Harris
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Preeti Bhanap
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Monica Wei
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nelida Y. Robles
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sue E. Gardner
- College of Nursing, The University of Iowa, Iowa City, IA 52242, USA
| | - Elizabeth A. Grice
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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20
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Qu YD, Ou SJ, Zhang W, Li JX, Xia CL, Yang Y, Liu JB, Ma YF, Jiang N, Wang YY, Chen B, Yu B, Qi Y, Xu CP. Microbiological profile of diabetic foot infections in China and worldwide: a 20-year systematic review. Front Endocrinol (Lausanne) 2024; 15:1368046. [PMID: 39010897 PMCID: PMC11247326 DOI: 10.3389/fendo.2024.1368046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Pathogens causing diabetic foot infections (DFIs) vary by region globally; however, knowledge of the causative organism is essential for effective empirical treatment. We aimed to determine the incidence and antibiotic susceptibility of DFI pathogens worldwide, focusing on Asia and China. Methods Through a comprehensive literature search, we identified published studies on organisms isolated from DFI wounds from January 2000 to December 2020. Results Based on our inclusion criteria, we analyzed 245 studies that cumulatively reported 38,744 patients and 41,427 isolated microorganisms. DFI pathogens varied according to time and region. Over time, the incidence of Gram-positive and Gram-negative aerobic bacteria have decreased and increased, respectively. America and Asia have the highest (62.74%) and lowest (44.82%) incidence of Gram-negative bacteria, respectively. Africa has the highest incidence (26.90%) of methicillin-resistant Staphylococcus aureus. Asia has the highest incidence (49.36%) of Gram-negative aerobic bacteria with species infection rates as follows: Escherichia coli, 10.77%; Enterobacter spp., 3.95%; and Pseudomonas aeruginosa, 11.08%, with higher local rates in China and Southeast Asia. Linezolid, vancomycin, and teicoplanin were the most active agents against Gram-positive aerobes, while imipenem and cefoperazone-sulbactam were the most active agents against Gram-negative aerobes. Discussion This systematic review showed that over 20 years, the pathogens causing DFIs varied considerably over time and region. This data may inform local clinical guidelines on empirical antibiotic therapy for DFI in China and globally. Regular large-scale epidemiological studies are necessary to identify trends in DFI pathogenic bacteria. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023447645.
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Affiliation(s)
- Yu-dun Qu
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shuan-ji Ou
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wei Zhang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jia-xuan Li
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chang-liang Xia
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yang Yang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jia-bao Liu
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yun-fei Ma
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ye-yang Wang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bo Chen
- Endocrinology Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bin Yu
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Qi
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chang-peng Xu
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
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21
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Wang YB, Lv Y, Li GY, Zheng JT, Jiang QX, Wei R. Clinical comprehensive treatment protocol for managing diabetic foot ulcers: A retrospective cohort study. World J Clin Cases 2024; 12:2976-2982. [PMID: 38898850 PMCID: PMC11185408 DOI: 10.12998/wjcc.v12.i17.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are a common complication of diabetes, often leading to severe infections, amputations, and reduced quality of life. The current standard treatment protocols for DFUs have limitations in promoting efficient wound healing and preventing complications. A comprehensive treatment approach targeting multiple aspects of wound care may offer improved outcomes for patients with DFUs. The hypothesis of this study is that a comprehensive treatment protocol for DFUs will result in faster wound healing, reduced amputation rates, and improved overall patient outcomes compared to standard treatment protocols. AIM To compare the efficacy and safety of a comprehensive treatment protocol for DFUs with those of the standard treatment protocol. METHODS This retrospective study included 62 patients with DFUs, enrolled between January 2022 and January 2024, randomly assigned to the experimental (n = 32) or control (n = 30) group. The experimental group received a comprehensive treatment comprising blood circulation improvement, debridement, vacuum sealing drainage, recombinant human epidermal growth factor and anti-inflammatory dressing, and skin grafting. The control group received standard treatment, which included wound cleaning and dressing, antibiotics administration, and surgical debridement or amputation, if necessary. Time taken to reduce the white blood cell count, number of dressing changes, wound healing rate and time, and amputation rate were assessed. RESULTS The experimental group exhibited significantly better outcomes than those of the control group in terms of the wound healing rate, wound healing time, and amputation rate. Additionally, the comprehensive treatment protocol was safe and well tolerated by the patients. CONCLUSION Comprehensive treatment for DFUs is more effective than standard treatment, promoting granulation tissue growth, shortening hospitalization time, reducing pain and amputation rate, improving wound healing, and enhancing quality of life.
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Affiliation(s)
- Yan-Bin Wang
- Department of Vascular Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Yan Lv
- First Department of General Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Guang-Yu Li
- Department of Vascular Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Ji-Ting Zheng
- Department of Vascular Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Qing-Xin Jiang
- First Department of General Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
| | - Ran Wei
- First Department of General Surgery, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China
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22
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Jupiter DC, Zhang Y, Shibuya N. Trajectories of Diabetes-Related Sequelae for Identifying Transition Probabilities, and Optimal Timepoints for Prevention of Ulceration, Infection, and Amputation. J Foot Ankle Surg 2024:S1067-2516(24)00109-1. [PMID: 38876208 DOI: 10.1053/j.jfas.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/30/2024] [Accepted: 05/25/2024] [Indexed: 06/16/2024]
Abstract
To reduce diabetes-related complications and to avoid futile procedures, foot and ankle surgeons need to understand the relative timings of catastrophic events, their incidence, and probabilities of transitions between disease states in diabetes in different patient populations. For this study, we tracked medical events (including an initial diagnosis of diabetes, ulcer, wound care, osteomyelitis, amputation, and reamputation, in order of severity) and the time between each such event in patients with diabetes, stratifying by sex, race, and ethnicity. We found that the longest average duration between the different lower extremity states was a diagnosis of diabetes to the occurrence of ulcer at 1137 days (38 months). The average durations of amputation to reamputation, osteomyelitis, wound care, and ulcer were 18, 49, 23, and 18 days, respectively. The length of each disease transition for females was greater, while those of the Hispanic population were shorter than in the total cohort. This knowledge may permit surgeons to time and tailor treatments to their patients, and help patients to address, delay, or avoid complications.
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Affiliation(s)
- Daniel C Jupiter
- Associate Professor, Department of Biostatistics and Data Science, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX
| | - Yuanyi Zhang
- Senior Biostatistician, Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- Clinical Professor, University of Texas Rio Grande Valley, School of Podiatric Medicine, Harlingen, TX.
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23
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Mayer AM, Cates NK, Tefera E, Ragothaman KK, Fan KL, Evans KK, Steinberg JS, Attinger CE. Outcomes in Drainage Ankle Disarticulation vs Guillotine Transtibial Amputation in the Staged Approach to Below-Knee Amputation. Foot Ankle Spec 2024:19386400241253880. [PMID: 38825986 DOI: 10.1177/19386400241253880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
A transtibial amputation is the traditional primary staged amputation for source control in the setting of non-salvageable lower extremity infection, trauma, or avascularity prior to progression to proximal amputation. The primary aim of the study is to compare preoperative risk factors and postoperative outcomes between patients who underwent transtibial amputation versus ankle disarticulation in staged amputations. A retrospective review of 152 patients that underwent staged below the knee amputation were compared between those that primarily underwent transtibial amputation (N = 70) versus ankle disarticulation (N = 82). The mean follow-up for all 152 patients was 2.1 years (range = 0.04-7.9 years). The odds of incisional healing were 3.2 times higher for patients with guillotine amputation compared to patients with ankle disarticulation (odds ratio [OR] = 3.2, 95% confidence interval [CI] = 1.437-7.057). The odds of postoperative infection is 7.4 times higher with ankle disarticulation compared to patients with guillotine amputation (OR = 7.345, 95% CI = 1.505-35.834). There were improved outcomes in patients that underwent staged below the knee amputation with primarily guillotine transtibial amputation compared to primarily ankle disarticulation. Ankle disarticulation should be reserved for more distal infections, to allow for adequate infectious control, in the aims of decreasing postoperative infection and improving incisional healing rates.Levels of Evidence: 3, Retrospective study.
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Affiliation(s)
- Alissa M Mayer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Nicole K Cates
- Fellowship Trained Foot and Ankle Surgeon, Hand & Microsurgery Medical Group, San Francisco, California
| | - Eshetu Tefera
- Department of Biostatistician and Biomedical Informatics, MedStar Health Research Institute, Washington, District of Columbia
| | - Kevin K Ragothaman
- Fellowship Trained Foot and Ankle Surgeon, Foot and Ankle Associates, Cupertino, California
| | - Kenneth L Fan
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Karen K Evans
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - John S Steinberg
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Christopher E Attinger
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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24
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Lau J, Huang J, Kassamali Escobar Z. Antipseudomonal Antibiotics in Diabetic Foot Infections: A Practical Perspective From a Community Hospital. Open Forum Infect Dis 2024; 11:ofae258. [PMID: 38933740 PMCID: PMC11200182 DOI: 10.1093/ofid/ofae258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/08/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Janice Lau
- Department of Pharmacy, UW Medicine, Valley Medical Center, Renton, Washington, USA
| | - Joanne Huang
- Department of Pharmacy, UW Medicine, Valley Medical Center, Renton, Washington, USA
| | - Zahra Kassamali Escobar
- Department of Pharmacy, UW Medicine, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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25
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Roh S, Hashimoto K, Kiriishi R, Matsubara K, Isozaki Y, Tanaka H, Kuwata T. Piperacillin/tazobactam-induced sudden severe thrombocytopenia in a patient with a pressure ulcer: a case report. J Wound Care 2024; 33:S25-S30. [PMID: 38843043 DOI: 10.12968/jowc.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
The standard treatment for an infected pressure ulcer (PU) with osteomyelitis is debridement, wound coverage and antibiotic administration. However, systemic administration of antibiotics in patients with osteomyelitis is controversial, and the optimal treatment duration for chronic osteomyelitis has not been standardised. We report a case of sudden severe thrombocytopenia induced by piperacillin/tazobactam (PIPC/TAZ) in a patient with PU-related osteomyelitis. A 57-year-old male patient with paraplegia, using a wheelchair full-time, presented to our plastic surgery department with infection of a stage IV hard-to-heal ischial PU. We surgically debrided the necrotising tissue and raised an ipsilateral biceps femoris musculocutaneous propeller flap for wound coverage. Polymicrobial infections, including Pseudomonas aeruginosa, were detected in the bone biopsy sample; therefore, systemic PIPC/TAZ was administered for the osteomyelitis. Unexpectedly, during the next 12 days of antibiotic administration, the patient's platelet count acutely dropped to 1×103/μl over three days. Based on a series of examinations, PIPC/TAZ was suspected to be the most likely cause of the severe thrombocytopenia. After drug discontinuation, the thrombocytopenia gradually improved. PIPC/TAZ is one of the most widely used antibiotic combinations in the plastic surgery field; it is conventionally administered for hard-to-heal wounds such as PUs and diabetic foot. The present case suggests that surgeons must take special precautions for patients undergoing PIPC/TAZ treatment. In this report, PIPC/TAZ-induced thrombocytopenia and the efficacy of antibiotic treatment for PU-related osteomyelitis are discussed in light of the available literature.
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Affiliation(s)
- Solji Roh
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Kohei Hashimoto
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Rina Kiriishi
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Ken Matsubara
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Yuki Isozaki
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | | | - Tomoyuki Kuwata
- Department of Plastic Surgery, Asahi General Hospital, Japan
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Zhou Y, Huang H, Chen G, Yuan Q, Ren J, Wu J, Lin Y, Lin Z, Xu L. Promoting the healing of diabetic wounds with an antimicrobial gel containing AgNPs with anti-infective and anti-inflammatory properties. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1236-1257. [PMID: 38460114 DOI: 10.1080/09205063.2024.2324494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
Diabetic wounds are prone to develop chronic wounds due to bacterial infection and persistent inflammatory response. However, traditional dressings are monofunctional, lack bioactive substances, have limited bacterial inhibition as well as difficulties in adhesion and retention. These limit the therapeutic efficacy of traditional dressings on diabetic wounds. Therefore, finding and developing efficient and safe wound dressings is currently an urgent clinical need. In this study, an antimicrobial gel loaded with silver nanoparticles (AgNPs) (referred to as AgNPs@QAC-CBM) was prepared by crosslinking quaternary ammonium chitosan (QAC) with carbomer (CBM) as a gel matrix. AgNPs@QAC-CBM exhibited a reticulated structure, strong adhesion, good stability, and remarkable bactericidal properties, killing 99.9% of Escherichia coli, Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa within 1 min. Furthermore, AgNPs@QAC-CBM improved the wound microenvironment and accelerated wound healing in diabetic mice by promoting tissue production and collagen deposition, inducing M2 macrophages, reducing pro-inflammatory factor secretion and increasing anti-inflammatory factor levels. Moreover, AgNPs@QAC-CBM was proven to be safe for use through skin irritation and cytotoxicity tests, as they did not cause any irritation or toxicity. To summarize, AgNPs@QAC-CBM showed promising potential in enhancing the diabetic wound healing process.
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Affiliation(s)
- Yanyan Zhou
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Haiyan Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Gong Chen
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Qi Yuan
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Jingyuan Ren
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Jiashen Wu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Yuchun Lin
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Zhongning Lin
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Ling Xu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen 361102, China
- Shenzhen Research Institute of Xiamen University, Shenzhen, China
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27
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Jalalzadeh M, Nasli-Esfahani E, Montazer M, Geravand F, Heidari-Seyedmahalle M, Mahmoodi M, Azadbakht L. Association between DASH and novel atherogenic risk factors, anthropometric indices and foot ulcer indicators in type 2 diabetic patients with foot ulcer: a cross-sectional study. J Diabetes Metab Disord 2024; 23:1315-1327. [PMID: 38932905 PMCID: PMC11196542 DOI: 10.1007/s40200-024-01427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/21/2024] [Indexed: 06/28/2024]
Abstract
Purpose Diabetes can cause nerve damage, vascular issues, and reduced blood flow to organs such as the feet, leading to foot deformities and ulcers due to high glucose levels. A healthy dietary pattern like DASH can improve insulin sensitivity and weight loss. Due to limited data and rare evidence, our study aims to investigate the relationship between DASH diet adherence and anthropometric, cardiovascular, and foot ulcer indicators. Methods The study included 339 diabetic patients with foot ulcers (122 females and 217 males). The study gathered data on patient dietary intake, anthropometric measurements, biochemistry, foot ulcers, and novel atherogenic risk factors per international definitions. Results The average BMI of the participants was 29.2 ± 5.0, 28.1 ± 4.3, and 28.2 ± 4.2 in the tertiles of DASH index (P-value: 0.18). By increasing the adherence to the DASH index, the monofilament score did not change significantly OR: 1.47; CI: (0.81-2.67). Also, foot ulcer area did not change significantly between DASH tertiles OR: 1.01; CI: (0.56-1.83). Atherogenic risk factors also decreased among the DASH tertiles, but statistically not significant. Conclusion DASH adherence did not change neuropathy score and cholindex and cardiovascular risk factors significantly and has no significant effect on foot ulcer size.
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Affiliation(s)
- Moharam Jalalzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O.Box: 14155-61170, Tehran, Iran
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Montazer
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O.Box: 14155-61170, Tehran, Iran
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Geravand
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O.Box: 14155-61170, Tehran, Iran
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Heidari-Seyedmahalle
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O.Box: 14155-61170, Tehran, Iran
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mahmoodi
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O.Box: 14155-61170, Tehran, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Bazikian S, Pyun AJ, Zheng H, Padula W, Khan T, Ziegler K, Shin L, Magee GA, Rowe VL, Armstrong DG. Evaluating the impact of an interdisciplinary integrated limb preservation service operating concurrently with a single-specialty service. J Foot Ankle Res 2024; 17:e12013. [PMID: 38613833 PMCID: PMC11080699 DOI: 10.1002/jfa2.12013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND This study examined the efficacy of an interdisciplinary limb preservation service (LPS) in improving surgical outcomes for diabetic foot ulcer (DFU) patients compared to traditional care. METHODS Data from January 1, 2017 to September 30, 2020 were retrospectively reviewed. An interdisciplinary LPS clinic began on August 1, 2018, coexisting with a preexisting single specialty service. Primary outcomes were major/minor amputation rates and ratios and hospital length of stay. Surgical endpoints pre- and post-LPS launch were compared. RESULTS Among 976 procedures for 731 unique DFU patients, most were male (80.4%) and Hispanic (89.3%). Patient demographics were consistent before and after LPS initiation. Major amputation rates decreased by 45.5% (15.4%-8.4%, p = 0.001), with outpatient procedures increasing over 5-fold (3.3% pre-LPS to 18.7% post-LPS, p < 0.001). Hospital stay reduced from 10.1 to 8.5 days post-LPS (p < 0.001). The major to minor amputation ratio declined from 22.4% to 12.7%. CONCLUSIONS The interdisciplinary LPS improved patient outcomes, marked by fewer major amputations and reduced hospital stays, suggesting the model's potential for broader application.
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Affiliation(s)
- Sebouh Bazikian
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alyssa J. Pyun
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Hanke Zheng
- Department of Pharmaceutical and Health EconomicsAlfred E. Mann School of Pharmacy and Pharmaceutical SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - William Padula
- Department of Pharmaceutical and Health EconomicsAlfred E. Mann School of Pharmacy and Pharmaceutical SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Tanzim Khan
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kenneth Ziegler
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Laura Shin
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Gregory A. Magee
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Vincent L. Rowe
- Division of Vascular Surgery and Endovascular TherapyDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - David G. Armstrong
- Division of Vascular Surgery and Endovascular TherapyDepartment of SurgeryKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Wang F, Zhang XL, Zhang J, Gong S, Tao J, Xiang H, Fu XQ, Bian XN, Yu XF, Xu AH, Yi CL, Shao SY. Therapeutic Effectiveness of Leukocyte- and Platelet-rich Fibrin for Diabetic Foot Ulcers: A Retrospective Study. Curr Med Sci 2024; 44:568-577. [PMID: 38789818 DOI: 10.1007/s11596-024-2874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation autologous platelet-rich plasma. This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice. METHODS Patients with DFU who received L-PRF treatment and standard of care (SOC) from 2018 to 2019 in Tongji Hospital were enrolled. The clinical information including patient characteristics, wound evaluation (area, severity, infection, blood supply), SOC of DFU, and images of ulcers was retrospectively extracted and analyzed. L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction (PVR) greater than 80%. Therapeutic effectiveness, including overall PVR and the overall and weekly healing rates, was evaluated. RESULTS Totally, 26 patients with DFU were enrolled, and they had an ulcer duration of 47.0 (35.0, 72.3) days. The severity and infection of ulcers varied, as indicated by the Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) scores of 2-6, Wagner grades of 1-4, and the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) scores of 2-4. The initial ulcer volume before L-PRF treatment was 4.94 (1.50, 13.83) cm3, and the final ulcer volume was 0.35 (0.03, 1.76) cm3. The median number of L-PRF doses was 3 (2, 5). A total of 11 patients achieved complete epithelialization after the fifth week of treatment, and 19 patients achieved at least an 80% volume reduction after the seventh week. The overall wound-healing rate was 1.47 (0.63, 3.29) cm3/week, and the healing rate was faster in the first 2 weeks than in the remaining weeks. Concurrent treatment did not change the percentage of complete epithelialization or healing rate. CONCLUSION Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index, SINBAD score, or Wagner grade, indicating that this method is appropriate for DFU treatment under different clinical conditions.
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Affiliation(s)
- Fen Wang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xiao-Ling Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Jing Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Song Gong
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Jing Tao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Hui Xiang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xiao-Qing Fu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xu-Na Bian
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - Xue-Feng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China
| | - An-Hui Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cheng-la Yi
- Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shi-Ying Shao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, China.
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Demirdal T, Sen P. Predictors of surgical management in diabetic foot infections. J Wound Care 2024; 33:clx-clxx. [PMID: 38850543 DOI: 10.12968/jowc.2021.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Early recognition of the need for surgical intervention is crucial in terms of limiting amputation level and decreasing mortality. We aimed to determine the risk factors for limb loss in patients with diabetic foot infection (DFI). METHOD Data of hospitalised patients with a DFI between 2010 and 2019 were collected retrospectively from their hospital records. Clinical and laboratory findings were analysed according to the type of treatment. RESULTS Data were collected for 401 patients, 280 (69.8%) of whom were male. The mean age was 59.6±11.1 years. Treatment modalities included: medical treatment (36.4%); debridement/drainage (21.9%); minor amputation (17.7%); and major amputation (23.9%). Forefoot infection (odds ratio (OR): 3.347; 95% confidence interval (Cl): 1.408-7.956) and peripheral arterial disease (OR: 4.990; 95% Cl: 1.225-20.324) were found to be significant in predicting limb loss, while duration of diabetes (≥20 years) and absence of forefoot infection were significant predictors of debridement/drainage. Subgroup analysis showed that high leukocyte levels (>16.4K/μl) and forefoot infections were independent predictors for major and minor amputation, respectively. CONCLUSION The clinical parameters used in this study are simple, broadly available, cost-effective and promising for predicting limb loss in patients with DFI.
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Affiliation(s)
- Tuna Demirdal
- Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Karabaglar/Izmir, Turkey
| | - Pinar Sen
- Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Karabaglar/Izmir, Turkey
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Hsu CC, Lai HY, Lin HY, Pan SC, Cheng NC, Chen LK, Hsiao FY, Lin SW. Recurrence of Diabetic Foot Complications: A Domino Effect Leading to Lethal Consequences-Insights From a National Longitudinal Study. Open Forum Infect Dis 2024; 11:ofae276. [PMID: 38868313 PMCID: PMC11167667 DOI: 10.1093/ofid/ofae276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/07/2024] [Indexed: 06/14/2024] Open
Abstract
Background Foot complications are common in people with diabetes mellitus (DM), leading to increased health care utilization, heightened mortality risk, and notable recurrence rates even after treatment. This retrospective cohort study aimed to investigate the impact of repeated occurrence of DM-related foot complications on the risk of all-cause mortality and to identify the potential risk factors associated with repeated events. Methods People with DM admitted with foot complications (ulcer, skin and soft tissue infection, or osteomyelitis) from 2012 to 2014 were identified from Taiwan's National Health Insurance Research Database, with a 3-year follow-up for repeated events. We categorized the study subjects based on their cumulative number of hospital admissions with foot complications. Logistic regression was conducted to explore the potential risk factors associated with repeated diabetic foot events. Kaplan-Meier curves and Cox proportional hazard models were used to examine the associations between repeated diabetic foot events and all-cause mortality. Results In this study, 28 754 eligible individuals were enrolled and classified into 3 groups: no repeated diabetic foot events (76.1%), 1 repeated event (16.0%), and 2 or more repeated events (7.9%). Logistic regression revealed that advanced age, male sex, congestive heart failure, dyslipidemia, hypertension, nephropathy, retinopathy, neuropathy, peripheral vascular disease, diabetes-related preventable hospitalizations, and outpatient visits due to diabetic foot were significantly associated with repeated events of diabetic foot complications. Compared with those with no repeated events, the adjusted hazard ratios for all-cause mortality were 1.26 (95% CI, 1.19-1.34) for 1 repeated event and 1.36 (95% CI, 1.26-1.47) for 2 or more repeated events. Conclusions The significant association between repeated diabetic foot and elevated mortality risk highlights the critical necessity for proactive and targeted patient care within clinical practice. More research to delve into the predictive factors related to the repeated occurrence of diabetic foot is needed to provide additional insights for prevention strategies.
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Affiliation(s)
- Chun-Chien Hsu
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsi-Yu Lai
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Hung-Yu Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sung-Ching Pan
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Nai-Chen Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Wen Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Cancer Center, Taipei, Taiwan
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Camilleri Attard F, Gatt A, Formosa C. Superficial Tissue Swabs Versus Deep Tissue Samples in the Detection of Microbiological Profile of Infected Diabetic Foot Ulcerations. INT J LOW EXTR WOUND 2024; 23:315-319. [PMID: 34693770 DOI: 10.1177/15347346211053481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study aimed to determine the most accurate microbiological test for the detection of micro-organisms in infected diabetic foot ulcerations in people living with type-2 Diabetes. For 20 eligible patients, a superficial tissue swab and a deep tissue sample were taken during a regular appointment at a Diabetes out-patient's Podiatry Clinic. Two specimens were collected from each wound for microbial culturing after debridement. Infected foot ulcerations were graded according to the Wagner's classification as per clinical protocol. This study found a significant difference [p = 0.028] between the two different samples. The deep tissue sample was found to be more accurate in identifying micro-organisms than the superficial swabs, although the latter is more widely used in clinical practice. Further studies are warranted to provide more evidence to clinicians on the best method to adopt when swabbing different types of diabetic foot ulcerations with different wound classification since, it is clearly still a matter of debate how to detect wound infection.
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Affiliation(s)
| | - A Gatt
- University of Malta, Msida, Malta
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33
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Wu C, Ling M, Chen Q, Chai H, Chen H. Multiplex Digital PCR-Based Development and discussion of the Detection of Genetic Association Between Staphylococcus aureus and mecA. Infect Drug Resist 2024; 17:2031-2041. [PMID: 38803520 PMCID: PMC11128719 DOI: 10.2147/idr.s464213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a predominant nosocomial infection-causing bacteria. The aim of this study was to develop a novel single-bacteria multiplex digital PCR assays (SMD-PCR), which is capable of simultaneously detecting and discriminating Methicillin-sensitive Staphylococcus aureus (MSSA) and MRSA. This protocol employed TaqMan probes to detect SAOUHSC_00106 and mecA genes, with the latter being linked to methicillin resistance. A total of 72 samples from various specimen types were evaluated. The accuracy rates for the sputum samples, pus samples, swab samples, ear secretion samples, and catheter samples were 94.44%, 100%, 92%, 100%, and 100%, respectively. Our results showed that the clinical practicability of SMD-PCR has applicability to the rapid detection of MRSA without DNA extraction or bacterial culture, and can be utilized for the rapid detection of Staphylococcus aureus and the timely identification of MRSA in clinical samples, thereby providing an advanced platform for the rapid diagnosis of clinical MRSA infection.
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Affiliation(s)
- Ciming Wu
- Zhejiang Chinese Medical University, College of Life Science, Hangzhou, Zhejiang, 310012, People’s Republic of China
| | - Ming Ling
- Jinhua Institute for Food and Drug Control, Jinhua, Zhejiang, People’s Republic of China
| | - Qiong Chen
- Hangzhou First People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Hui Chai
- Zhejiang Chinese Medical University, College of Life Science, Hangzhou, Zhejiang, 310012, People’s Republic of China
| | - Huan Chen
- Zhejiang Chinese Medical University, College of Life Science, Hangzhou, Zhejiang, 310012, People’s Republic of China
- Hangzhou Digital-Micro Biotech Co, Ltd, Hangzhou, Zhejiang, People’s Republic of China
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Keogh RA, Huyvaert S, Moore GD, Horswill AR, Doran KS. Virulence characteristics of Gram-positive bacteria isolated from diabetic foot ulcers. FEMS MICROBES 2024; 5:xtae013. [PMID: 38783991 PMCID: PMC11114470 DOI: 10.1093/femsmc/xtae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/02/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Diabetic wound infections including diabetic foot ulcers (DFUs) are a major global health concern and a leading cause of non-traumatic amputations. Numerous bacterial species establish infection in DFUs, and treatment with antibiotics often fails due to widespread antibiotic resistance and biofilm formation. Determination of bacterial species that reside in DFU and their virulence potential is critical to inform treatment options. Here, we isolate bacteria from debridement tissues from patients with diabetes at the University of Colorado Anschutz Medical Center. The most frequent species were Gram-positive including Enterococcus faecalis, Staphylococcus aureus, and Streptococcus agalactiae, also known as Group B Streptococcus (GBS). Most tissues had more than one species isolated with E. faecalis and GBS frequently occurring in polymicrobial infection with S. aureus. S. aureus was the best biofilm producing species with E. faecalis and GBS isolates exhibiting little to no biofilm formation. Antibiotic susceptibility varied amongst strains with high levels of penicillin resistance amongst S. aureus, clindamycin resistance amongst GBS and intermediate vancomycin resistance amongst E. faecalis. Finally, we utilized a murine model of diabetic wound infection and found that the presence of S. aureus led to significantly higher recovery of GBS and E. faecalis compared to mice challenged in mono-infection.
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Affiliation(s)
- Rebecca A Keogh
- Department of Immunology and Microbiology, University of Colorado Anschutz, Aurora, CO 80045, United States
| | - Savannah Huyvaert
- Department of Immunology and Microbiology, University of Colorado Anschutz, Aurora, CO 80045, United States
| | - Garrett D Moore
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Alexander R Horswill
- Department of Immunology and Microbiology, University of Colorado Anschutz, Aurora, CO 80045, United States
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO 80045, United States
| | - Kelly S Doran
- Department of Immunology and Microbiology, University of Colorado Anschutz, Aurora, CO 80045, United States
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Hassold N, Bihan H, Moumba YP, Poilane I, Méchaï F, Assad N, Labbe-Gentils V, Sal M, Koutcha ON, Martin A, Radu D, Martinod E, Cordel H, Vignier N, Tatulashvili S, Berkane N, Carbonnelle E, Bouchaud O, Cosson E. BedBiopsy: Diagnostic performance of bedside ultrasound-guided bone biopsies for the management of diabetic foot infection. DIABETES & METABOLISM 2024; 50:101525. [PMID: 38442769 DOI: 10.1016/j.diabet.2024.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We aimed to assess the feasibility and diagnostic performance of ultrasound-guided bone biopsies at the bedside of diabetic patients admitted for suspected foot osteitis not requiring surgery. RESEARCH DESIGN AND METHODS In this retrospective monocentric study, we compared the performance of ultrasound-guided (n = 29 consecutive patients, Dec.2020-Oct.2022) versus surgical (n = 24 consecutive patients, Jan.2018-Nov.2020) bone biopsies at confirming or ruling out diabetic foot osteitis (primary outcome). RESULTS Patient characteristics were similar in the two intervention groups, including arteritis prevalence (62.3 %), SINBAD score, and wound location (phalanges 36 %, metatarsus 43 %, and calcaneus 21 %). However, the ultrasound-guided group was older (67 ± 11 versus 60 ± 13 years respectively, P = 0.047) and had more type 2 diabetes (97 % versus 75 %, P = 0.038). Diagnostic performance (i.e., capacity to confirm or rule out suspected osteitis) was similar for ultrasound-guided (28/29 cases: 25 confirmations, 3 invalidations) and surgical (24 confirmations/24) biopsies, P = 0.358. No biopsy-related side effect or complication was observed for either intervention, even for patients on antiaggregation and/or anticoagulation therapy. The mean (± standard deviation) time necessary to perform the biopsy was shorter in the ultrasound-guided group (2.6 ± 3.0 versus 7.2 ± 5.8 days, respectively, P < 0.001) and wound evolution at three months was more favorable (83.3 versus 41.2 %, P = 0.005) (94.4 % versus 66.7 %, respectively, patients with new surgical procedure within six months excluded; P = 0.055). Even though not statistically significant, healing rates in terms of wound and osteitis at six months were also better in the ultrasound-guided group (wound: 40.9 % versus 36.8 %; P = 0.790, and osteitis: 81.8 vs 55.6 % P = 0.071). CONCLUSION In diabetic patients with suspected foot osteitis not requiring surgery, bedside ultrasound-guided bone biopsies may constitute a promising alternative to surgical biopsies. This intervention provided excellent tolerance and microbiological documentation, short lead-times, and more favorable wound prognosis.
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Affiliation(s)
- Nolan Hassold
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France.
| | - Hélène Bihan
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; LEPS (Laboratoire Educations et Promotion de la Santé) EA 3412-Université Paris 13, France
| | - Yolène Pambo Moumba
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | | | - Frédéric Méchaï
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
| | - Nabil Assad
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Véronique Labbe-Gentils
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Meriem Sal
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Omar Nouhou Koutcha
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Antoine Martin
- Department of anatomopathology, Avicenne Hospital, Bobigny, France
| | - Dana Radu
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny. France
| | - Emmanuel Martinod
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny. France
| | - Hugues Cordel
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
| | - Nicolas Vignier
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; IAME, INSERM UMR 1137, Université Sorbonne Paris Nord, Bobigny, France
| | - Sopio Tatulashvili
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | - Narimane Berkane
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
| | | | - Olivier Bouchaud
- Department of infectious diseases, Avicenne Hospital, Hôpitaux universitaires Paris Seine-Saint-Denis, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
| | - Emmanuel Cosson
- Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
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36
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Frazee BW. Diabetic Foot Infections in the Emergency Department. Emerg Med Clin North Am 2024; 42:267-285. [PMID: 38641391 DOI: 10.1016/j.emc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Diabetic foot infection (DFI) is among the most common diabetic complications requiring hospitalization. Prompt emergency department diagnosis and evidence-based management can prevent eventual amputation and associated disability and mortality. Underlying neuropathy, arterial occlusion, immune dysfunction, and hyperglycemia-associated dehydration and ketoacidosis can all contribute to severity and conspire to make DFI diagnosis and management difficult. Serious complications include osteomyelitis, necrotizing infection, and sepsis. Practice guidelines are designed to assist frontline providers with correct diagnosis, categorization, and treatment decisions. Management generally includes a careful lower extremity examination and plain x-ray, obtaining appropriate tissue cultures, and evidence-based antibiotic selection tailored to severity.
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Affiliation(s)
- Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA.
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Edwards SJ, Yao J, Schechter MC, Fayfman M, Santamarina G, Feiweier T, Blanco G, Alvarez J, Risk BB, Rajani R, Reiter DA. Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using Intravoxel Incoherent Motion and Blood Oxygenation-Level Dependent MRI. J Magn Reson Imaging 2024; 59:1555-1566. [PMID: 37596872 PMCID: PMC10875144 DOI: 10.1002/jmri.28955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Patients with type-2 diabetes (T2DM) are at increased risk of developing diabetic foot ulcers (DFU) and experiencing impaired wound healing related to underlying microvascular disease. PURPOSE To evaluate the sensitivity of intra-voxel incoherent motion (IVIM) and blood oxygen level dependent (BOLD) MRI to microvascular changes in patients with DFUs. STUDY TYPE Case-control. POPULATION 20 volunteers who were age and body mass index matched, including T2DM patients with DFUs (N = 10, mean age = 57.5 years), T2DM patients with controlled glycemia and without DFUs (DC, N = 5, mean age = 57.4 years) and healthy controls (HC, N = 5, mean age = 52.8 years). FIELD STRENGTH/SEQUENCE 3T/multi-b-value IVIM and dynamic BOLD. ASSESSMENT Resting IVIM parameters were obtained using a multi-b-value diffusion-weighted imaging sequence and two IVIM models were fit to obtain diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and microvascular volume fraction (MVF) parameters. Microvascular reactivity was evaluated by inducing an ischemic state in the foot with a blood pressure cuff during dynamic BOLD imaging. Perfusion indices were assessed in two regions of the foot: the medial plantar (MP) and lateral plantar (LP) regions. STATISTICAL TESTS Effect sizes of group mean differences were assessed using Hedge's g adjusted for small sample sizes. RESULTS DFU participants exhibited elevated D*, f, and MVF values in both regions (g ≥ 1.10) and increased D (g = 1.07) in the MP region compared to DC participants. DC participants showed reduced f and MVF compared to HC participants in the MP region (g ≥ 1.06). Finally, the DFU group showed reduced tolerance for ischemia in the LP region (g = -1.51) and blunted reperfusion response in both regions (g < -2.32) compared to the DC group during the cuff-occlusion challenge. DATA CONCLUSION The combined use of IVIM and BOLD MRI shows promise in differentiating perfusion abnormalities in the feet of diabetic patients and suggests hyperperfusion in DFU patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Scott J. Edwards
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jingting Yao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcos C. Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Maya Fayfman
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriel Santamarina
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of Vascular Surgery, Department of Surgery, Atlanta, GA, United States of America
| | | | - Gerardo Blanco
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ravi Rajani
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Vascular Surgery, Department of Surgery, Atlanta, GA, United States of America
| | - David A. Reiter
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA
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Zhang G, Samarawickrama PN, Gui L, Ma Y, Cao M, Zhu H, Li W, Yang H, Li K, Yang Y, Zhu E, Li W, He Y. Revolutionizing Diabetic Foot Ulcer Care: The Senotherapeutic Approach. Aging Dis 2024:AD.2024.0065. [PMID: 38739931 DOI: 10.14336/ad.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
Diabetic foot ulcers (DFUs) are a prevalent and profoundly debilitating complication that afflicts individuals with diabetes mellitus (DM). These ulcers are associated with substantial morbidity, recurrence rates, disability, and mortality, imposing substantial economic, psychological, and medical burdens. Timely detection and intervention can mitigate the morbidity and disparities linked to DFU. Nevertheless, current therapeutic approaches for DFU continue to grapple with multifaceted limitations. A growing body of evidence emphasizes the crucial role of cellular senescence in the pathogenesis of chronic wounds. Interventions that try to delay cellular senescence, eliminate senescent cells (SnCs), or suppress the senescence-associated secretory phenotype (SASP) have shown promise for helping chronic wounds to heal. In this context, targeting cellular senescence emerges as a novel therapeutic strategy for DFU. In this comprehensive review, we look at the pathology and treatment of DFU in a systematic way. We also explain the growing importance of investigating SnCs in DFU and highlight the great potential of senotherapeutics that target SnCs in DFU treatment. The development of efficacious and safe senotherapeutics represents a pioneering therapeutic approach aimed at enhancing the quality of life for individuals affected by DFU.
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Affiliation(s)
- Guiqin Zhang
- Department of Endocrinology, the Second Affiliated Hospital of Dali University (the Third People's Hospital of Yunnan Province), Kunming, Yunnan 650011, China
| | - Priyadarshani Nadeeshika Samarawickrama
- Key Laboratory of Genetic Evolution & Animal Models, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
- Key Laboratory of Healthy Aging Research of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
| | - Li Gui
- Department of Endocrinology, the Second Affiliated Hospital of Dali University (the Third People's Hospital of Yunnan Province), Kunming, Yunnan 650011, China
| | - Yuan Ma
- Department of Orthopedics, the Third People's Hospital of Yunnan Province, Kunming, Yunnan 650011, China
| | - Mei Cao
- Department of Endocrinology, the Second Affiliated Hospital of Dali University (the Third People's Hospital of Yunnan Province), Kunming, Yunnan 650011, China
| | - Hong Zhu
- Department of Endocrinology, the Second Affiliated Hospital of Dali University (the Third People's Hospital of Yunnan Province), Kunming, Yunnan 650011, China
| | - Wei Li
- Department of Endocrinology, the Second Affiliated Hospital of Dali University (the Third People's Hospital of Yunnan Province), Kunming, Yunnan 650011, China
| | - Honglin Yang
- Department of Orthopedics, the Third People's Hospital of Yunnan Province, Kunming, Yunnan 650011, China
| | - Kecheng Li
- Department of Orthopedics, the Third People's Hospital of Yunnan Province, Kunming, Yunnan 650011, China
| | - Yang Yang
- Department of Biochemistry & Structural Biology, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Enfang Zhu
- Department of Endocrinology, the Second Affiliated Hospital of Dali University (the Third People's Hospital of Yunnan Province), Kunming, Yunnan 650011, China
| | - Wen Li
- Department of Endocrinology, the Second Affiliated Hospital of Dali University (the Third People's Hospital of Yunnan Province), Kunming, Yunnan 650011, China
| | - Yonghan He
- Key Laboratory of Genetic Evolution & Animal Models, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
- Key Laboratory of Healthy Aging Research of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
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Cook IO, Mayor JM, Mills JL. A Review of WIfI Clinical Staging to Predict Outcomes in Patients With Threatened Limbs. Ann Vasc Surg 2024:S0890-5096(24)00157-2. [PMID: 38583759 DOI: 10.1016/j.avsg.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/01/2024] [Indexed: 04/09/2024]
Abstract
The Society for Vascular Surgery Wound, Ischemia, and foot Infection's (WIfI's) threatened limb classification system serves to comprehensively assess the severity of disease in patients with chronic limb-threatening ischemia by identifying and grading the main factors that place the threatened limb at greatest risk: wound severity, ischemic burden, and presence of infection. Each of these 3 factors is graded and the limb placed into a clinical stage, with increasing stage associated with severity of limb threat and predicted risk of major limb amputation at 1 year. Globally, there is a growing body of evidence reported from multiple institutions that has assessed amputation rates and wound-healing outcomes following revascularization in patients with WIfI clinical staging. Risk of major amputation at 1 year is low in clinical stage 1, moderate in stages 2 and 3, and high in stage 4. Higher clinical stages are associated with prolonged time to wound healing, while 1-year wound healing rates consistently decrease with increasing clinical stage. Additional avenues of investigation utilizing WIfI as an objective clinical staging tool have yielded new insights into which patients benefit from revascularization, complexity of care, hospital length of stay, quality of life, ethnic and socioeconomic disparities, as well as spurred interest in other modalities of assessing limb perfusion and their possible clinical utility. Ongoing study and refinement of WIfI grading and clinical staging will continue to improve its prognostic utility.
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Affiliation(s)
- Ian O Cook
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Jessica M Mayor
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
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Moja L, Zanichelli V, Mertz D, Gandra S, Cappello B, Cooke GS, Chuki P, Harbarth S, Pulcini C, Mendelson M, Tacconelli E, Ombajo LA, Chitatanga R, Zeng M, Imi M, Elias C, Ashorn P, Marata A, Paulin S, Muller A, Aidara-Kane A, Wi TE, Were WM, Tayler E, Figueras A, Da Silva CP, Van Weezenbeek C, Magrini N, Sharland M, Huttner B, Loeb M. WHO's essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections. Clin Microbiol Infect 2024; 30 Suppl 2:S1-S51. [PMID: 38342438 DOI: 10.1016/j.cmi.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
The WHO Model List of Essential Medicines (EML) prioritizes medicines that have significant global public health value. The EML can also deliver important messages on appropriate medicine use. Since 2017, in response to the growing challenge of antimicrobial resistance, antibiotics on the EML have been reviewed and categorized into three groups: Access, Watch, and Reserve, leading to a new categorization called AWaRe. These categories were developed taking into account the impact of different antibiotics and classes on antimicrobial resistance and the implications for their appropriate use. The 2023 AWaRe classification provides empirical guidance on 41 essential antibiotics for over 30 clinical infections targeting both the primary health care and hospital facility setting. A further 257 antibiotics not included on the EML have been allocated an AWaRe group for stewardship and monitoring purposes. This article describes the development of AWaRe, focussing on the clinical evidence base that guided the selection of Access, Watch, or Reserve antibiotics as first and second choices for each infection. The overarching objective was to offer a tool for optimizing the quality of global antibiotic prescribing and reduce inappropriate use by encouraging the use of Access antibiotics (or no antibiotics) where appropriate. This clinical evidence evaluation and subsequent EML recommendations are the basis for the AWaRe antibiotic book and related smartphone applications. By providing guidance on antibiotic prioritization, AWaRe aims to facilitate the revision of national lists of essential medicines, update national prescribing guidelines, and supervise antibiotic use. Adherence to AWaRe would extend the effectiveness of current antibiotics while helping countries expand access to these life-saving medicines for the benefit of current and future patients, health professionals, and the environment.
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Affiliation(s)
- Lorenzo Moja
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland.
| | - Veronica Zanichelli
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; World Health Organization Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Canada
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Bernadette Cappello
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Graham S Cooke
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Pem Chuki
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; World Health Organization Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva, Switzerland
| | - Celine Pulcini
- APEMAC, and Centre régional en antibiothérapie du Grand Est AntibioEst, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Evelina Tacconelli
- Infectious Diseases Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Loice Achieng Ombajo
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Ronald Chitatanga
- Antimicrobial Resistance National Coordinating Centre, Public Health Institute of Malawi, Blantyre, Malawi
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | | | - Christelle Elias
- Service Hygiène et Epidémiologie, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | | | - Sarah Paulin
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Arno Muller
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | | | - Teodora Elvira Wi
- Department of Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
| | - Wilson Milton Were
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Elizabeth Tayler
- WHO Regional Office for the Eastern Mediterranean (EMRO), World Health Organisation, Cairo, Egypt
| | | | - Carmem Pessoa Da Silva
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nicola Magrini
- NHS Clinical Governance, Romagna Health Authority, Ravenna, Italy; World Health Organization Collaborating Centre for Evidence Synthesis and Guideline Development, Bologna, Italy
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infections, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Benedikt Huttner
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; World Health Organization Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Canada
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López-Moral M, García-Madrid M, Molines-Barroso RJ, García-Álvarez Y, Álvaro-Afonso FJ, Lázaro-Martínez JL. Diagnostic Performance of Ultrasonography for Diabetic Foot Osteomyelitis. Adv Wound Care (New Rochelle) 2024; 13:167-175. [PMID: 37950713 DOI: 10.1089/wound.2023.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Objective: This study aims to analyze the potential diagnostic capability of ultrasonography (US) in detecting diabetic foot osteomyelitis (DFO) in patients with diabetic foot ulcers (DFUs). Approach: A 1-year prospective study was conducted on 47 consecutive patients with active DFUs and suspicion of DFO at a specialized diabetic foot unit. The following ultrasonographic features were evaluated at baseline: (1) periosteal reaction; (2) periosteal elevation; (3) cortical disruption; (4) sequestrum; and (5) positive power Doppler. The primary outcome measure aimed to establish the effectiveness of ultrasonographic features compared with aseptic bone culture for diagnosing DFO. Receiver operating characteristic (ROC) curves were utilized to evaluate the diagnostic performance of ultrasonographic features. Sample size could not be determined as it is the first study to assess ultrasonographic features for the diagnosis of DFO. The research adhered to the guidelines for diagnostic accuracy studies (Standards for Reporting of Diagnostic Accuracy Studies [STARD] 2015). Results: All patients (n = 24) diagnosed with DFO exhibited positive power Doppler, resulting in a sensitivity (S) and specificity (SP) of 1 and an area under the curve (AUC) of 1 (p < 0.001 [1-1]). Cortical disruption was present in 23 patients (95.8%) with DFO, yielding an S of 0.93, SP of 1, and AUC of 0.96 (p < 0.001 [0.88-1]). Innovation: It validates the diagnostic value of US for DFO as it is the first and largest study of its kind to establish a clear reference standard to guide clinician decision-making. Conclusion: This study demonstrates the effectiveness of cortical disruption and positive power Doppler in assessing DFO through US.
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Affiliation(s)
- Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marta García-Madrid
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Raúl J Molines-Barroso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Yolanda García-Álvarez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco J Álvaro-Afonso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Lipsky BA, Kim PJ, Murphy B, McKernan PA, Armstrong DG, Baker BHJ. Topical pravibismane as adjunctive therapy for moderate or severe diabetic foot infections: A phase 1b randomized, multicenter, double-blind, placebo-controlled trial. Int Wound J 2024; 21:e14817. [PMID: 38567778 PMCID: PMC10988878 DOI: 10.1111/iwj.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 04/05/2024] Open
Abstract
This Phase 1b study was designed to evaluate the safety and efficacy of pravibismane, a novel broad-spectrum topical anti-infective, in managing moderate or severe chronic diabetic foot ulcer (DFU) infections. This randomized, double-blind, placebo-controlled, multicenter study consisted of 39 individuals undergoing pravibismane treatment and 13 individuals in the placebo group. Assessment of safety parameters included clinical observations of tolerability and pharmacokinetics from whole blood samples. Pravibismane was well-tolerated and exhibited minimal systemic absorption, as confirmed by blood concentrations that were below the lower limit of quantitation (0.5 ng/mL) or in the low nanomolar range, which is orders of magnitude below the threshold of pharmacological relevance for pravibismane. Pravibismane treated subjects showed approximately 3-fold decrease in ulcer size compared to the placebo group (85% vs. 30%, p = 0.27). Furthermore, the incidence of ulcer-related lower limb amputations was approximately 6-fold lower (2.6%) in the pooled pravibismane group versus 15.4% in the placebo group (p = 0.15). There were no treatment emergent or serious adverse events related to study drug. The initial findings indicate that topical pravibismane was safe and potentially effective treatment for improving recovery from infected chronic ulcers by reducing ulcer size and facilitating wound healing in infected DFUs (ClinicalTrials.gov Identifier NCT02723539).
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Affiliation(s)
| | - Paul J. Kim
- Departments of Plastic Surgery and Orthopaedic SurgeryUniversity of Texas SouthwesternDallasTexasUSA
| | | | | | - David G. Armstrong
- Department of SurgerySchool of Medicine at the University of Southern CaliforniaLos AngelesCaliforniaUSA
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Debs P, Boutin RD, Smith SE, Babic M, Blankenbaker D, Chandra V, Murphey M, Thottacherry E, Kreulen C, Fayad LM. Chronic Nonspinal Osteomyelitis in Adults: Consensus Recommendations on Percutaneous Bone Biopsies from the Society of Academic Bone Radiologists. Radiology 2024; 311:e231348. [PMID: 38625010 PMCID: PMC11070610 DOI: 10.1148/radiol.231348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 04/17/2024]
Abstract
The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis.
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Affiliation(s)
- Patrick Debs
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Robert D. Boutin
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Stacy E. Smith
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Maja Babic
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Donna Blankenbaker
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Venita Chandra
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Mark Murphey
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Elizabeth Thottacherry
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Christopher Kreulen
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
| | - Laura M. Fayad
- From The Russell H. Morgan Department of Radiology and Radiological
Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and
Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N
Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and
Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University
School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and
Intervention, Department of Radiology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department,
Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.);
Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic
Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and
Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department
of Orthopaedic Surgery, University of California–Davis, Sacramento, Calif
(C.K.)
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44
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Hetta HF, Elsaghir A, Sijercic VC, Akhtar MS, Gad SA, Moses A, Zeleke MS, Alanazi FE, Ahmed AK, Ramadan YN. Mesenchymal stem cell therapy in diabetic foot ulcer: An updated comprehensive review. Health Sci Rep 2024; 7:e2036. [PMID: 38650719 PMCID: PMC11033295 DOI: 10.1002/hsr2.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/06/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Background Diabetes has evolved into a worldwide public health issue. One of the most serious complications of diabetes is diabetic foot ulcer (DFU), which frequently creates a significant financial strain on patients and lowers their quality of life. Up until now, there has been no curative therapy for DFU, only symptomatic relief or an interruption in the disease's progression. Recent studies have focused attention on mesenchymal stem cells (MSCs), which provide innovative and potential treatment candidates for several illnesses as they can differentiate into various cell types. They are mostly extracted from the placenta, adipose tissue, umbilical cord (UC), and bone marrow (BM). Regardless of their origin, they show comparable features and small deviations. Our goal is to investigate MSCs' therapeutic effects, application obstacles, and patient benefit strategies for DFU therapy. Methodology A comprehensive search was conducted using specific keywords relating to DFU, MSCs, and connected topics in the databases of Medline, Scopus, Web of Science, and PubMed. The main focus of the selection criteria was on English-language literature that explored the relationship between DFU, MSCs, and related factors. Results and Discussion Numerous studies are being conducted and have demonstrated that MSCs can induce re-epithelialization and angiogenesis, decrease inflammation, contribute to immunological modulation, and subsequently promote DFU healing, making them a promising approach to treating DFU. This review article provides a general snapshot of DFU (including clinical presentation, risk factors and etiopathogenesis, and conventional treatment) and discusses the clinical progress of MSCs in the management of DFU, taking into consideration the side effects and challenges during the application of MSCs and how to overcome these challenges to achieve maximum benefits. Conclusion The incorporation of MSCs in the management of DFU highlights their potential as a feasible therapeutic strategy. Establishing a comprehensive understanding of the complex relationship between DFU pathophysiology, MSC therapies, and related obstacles is essential for optimizing therapy outcomes and maximizing patient benefits.
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Affiliation(s)
- Helal F. Hetta
- Division of Microbiology, Immunology and Biotechnology, Department of Natural Products and Alternative MedicineFaculty of Pharmacy, University of TabukTabukSaudi Arabia
- Department of Medical Microbiology and ImmunologyFaculty of Medicine, Assiut UniversityAssiutEgypt
| | - Alaa Elsaghir
- Department of Microbiology and ImmunologyFaculty of Pharmacy, Assiut UniversityAssiutEgypt
| | | | | | - Sayed A. Gad
- Faculty of Medicine, Assiut UniversityAssiutEgypt
| | | | - Mahlet S. Zeleke
- Menelik II Medical and Health Science College, Kotebe Metropolitan UniversityAddis AbabaEthiopia
| | - Fawaz E. Alanazi
- Department of Pharmacology and ToxicologyFaculty of Pharmacy, University of TabukTabukSaudi Arabia
| | | | - Yasmin N. Ramadan
- Department of Microbiology and ImmunologyFaculty of Pharmacy, Assiut UniversityAssiutEgypt
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45
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Mokoala TC, Sididzha V, Molefe ED, Luvhengo TE. Life expectancy of patients with diabetic foot sepsis post-lower extremity amputation at a regional hospital in a South African setting. A retrospective cohort study. Surgeon 2024; 22:e109-e114. [PMID: 38101992 DOI: 10.1016/j.surge.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Diabetes foot sepsis (DFS) is the leading cause of amputation of lower extremities. Over 50 % of patients who have had major lower extremity amputation due to DFS are dead within 4 years following the procedure. AIM To determine the life expectancy of patients following amputation for DFS at a regional hospital in South Africa. METHODS We conducted an audit of patients who had DFS and were admitted over a 5-year period. The duration from admission to time of death was recorded in days. Occurrence of death was confirmed from family members of the deceased using structured telephonic interview questionnaires. Categorical findings were summarized using actual counts and percentages and compared using either the Chi-square or Fisher's exact test. We used the mean with standard deviation or median and range to compare parametric and non-parametric continuous data, respectively. The Shapiro-Wilk test was used to test normality of data. Multivariate logistic regression was done to establish factors that were strongly associated with the mortalities. Adjusted survival curves were added to compare the rate of occurrence of mortality between males and females with age as a confounder. Statistical significance was set at a p-value below 0.05. RESULTS 197 were found of which 100 % of participants had Type 2 diabetes mellitus and 63.5 % were males. Associated comorbidities included hypertension in 73.6 %, obesity in 66 %, alcohol use in 64.5 % and smoking in 58.4 %. 190 participants had an amputation and 19.3 % died. CONCLUSION DFS was more common in males and 96 % of the patients had an amputation. Mortality rate within 4 years following amputation was 19.3 % and was higher in females and individuals with multiple comorbidities.
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46
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Wang Y, Wang C, Zheng L. Bibliometric analysis of systematic review and meta-analysis on diabetic foot ulcer. Heliyon 2024; 10:e27534. [PMID: 38496839 PMCID: PMC10944227 DOI: 10.1016/j.heliyon.2024.e27534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
Many clinical management strategies have been proposed to deal with diabetic foot ulcers. However, the occurrence and recurrence of foot ulcers remain the major problems for diabetics. This study aims to identify, visualize, and characterize the meta-analyses on diabetic foot ulcer research. Articles published online were retrieved from the Web of Science core collection database using a search query incorporating MeSH terms and topics related to diabetic foot ulcers and meta-analysis. The publications were then analyzed for basic characteristics, including publication year, countries, topics covered, references, and keywords discussed in the articles. Data visualization was performed using CiteSpace. 334 meta-analyses and systematic reviews on diabetic foot ulcers were identified. The number of publications has experienced rapid growth in recent years (nearly 6-fold since 2016). The United States, China, Netherlands, England, and Australia had a strong collaboration in the contribution of publication. 7 primary topics were summarized from the top 100 highly cited publications: #1 Interventions (proportion: 59%), #2 Risk factors and Prevention (22%), #3 Epidemiology analysis (6%), #4 Cost-effectiveness of interventions (5%), #5 Long-term prognosis (3%), #6 Quality of life analysis (3%), and #7 Economic burden analysis (2%). Footwear and offloading interventions, multidisciplinary care, hyperbaric oxygen, platelet-rich plasma, and negative pressure wound therapies are highly regarded in terms of intervention. Diabetic foot osteomyelitis, peripheral diabetic neuropathy, chronic limb-threatening ischemia, and infections are the main comorbidities. In recent years, offloading interventions, debridement, telemedicine, long-term prognosis, and economic burden analyses have gradually received attention. Individualized treatment, multidisciplinary collaboration, quality of life considerations, and economic burden analyses are the long-term concerns.
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Affiliation(s)
- Yanyan Wang
- Department of Endocrinology, the Fourth Medical Centre, Chinese PLA General Hospital, China
| | - Cong Wang
- Department of Endocrinology, the Fourth Medical Centre, Chinese PLA General Hospital, China
| | - Lei Zheng
- Department of Endocrinology, the Fourth Medical Centre, Chinese PLA General Hospital, China
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47
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Flores-Escobar S, López-Moral M, García-Madrid M, Álvaro-Afonso FJ, Tardáguila-García A, Lázaro-Martínez JL. Diagnostic Performance of Atherogenic Index of Plasma for Predicting Diabetic Foot Osteomyelitis with Peripheral Artery Disease. J Clin Med 2024; 13:1934. [PMID: 38610699 PMCID: PMC11012599 DOI: 10.3390/jcm13071934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study aims to assess the atherogenic index of plasma (AIP) diagnostic value in detecting diabetic foot osteomyelitis (DFO) among patients with diabetic foot ulcers (DFUs). Methods: A prospective cohort study was conducted on 80 patients with DFUs and suspected DFO between January 2022 and December 2023. The primary outcome measures included the diagnosis of DFO, determined by positive microbiological analysis results from bone samples and its correlation with the AIP. Receiver operating characteristic (ROC) curves were utilized to select the optimal diagnostic cut-off points for AIP and post hoc analysis was performed to evaluate the difference in the AIP for diagnosing DFO in patients with and without peripheral arterial disease (PAD). Results: The diagnostic potential for DFO in PAD patients of AIP-1 (Log TC/HDL) showed an AUC of 0.914 (p < 0.001 [0.832-0.996]), leading to a sensitivity of 83% and a specificity of 85%. By contrast, AIP-2 (Log TG/HDL) demonstrated a slightly lower AUC of 0.841 (p < 0.001 [0.716-0.967]), leading to a sensitivity of 76% and a specificity of 74%. Conclusions: The AIP tool, with its ideal blend of sensitivity and specificity, aids in predicting DFO effectively. Therefore, clinicians should consider using AIP for patients suffering from PAD and associated DFO.
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Affiliation(s)
- Sebastián Flores-Escobar
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marta García-Madrid
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Francisco J. Álvaro-Afonso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Aroa Tardáguila-García
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Răducu L, Moraru OE, Gheoca-Mutu DE, Peligrad T, Țigăran AE, Abu-Baker A, Ion DE, Ursuț BM, Jecan CR, Avino A. Confronting a New Challenge in Plastic Surgery: MDR Infections in Patients with Chronic Wounds. Life (Basel) 2024; 14:444. [PMID: 38672715 PMCID: PMC11050788 DOI: 10.3390/life14040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The presence of a wound can be anywhere from non-problematic to life-threatening on a severity spectrum, with bacterial infection and resistance playing a major role in the development of chronicity, delaying wound healing. Wound colonization with multiple organisms and the limited number of effective antibiotics place a heavy burden on the healthcare system, with patients going through multiple surgeries during a prolonged hospitalization time. By analyzing the resistance patterns of pluri-bacterial populations and the approach used in managing complex cases, we aim to improve the protocols applied in caring for chronic wounds in our practice and share our experiences and observations. METHODS We designed a retrospective study on 212 diabetic and non-diabetic patients, aiming to evaluate the course of chronic wound treatment in our practice. We focused on the impact that MDR bacteria and diabetes have on surgical outcomes and their role in the healing process. RESULTS Patients who received empiric antibiotic therapy before being admitted eventually presented with multiple MDR bacteria compared to those who did not receive antibiotics (p = 0.014). The presence of at least one MDR bacteria in the wound bed was associated with ulcers reaching bone (p = 0.02) and was positively correlated with the number of surgeries performed (p < 0.001). Diabetes played a significant role in surgery-related complications (p = 0.02) and hospitalization time (p < 0.001). CONCLUSIONS Proper management of chronic wounds requires a comprehensive, multidisciplinary approach and a thorough understanding of antibiotic usage. To address this need, we have developed and implemented a chronic wound treatment protocol in our clinic, with the goal of discharging patients once their ulcers have been treated and closed. A key summary of the protocol presented is to reduce the incidence of MDR bacteria and improve the patient's quality of life.
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Affiliation(s)
- Laura Răducu
- Discipline of Plastic Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.R.); (C.-R.J.); (A.A.)
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Oriana Elena Moraru
- Discipline of Cardiovascular Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Vascular Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
- Discipline of Anatomy, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Abdalah Abu-Baker
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Bogdan Mihai Ursuț
- Discipline of Anatomy, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of General Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Cristian-Radu Jecan
- Discipline of Plastic Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.R.); (C.-R.J.); (A.A.)
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Adelaida Avino
- Discipline of Plastic Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.R.); (C.-R.J.); (A.A.)
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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49
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Swoboda L, Fasing S. Getting Ready for Certification: Nail Debridement. J Wound Ostomy Continence Nurs 2024; 51:156-158. [PMID: 38527326 DOI: 10.1097/won.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Laura Swoboda
- Laura Swoboda, DNP, APNP, FNP-C, FNP-BC, CWOCN-AP, WOCNF, Director Skin & Wound Care, The Healing Institute, Mequon, WI, 53092
- Sandra Fasing, MSN, RN, CWOCN, ACNS-BC, WOC Nurse, Virginia Hospital Center Health, Arlington
| | - Sandra Fasing
- Laura Swoboda, DNP, APNP, FNP-C, FNP-BC, CWOCN-AP, WOCNF, Director Skin & Wound Care, The Healing Institute, Mequon, WI, 53092
- Sandra Fasing, MSN, RN, CWOCN, ACNS-BC, WOC Nurse, Virginia Hospital Center Health, Arlington
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Dehghan O, Tabaie SM, Rafinejad J, Toutounchi M, Tiyuri A, Azarmi S, Esmaeeli Djavid G, Akbarzadeh K. A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2). INT J LOW EXTR WOUND 2024; 23:133-139. [PMID: 34533091 DOI: 10.1177/15347346211044295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of Lucilia sericata were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan-Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag (P = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, P = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients (P = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.
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Affiliation(s)
- Omid Dehghan
- Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Amir Tiyuri
- Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Azarmi
- Tehran University of Medical Sciences, Tehran, Iran
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