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Wu M, Guo F, He X, Zheng D, Ye W, Li S, Lin Z, Wang F. Analysis of Distribution and Drug Susceptibility Test Results of Pathogenic Bacteria in Diabetic Foot Ulcers. Diabetes Ther 2024; 15:1627-1637. [PMID: 38771473 PMCID: PMC11211311 DOI: 10.1007/s13300-024-01601-x] [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: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION This study aimed to determine the pathogen distribution and drug susceptibility of diabetic foot wound secretions in a tertiary hospital in a coastal area of southeastern China to guide clinical antibiotic selection. METHODS A retrospective analysis was conducted on 212 patients with diabetic foot hospitalized at Xiamen Third Hospital from 2018 to 2023, and foot wound secretions were collected for microbial culture and drug susceptibility testing. RESULTS Among 212 cases of patients with diabetic foot wound secretions, 163 cases (76.9%) were cultured with pathogenic bacteria, and a total of 207 strains of pathogenic bacteria were cultured, including 75 strains (36.23%) of Gram-positive (G+) bacteria, 118 strains of Gram-negative (G-) bacteria (57.00%), 14 strains of fungi (6.76%), 120 cases of single microorganism infection (73.62%), 43 cases of mixed infection (26.38%), and 15 strains of multidrug-resistant bacteria (7.25%). The top three pathogenic bacteria were Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. G+ bacteria were dominated by S. aureus. Drug susceptibility results showed that G+ bacteria were highly susceptible to vancomycin, linezolid, tigecycline, quinupristin/dalfopristin, rifampicin, and furotoxin, and somewhat resistant to penicillin, erythromycin, clindamycin, and cefoxitin. Among G- bacterial infections, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Proteus were the major species. Drug susceptibility testing indicated that carbapenems such as imipenem and ertapenem were the most effective antibacterial drugs against G- strains, followed by amikacin, piperacillin, and tazabactams to which these bacteria were also relatively sensitive, while resistance to penicillins and first-generation cephalosporins increased significantly. We isolated one strain of pathogenic bacteria from a Wagner grade 1 ulcer, which was G+ bacteria. In Wagner grade 2 ulcers, the distribution of pathogenic bacteria was mainly G+ bacteria. In Wagner grade 3 and 4 ulcers, the distribution of pathogenic bacteria was mainly G- bacteria, and the increased rate of mixed infection was mainly due to mixed infection of G+ and G-. Two strains of pathogenic bacteria were isolated at Wagner grade 5, which were mixed infections of G+ and G-. CONCLUSIONS Pathogenic bacteria in diabetic foot wounds are predominantly G- bacteria, followed by G+ bacteria. As the Wagner ulcer grade increases, the distribution of pathogenic bacteria changes from G+ bacteria to G- bacteria, and the mixed infection rate increases. G+ bacteria are highly susceptible to vancomycin, linezolid, tigecycline, quinupristin/dalfopristin, rifampicin, and furotoxin, and somewhat resistant to penicillin, erythromycin, clindamycin, and cefoxitin. G- bacteria are more sensitive to the antimicrobial drugs ertapenem, imipenem, amikacin, piperacillin tazobactam, and have high resistance to penicillin and first-generation cephalosporins.
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Affiliation(s)
- Man Wu
- Department of Endocrinology, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen, 361100, Fujian, China
| | - Fangting Guo
- Department of Endocrinology, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen, 361100, Fujian, China
| | - Xiaowei He
- Department of Hand and Foot Surgery, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen City, 361100, Fujian, China
| | - Dayin Zheng
- Department of Hand and Foot Surgery, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen City, 361100, Fujian, China
| | - Weiqian Ye
- Department of Endocrinology, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen, 361100, Fujian, China
| | - Shaobin Li
- Department of Endocrinology, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen, 361100, Fujian, China
| | - Zhihua Lin
- Department of Endocrinology, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen, 361100, Fujian, China
| | - Fengxiong Wang
- Department of Hand and Foot Surgery, The Third Hospital of Xiamen, No. 2, Yangzhai 2nd Road, Xiangping Street, Tong'an District, Xiamen City, 361100, Fujian, China.
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Yovera-Aldana M, Sifuentes-Hermenegildo P, Cervera-Ocaña MS, Mezones-Holguin E. Association of multidrug-resistant bacteria and clinical outcomes in patients with infected diabetic foot in a Peruvian hospital: A retrospective cohort analysis. PLoS One 2024; 19:e0299416. [PMID: 38833431 PMCID: PMC11149844 DOI: 10.1371/journal.pone.0299416] [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: 02/14/2024] [Accepted: 05/11/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To evaluate the association of multidrug-resistant bacteria (MDRB) and adverse clinical outcomes in patients with diabetic foot infection (DFI) in a Peruvian hospital. MATERIALS AND METHODS This retrospective cohort study evaluated patients treated in the Diabetic Foot Unit of a General Hospital in Lima, Peru. MDRB was defined by resistance to more than two pharmacological groups across six clinically significant genera. The primary outcome was death due to DFI complications and/or major amputation. Other outcomes included minor amputation, hospitalization, and a hospital stay longer than 14 days. Relative risks were estimated using Poisson regression for all outcomes. RESULTS The study included 192 DFI patients with a mean age of 59.9 years; 74% were males. A total of 80.8% exhibited MDRB. The primary outcome had an incidence rate of 23.2% and 5.4% in patients with and without MDRB, respectively (p = 0.01). After adjusting for sex, age, bone involvement, severe infection, ischemia, diabetes duration, and glycosylated hemoglobin, MDRB showed no association with the primary outcome (RR 3.29; 95% CI, 0.77-13.9), but did with hospitalization longer than 14 days (RR 1.43; 95% CI, 1.04-1.98). CONCLUSIONS Our study found no association between MDRB and increased mortality and/or major amputation due to DFI complications, but did find a correlation with prolonged hospitalization. The high proportion of MDRB could limit the demonstration of the relationship. It is urgent to apply continuous evaluation of bacterial resistance, implement a rational plan for antibiotic use, and maintain biosafety to confront this threat.
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Affiliation(s)
- Marlon Yovera-Aldana
- Grupo de Investigación de Neurociencias, Efectividadad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Paola Sifuentes-Hermenegildo
- Departamento de Medicina, Servicio de Endocrinología, Hospital María Auxiliadora, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Perú
| | | | - Edward Mezones-Holguin
- Centro de Estudios Económicos y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- Soluciones de Epi-gnosis, Piura, Peru
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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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Orfali R, Ghaffar S, AlAjlan L, Perveen S, Al-Turki E, Ameen F. Diabetes-related lower limb wounds: Antibiotic susceptibility pattern and biofilm formation. Saudi Pharm J 2024; 32:102069. [PMID: 38681738 PMCID: PMC11046075 DOI: 10.1016/j.jsps.2024.102069] [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: 03/01/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024] Open
Abstract
The expeditious incidence of diabetes mellitus in Riyadh, Saudi Arabia, there is a significant increase in the total number of people with diabetic foot ulcers. For diabetic lower limb wound infections (DLWs) to be effectively treated, information on the prevalence of bacteria that cause in this region as well as their patterns of antibiotic resistance is significant. Growing evidence indicates that biofilm formers are present in chronic DFU and that these biofilm formers promote the emergence of multi-drug antibiotic resistant (MDR) strains and therapeutic rejection. The current study targeted to isolate bacteria from wounds caused by diabetes specifically at hospitals in Riyadh and assess the bacterium's resistance to antibiotics and propensity to develop biofilms. Totally 63 pathogenic microbes were identified from 70 patients suffering from DFU. Sixteen (25.4%) of the 63 bacterial strains were gram-positive, and 47 (74.6%) were gram-negative. Most of the gram-negative bacteria were resistant to tigecycline, nitrofurantoin, ampicillin, amoxicillin, cefalotin, and cefoxitin. Several gram-negative bacteria are susceptible to piperacillin, meropenem, amikacin, gentamicin, imipenem, ciprofloxacin, and trimethoprim. The most significant antibiotic that demonstrated 100% susceptibility to all pathogens was meropenem. Serratia marcescens and Staphylococcus aureus were shown to have significant biofilm formers. MDR bacterial strains comprised about 87.5% of the biofilm former strains. To the best of our knowledge, Riyadh, Saudi Arabia is the first region where Serratia marcescens was the most common bacteria from DFU infections. Our research findings would deliver information on evidence-based alternative strategies to develop effective treatment approaches for DFU treatment.
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Affiliation(s)
- Raha Orfali
- Department of Pharmacognosy, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia
| | - Safina Ghaffar
- Department of Pharmacognosy, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia
| | - Lateefa AlAjlan
- Department of Pharmacognosy, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia
| | - Shagufta Perveen
- Department of Pharmacognosy, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia
| | - Eman Al-Turki
- Department of Pharmacognosy, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia
| | - Fuad Ameen
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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Villa F, Marchandin H, Lavigne JP, Schuldiner S, Cellier N, Sotto A, Loubet P. Anaerobes in diabetic foot infections: pathophysiology, epidemiology, virulence, and management. Clin Microbiol Rev 2024:e0014323. [PMID: 38819166 DOI: 10.1128/cmr.00143-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
SUMMARYDiabetic foot infections (DFI) are a public health problem worldwide. DFI are polymicrobial, biofilm-associated infections involving complex bacterial communities organized in functional equivalent pathogroups, all including anaerobes. Indeed, multiple pathophysiological factors favor the growth of anaerobes in this context. However, the prevalence, role, and contribution of anaerobes in wound evolution remain poorly characterized due to their challenging detection. Studies based on culture reviewed herein showed a weighted average of 17% of patients with anaerobes. Comparatively, the weighted average of patients with anaerobes identified by 16S rRNA gene sequencing was 83.8%. Culture largely underestimated not only the presence but also the diversity of anaerobes compared with cultivation-independent approaches but both methods showed that anaerobic Gram-negative bacilli and Gram-positive cocci were the most commonly identified in DFI. Anaerobes were more present in deeper lesions, and their detection was associated with fever, malodorous lesions, and ulcer depth and duration. More specifically, initial abundance of Peptoniphilus spp. was associated with ulcer-impaired healing, Fusobacterium spp. detection was significantly correlated with the duration of DFI, and the presence of Bacteroides spp. was significantly associated with amputation. Antimicrobial resistance of anaerobes in DFI remains slightly studied and warrants more consideration in the context of increasing resistance of the most frequently identified anaerobes in DFI. The high rate of patients with DFI-involving anaerobes, the increased knowledge on the species identified, their virulence factors, and their potential role in wound evolution support recommendations combining debridement and antibiotic therapy effective on anaerobes in moderate and severe DFI.
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Affiliation(s)
- Fanny Villa
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
| | - Hélène Marchandin
- HydroSciences Montpellier, Univ Montpellier, CNRS, IRD, Service de Microbiologie et Hygiène, Hospitalière, CHU Nîmes, Nîmes, France
| | - Jean-Philippe Lavigne
- VBIC, INSERM U1047, Univ Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
| | - Sophie Schuldiner
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Métaboliques et Endocriniennes, CHU Nîmes, Nîmes, France
| | | | - Albert Sotto
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
| | - Paul Loubet
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
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AlMotawa RY, Alhamid G, Badran MM, Orfali R, Alomrani AH, Tawfik EA, Alzahrani DA, Alfassam HA, Ghaffar S, Fathaddin A, Al-Taweel A, Almomen A. Co-Delivery of Dragon's Blood and Alkanna tinctoria Extracts Using Electrospun Nanofibers: In Vitro and In Vivo Wound Healing Evaluation in Diabetic Rat Model. Pharmaceutics 2024; 16:704. [PMID: 38931828 PMCID: PMC11206803 DOI: 10.3390/pharmaceutics16060704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/06/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
The increasing prevalence of diabetic wounds presents a significant challenge due to the difficulty of natural healing and various obstacles. Dragon's blood (DB) and Alkanna tinctoria (AT) are well recognized for their potent healing abilities, which include potent antibacterial and anti-inflammatory activities. In this study, electrospun nanofibers (NFs) based on polyvinyl pyrrolidone (PVP) were co-loaded with both DB and AT, aiming to magnify their efficacy as wound-dressing applications for diabetic wound healing. The evaluation of these NFs as wound dressings was conducted using a streptozotocin-induced diabetic rat model. Electrospun NFs were prepared using the electrospinning of the PVP polymer, resulting in nanofibers with consistent, smooth surfaces. The loading capacity (LC) of AT and DB into NFs was 64.1 and 70.4 µg/mg, respectively, while in the co-loaded NFs, LC was 49.6 for AT and 57.2 µg/mg for DB. In addition, X-ray diffraction (XRD) revealed that DB and AT were amorphously dispersed within the NFs. The loaded NFs showed a dissolution time of 30 s in PBS (pH 7.4), which facilitated the release of AT and DB (25-38% after 10 min), followed by a complete release achieved after 180 min. The antibacterial evaluation demonstrated that the DB-AT mixture had potent activity against Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus). Along with that, the DB-AT NFs showed effective growth inhibition for both P. aeruginosa and S. aureus compared to the control NFs. Moreover, wound healing was evaluated in vivo in diabetic Wistar rats over 14 days. The results revealed that the DB-AT NFs improved wound healing within 14 days significantly compared to the other groups. These results highlight the potential application of the developed DB-AT NFs in wound healing management, particularly in diabetic wounds.
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Affiliation(s)
- Rana Y. AlMotawa
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Ghadeer Alhamid
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Mohamed M. Badran
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
- Nanobiotechnology Unit, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
| | - Raha Orfali
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Abdullah H. Alomrani
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
- Nanobiotechnology Unit, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
| | - Essam A. Tawfik
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Dunia A. Alzahrani
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Haya A. Alfassam
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Safina Ghaffar
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Amany Fathaddin
- Pathology Department, College of Medicine, King Saud University, Riyadh 11495, Saudi Arabia
| | - Areej Al-Taweel
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Aliyah Almomen
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia;
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Roberts RHR, Davies-Jones GR, Brock J, Satheesh V, Robertson GAJ. Surgical management of the diabetic foot: The current evidence. World J Orthop 2024; 15:404-417. [PMID: 38835689 PMCID: PMC11145970 DOI: 10.5312/wjo.v15.i5.404] [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: 01/31/2024] [Revised: 03/12/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
The prevalence of diabetes mellitus and its associated complications, particularly diabetic foot pathologies, poses significant healthcare challenges and economic burdens globally. This review synthesises current evidence on the surgical management of the diabetic foot, focusing on the interplay between neuropathy, ischemia, and infection that commonly culminates in ulcers, infections, and, in severe cases, amputations. The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies, as diabetic foot complications are a leading cause of hospital admissions among diabetic patients, significantly impacting morbidity and mortality rates. This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers, infections, and skeletal pathologies such as Charcot arthropathy, emphasising the critical role of early diagnosis, comprehensive management strategies, and interdisciplinary care in mitigating adverse outcomes. In addressing surgical interventions, this review evaluates conservative surgeries, amputations, and reconstructive procedures, highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies. The integration of advanced diagnostic tools, novel surgical techniques, and postoperative care, including offloading and infection control, are discussed in the context of optimising healing and preserving limb function.
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Affiliation(s)
| | - Gareth Rhys Davies-Jones
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
| | - James Brock
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Vaishnav Satheesh
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Greg AJ Robertson
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
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Fauziah N, Safirah NA, Rahmadani IN, Hidayat MN, Fadhilah NA, Djide NJN, Permana AD. Selective Delivery of Clindamycin Using a Combination of Bacterially Sensitive Microparticle and Separable Effervescent Microarray Patch on Bacteria Causing Diabetic Foot Infection. Pharm Res 2024; 41:967-982. [PMID: 38637438 DOI: 10.1007/s11095-024-03697-z] [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: 10/25/2023] [Accepted: 03/30/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Diabetic foot infection (DFI) is one of the complications of diabetes mellitus. Clindamycin (CLY) is one of the antibiotics recommended to treat DFI, but CLY given orally and intravenously still causes many side effects. METHODS In this study, we encapsulated CLY in a bacteria sensitive microparticle system (MP-CLY) using polycaprolactone (PCL) polymer. MP-CLY was then delivered in a separable effervescent microarray patch (MP-CLY-SEMAP), which has the ability to separate between the needle layer and separable layer due to the formation of air bubbles when interacting with interstitial fluid in the skin. RESULT The characterization results of MP-CLY proved that CLY was encapsulated in large amounts as the amount of PCL polymer used increased, and there was no change in the chemical structure of CLY. In vitro release test results showed increased CLY release in media cultured with Staphylococcus aureus bacteria and showed controlled release. The characterization results of MPCLY-SEMAP showed that the developed formula has optimal mechanical and penetration capabilities and can separate in 56 ± 5.099 s. An ex vivo dermatokinetic test on a bacterially infected skin model showed an improvement of CLY dermatokinetic profile from MP-CLY SEMAP and a decrease in bacterial viability by 99.99%. CONCLUSION This research offers proof of concept demonstrating the improved dermatokinetic profile of CLY encapsulated in a bacteria sensitive MP form and delivered via MP-CLY-SEMAP. The results of this research can be developed for future research by testing MP-CLY-SEMAP in vivo in appropriate animal models.
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Affiliation(s)
- Nurul Fauziah
- Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, South Sulawesi, Indonesia
| | - Nur Annisa Safirah
- Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, South Sulawesi, Indonesia
| | - Iis Nurul Rahmadani
- Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, South Sulawesi, Indonesia
| | - Muhammad Nur Hidayat
- Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, South Sulawesi, Indonesia
| | - Nur Azizah Fadhilah
- Faculty of Medicine, Hasanuddin University, Makassar, 90245, South Sulawesi, Indonesia
| | | | - Andi Dian Permana
- Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, South Sulawesi, Indonesia.
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Mitroi RM, Roșu MM, Clenciu D, Pădureanu V, Mitrea A, Grigore MA, Mazilu ER, Rădulescu D, Vladu IM. Vasculitis and infectious risk in a patient with type 2 diabetes mellitus: A case report. Exp Ther Med 2024; 27:234. [PMID: 38628659 PMCID: PMC11019656 DOI: 10.3892/etm.2024.12522] [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: 05/09/2023] [Accepted: 01/16/2024] [Indexed: 04/19/2024] Open
Abstract
The connection between vasculitis and infection is complex. The present study described a typical situation for a patient with unbalanced type 2 diabetes and chronic complications, in which a lack of adherence to the protection and care measures ultimately led to the appearance of some of the worst consequences of the condition, namely, ulceration, gangrene and amputation. In the context of an unstable condition with significant metabolic imbalance there was an impaired response to infections in the present patient, and the amputation resulted in wound persistence and ulcer development, followed by superinfection with methicillin-resistant Staphylococcus aureus according to the antibiogram performed. In this case, an episode of vasculitis was triggered without evidence of bacteraemia. The present case report highlighted the importance of proper hygiene and good metabolic control in patients with diabetes that suffer from amputations and conditions that expose them to certain complications, including vasculitis.
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Affiliation(s)
- Roxana Mădălina Mitroi
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Maria Magdalena Roșu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Diana Clenciu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital ‘Philanthropy’ of Craiova, 200143 Craiova, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Mitrea
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital ‘Philanthropy’ of Craiova, 200143 Craiova, Romania
| | - Maria Andreea Grigore
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Emilia Roxana Mazilu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Dumitru Rădulescu
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ionela Mihaela Vladu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Uberoi A, McCready-Vangi A, Grice EA. The wound microbiota: microbial mechanisms of impaired wound healing and infection. Nat Rev Microbiol 2024:10.1038/s41579-024-01035-z. [PMID: 38575708 DOI: 10.1038/s41579-024-01035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
The skin barrier protects the human body from invasion by exogenous and pathogenic microorganisms. A breach in this barrier exposes the underlying tissue to microbial contamination, which can lead to infection, delayed healing, and further loss of tissue and organ integrity. Delayed wound healing and chronic wounds are associated with comorbidities, including diabetes, advanced age, immunosuppression and autoimmune disease. The wound microbiota can influence each stage of the multi-factorial repair process and influence the likelihood of an infection. Pathogens that commonly infect wounds, such as Staphylococcus aureus and Pseudomonas aeruginosa, express specialized virulence factors that facilitate adherence and invasion. Biofilm formation and other polymicrobial interactions contribute to host immunity evasion and resistance to antimicrobial therapies. Anaerobic organisms, fungal and viral pathogens, and emerging drug-resistant microorganisms present unique challenges for diagnosis and therapy. In this Review, we explore the current understanding of how microorganisms present in wounds impact the process of skin repair and lead to infection through their actions on the host and the other microbial wound inhabitants.
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Affiliation(s)
- Aayushi Uberoi
- Departments of Dermatology and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amelia McCready-Vangi
- Departments of Dermatology and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth A Grice
- Departments of Dermatology and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Yang S, Hu L, Zhao Y, Meng G, Xu S, Han R. Prevalence of multidrug-resistant bacterial infections in diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14864. [PMID: 38619084 PMCID: PMC11017433 DOI: 10.1111/iwj.14864] [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: 12/28/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Multidrug-resistant (MDR) bacterial infections have become increasingly common in recent years due to the increased prevalence of diabetic foot ulcers (DFUs). We carried out a meta-analysis aimed at investigating the prevalence of MDR bacteria isolated from DFUs and analysing the risk factors for MDR bacterial infection in patients with DFUs. The PubMed/Medline, Web of Science, Embase, Cochrane Library, Ovid, Scopus, and ProQuest databases were searched for studies published up to November 2023 on the clinical outcomes of MDR bacteria in DFUs. The main outcome was the prevalence of MDR bacteria in DFUs. A total of 21 studies were included, representing 4885 patients from which 2633 MDR bacterial isolates were obtained. The prevalence of MDR bacteria in DFUs was 50.86% (95% confidence interval (CI): 41.92%-59.78%). The prevalence of MDR gram-positive bacteria (GPB) in DFUs was 19.81% (95% CI: 14.35%-25.91%), and the prevalence of MDR gram-negative bacteria (GNB) in DFUs was 32.84% (95% CI: 26.40%-39.62%). MDR Staphylococcus aureus (12.13% (95% CI: 8.79%-15.91%)) and MDR Enterococcus spp. (3.33% (95% CI: 1.92%-5.07%)) were the main MDR-GPB in DFUs. MDR Escherichia coli, MDR Pseudomonas aeruginosa, MDR Enterobacter spp., MDR Klebsiella pneumoniae, and MDR Proteus mirabilis were the main MDR-GNB in DFUs. The prevalence rates were 6.93% (95% CI: 5.15%-8.95%), 6.01% (95% CI: 4.03%-8.33%), 3.59% (95% CI: 0.42%-9.30%), 3.50% (95% CI: 2.31%-4.91%), and 3.27% (95% CI: 1.74%-5.21%), respectively. The clinical variables of diabetic foot ulcer patients infected with MDR bacteria and non-MDR bacteria in the included studies were analysed. The results showed that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization and previous use of antibacterial drugs were significantly different between the MDR bacterial group and the non-MDR bacterial group. We concluded that there is a high prevalence of MDR bacterial infections in DFUs. The prevalence of MDR-GNB was greater than that of MDR-GPB in DFUs. MDR S. aureus was the main MDR-GPB in DFUs, and MDR E. coli was the main MDR-GNB in DFUs. Our study also indicated that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization, and previous use of antibacterial drugs were associated with MDR bacterial infections in patients with DFUs.
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Affiliation(s)
- Shaoling Yang
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Liye Hu
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Yue Zhao
- Department of OrthopaedicsThe Gucheng County Hospital of Hebei ProvinceGuchengChina
| | - Guangzhe Meng
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Sijia Xu
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Rui Han
- Department of NeurologyThe First Affiliated Hospital of Hebei Medical UniversityShijiazhuangChina
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12
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Prasathkumar M, George A, Sadhasivam S. Influence of chitosan and hydroxyethyl cellulose modifications towards the design of cross-linked double networks hydrogel for diabetic wound healing. Int J Biol Macromol 2024; 265:130851. [PMID: 38484821 DOI: 10.1016/j.ijbiomac.2024.130851] [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: 10/14/2023] [Revised: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
The wound dressings' lack of antioxidant and antibacterial properties, and delayed wound healing limit their use in wound treatment and management. Recent advances in dressing materials are aimed at improving the limitations discussed above. Therefore, the aim of this study includes the preparation and characterization of oxidized hydroxyethyl cellulose (OHEC) and ferulic acid-grafted chitosan (CS-FA) hydrogel loaded with green synthesized selenium nanoparticles (Se NPs) (OHEC-CS-FA-Se NPs named as nanohydrogel) for diabetic wound healing. The structure and properties of the hydrogel was characterized by FTIR, FE-SEM, HR-TEM, EDAX, UV-Vis spectrophotometry, XRD, DLS, zeta potential and rheological studies. The findings of these experiments demonstrate that nanohydrogel possesses a variety of outstanding qualities, including an optimal gel time, good swelling characteristics, a fair water retention rate, a good degradation rate, and strong mechanical stability. Nanohydrogel has been shown to have a synergistic impact by significantly increasing antioxidant activity by scavenging ABTS and DPPH radicals. The nanohydrogel's strong biocompatibility was confirmed by cytocompatibility testing using L929 mouse fibroblast cells. In addition, the wound healing potential of nanohydrogel was tested on L929 cells by an in vitro scratch assay and the nanohydrogel showed a wound closure rate of 100 % after 12 h. In addition to this study, nanohydrogel has demonstrated significant antimicrobial properties against human and wound infection causing pathogens such as Bacillus subtilis, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, and Pseudomonas aeruginosa. In the animal model, almost complete diabetic wound healing was achieved on day 14 after application of the nanohydrogel. The results obtained indicate that the multifunctional bioactive nature of OHEC-CS-FA-Se NPs showed exceptional antioxidant and antibacterial potential for the treatment of infected and chronic wounds.
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Affiliation(s)
- Murugan Prasathkumar
- Biomaterials and Bioprocess Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore 641046, India; Brodie Tooth Development Genetics & Regenerative Medicine Research Laboratory, Department of Oral Biology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Anne George
- Brodie Tooth Development Genetics & Regenerative Medicine Research Laboratory, Department of Oral Biology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Subramaniam Sadhasivam
- Biomaterials and Bioprocess Laboratory, Department of Microbial Biotechnology, Bharathiar University, Coimbatore 641046, India; B.Sc., Blended Programme, Centre for International Affairs, Bharathiar University, Coimbatore 641046, India.
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13
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Darwitz BP, Genito CJ, Thurlow LR. Triple threat: how diabetes results in worsened bacterial infections. Infect Immun 2024:e0050923. [PMID: 38526063 DOI: 10.1128/iai.00509-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Diabetes mellitus, characterized by impaired insulin signaling, is associated with increased incidence and severity of infections. Various diabetes-related complications contribute to exacerbated bacterial infections, including hyperglycemia, innate immune cell dysfunction, and infection with antibiotic-resistant bacterial strains. One defining symptom of diabetes is hyperglycemia, resulting in elevated blood and tissue glucose concentrations. Glucose is the preferred carbon source of several bacterial pathogens, and hyperglycemia escalates bacterial growth and virulence. Hyperglycemia promotes specific mechanisms of bacterial virulence known to contribute to infection chronicity, including tissue adherence and biofilm formation. Foot infections are a significant source of morbidity in individuals with diabetes and consist of biofilm-associated polymicrobial communities. Bacteria perform complex interspecies behaviors conducive to their growth and virulence within biofilms, including metabolic cross-feeding and altered phenotypes more tolerant to antibiotic therapeutics. Moreover, the metabolic dysfunction caused by diabetes compromises immune cell function, resulting in immune suppression. Impaired insulin signaling induces aberrations in phagocytic cells, which are crucial mediators for controlling and resolving bacterial infections. These aberrancies encompass altered cytokine profiles, the migratory and chemotactic mechanisms of neutrophils, and the metabolic reprogramming required for the oxidative burst and subsequent generation of bactericidal free radicals. Furthermore, the immune suppression caused by diabetes and the polymicrobial nature of the diabetic infection microenvironment may promote the emergence of novel strains of multidrug-resistant bacterial pathogens. This review focuses on the "triple threat" linked to worsened bacterial infections in individuals with diabetes: (i) altered nutritional availability in diabetic tissues, (ii) diabetes-associated immune suppression, and (iii) antibiotic treatment failure.
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Affiliation(s)
- Benjamin P Darwitz
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher J Genito
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Lance R Thurlow
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Jaber D, Younes N, Khalil E, Albsoul-Younes A, Zawiah M, Al-Bakri AG. Studying Microbial Ecology of Diabetic Foot Infections: Significance of PCR Analysis for Prudent Antimicrobial Stewardship. INT J LOW EXTR WOUND 2024:15347346241230288. [PMID: 38373396 DOI: 10.1177/15347346241230288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
This study presents a comprehensive investigation into the microbial ecology of diabetic foot infections (DFIs), using molecular-polymerase chain reaction (PCR) analysis to accurately identify the causative agents. One hundred DFI patients were recruited and classified using the Depth Extent Phase and Associated Etiology (DEPA) score according to their severity. Results revealed polymicrobial infections in 75% of cases, predominantly featuring Staphylococcus epidermidis (83%) and Staphylococcus aureus (63%). Importantly, 20% of samples exhibited facultative anaerobes Bacteroides fragilis or Clostridium perfringens, exclusively in high DEPA score ulcers. Candida albicans coinfection was identified in 19.2% of cases, underscoring the need for mycological evaluation. Empirical antimicrobial therapy regimens were tailored to DEPA severity, yet our findings highlighted a potential gap in methicillin-resistant Staphylococcus aureus (MRSA) coverage. Despite an 88% prevalence of methicillin-resistant Staphylococci, vancomycin usage was suboptimal. This raises concerns about the underestimation of MRSA risk and the need for tailored antibiotic guidelines. Our study demonstrates the efficacy of molecular-PCR analysis in identifying diverse microbial communities in DFIs, influencing targeted antibiotic choices. The results advocate for refined antimicrobial guidelines, considering regional variations in microbial patterns and judiciously addressing multidrug-resistant strains. This research contributes crucial insights for optimizing DFIs management and helps the physicians to have a fast decision in selection the suitable antibiotic for each patient and to decrease the risk of bacterial resistance from the improper use of broad-spectrum empirical therapies.
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Affiliation(s)
- Deema Jaber
- School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Nidal Younes
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Enam Khalil
- School of Pharmacy, The University of Jordan, Amman, Jordan
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15
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Zhou S, Hu X, Wang Y, Fei W, Sheng Y, Que H. The Global Prevalence of Methicillin-Resistant Staphylococcus Aureus in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Diabetes Metab Syndr Obes 2024; 17:563-574. [PMID: 38333763 PMCID: PMC10849909 DOI: 10.2147/dmso.s446911] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Objective Diabetic foot ulcer (DFU) frequently leads to infections, with infected DFUs being a common cause of amputation. Infection by methicillin-resistant Staphylococcus aureus (MRSA) notably increases the necessity for amputation and surgical debridement in affected individuals. Consequently, determining the prevalence and trends of MRSA in patients with DFU is of critical importance. This study aimed to assess the global prevalence and to identify trends in the occurrence of MRSA in tissue or wound swab samples from DFU patients. Methods We conducted a comprehensive literature search across PubMed, Embase, Scopus, and Ovid, spanning from the inception of these databases to July 2023, imposing no language restrictions. The inclusion criteria required that the studies report on 30 or more patients with DFU. Additionally, we categorized our analysis based on geographic region, publication date, and the economic status of the patient's domicile. Our primary endpoint was to ascertain the prevalence of MRSA in DFUs. This systematic review has been registered at (https://www.crd.york.ac.uk/prospero/), with the identifier CRD 42023444360. Results Our analysis encompassed 40 studies involving 12,924 patients across 20 countries. We found that the overall prevalence of MRSA in DFU was 17% (95% Confidence Interval [CI] 0.14-0.20). Regional prevalence varied significantly: in South America, it was 61% (95% CI 0.46-0.76), in North America 20% (95% CI 0.12-0.27), in Europe 19% (95% CI 0.14-0.25), in Africa 13% (95% CI 0.06-0.20), and in other subgroups 11% (95% CI 0.08-0.15). The prevalence of MRSA in DFUs also differed according to the economic status of the countries: 19% (95% CI 0.15-0.23) in high-income countries, 24% (95% CI 0.1-0.37) in upper-middle-income countries, 11% (95% CI 0.07-0.15) in lower-middle-income countries, and 20% (95% CI 0.13-0.27) in low-income countries. Notably, there has been a decline in MRSA prevalence, from 25% before 2010 to 9% thereafter. Conclusion This meta-analysis reveals a decreasing yet still significant global prevalence of MRSA in DFUs. This trend has important implications for antimicrobial resistance and underscores the need for developing targeted programs focusing on infection prevention and exploring alternative therapeutic strategies.
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Affiliation(s)
- Siyuan Zhou
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiaojie Hu
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yunfei Wang
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Wenting Fei
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yuqin Sheng
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Huafa Que
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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16
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Wilkinson HN, Stafford AR, Rudden M, Rocha NDC, Kidd AS, Iveson S, Bell AL, Hart J, Duarte A, Frieling J, Janssen F, Röhrig C, de Rooij B, Ekhart PF, Hardman MJ. Selective Depletion of Staphylococcus aureus Restores the Skin Microbiome and Accelerates Tissue Repair after Injury. J Invest Dermatol 2024:S0022-202X(24)00092-7. [PMID: 38307323 DOI: 10.1016/j.jid.2024.01.018] [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: 11/10/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
Our skin is home to a diverse community of commensal microorganisms integral to cutaneous function. However, microbial dysbiosis and barrier perturbation increase the risk of local and systemic infection. Staphylococcus aureus is a particularly problematic bacterial pathogen, with high levels of antimicrobial resistance and direct association with poor healing outcome. Innovative approaches are needed to selectively kill skin pathogens, such as S aureus, without harming the resident microbiota. In this study, we provide important data on the selectivity and efficacy of an S aureus-targeted endolysin (XZ.700) within the complex living skin/wound microbiome. Initial cross-species comparison using Nanopore long-read sequencing identified the translational potential of porcine rather than murine skin for human-relevant microbiome studies. We therefore performed an interventional study in pigs to assess the impact of endolysin administration on the microbiome. XZ.700 selectively inhibited endogenous porcine S aureus in vivo, restoring microbial diversity and promoting multiple aspects of wound repair. Subsequent mechanistic studies confirmed the importance of this microbiome modulation for effective healing in human skin. Taken together, these findings strongly support further development of S aureus-targeted endolysins for future clinical management of skin and wound infections.
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Affiliation(s)
- Holly N Wilkinson
- Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom; Skin Research Centre, Hull York Medical School, The University of York, Heslington, United Kingdom.
| | - Amber R Stafford
- Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | - Michelle Rudden
- Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom; Skin Research Centre, Hull York Medical School, The University of York, Heslington, United Kingdom
| | - Nina D C Rocha
- Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | - Alexandria S Kidd
- Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | - Sammi Iveson
- Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | | | | | - Ana Duarte
- Micreos Pharma B.V., Bilthoven, The Netherlands
| | | | | | | | | | | | - Matthew J Hardman
- Biomedical Institute for Multimorbidity, Centre for Biomedicine, Hull York Medical School, The University of Hull, Hull, United Kingdom; Skin Research Centre, Hull York Medical School, The University of York, Heslington, United Kingdom
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17
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Makeri D, Eilu E, Odoki M, Agwu E. A Systematic Review of the Microbial Landscape of Diabetic Foot Ulcers in Uganda. Infect Drug Resist 2024; 17:143-151. [PMID: 38234374 PMCID: PMC10793123 DOI: 10.2147/idr.s446838] [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: 10/27/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
Background Diabetes is a growing health concern globally. Poorly managed diabetes may result in diabetic foot ulcers (DFU), which can become a source of chronic infection known as diabetic foot infections. The increasing trend of diabetes in Uganda speaks to the potential for diabetic foot ulcers which may eventually become infected and their attendant impact on the quality of life of diabetic patients. This review assesses the microbial diversity of DFUs in Uganda, aiming to guide treatment and identify research gaps. Main Body of the Abstract We searched PubMed, Scopus and Embase for studies conducted in Uganda that reported isolating microorganisms from diabetic foot ulcers. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA), we included two eligible studies that reported isolating 122 bacteria spread across eleven (11) species using swab samples and conventional culture methods. Significant isolates included World Health Organization priority pathogens including: Enterobacter specie, Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter specie. Methicillin resistant Staphylococcus aureus (MRSA) constituted 33.3% of Staphylococci species and 26% of all bacterial isolates while extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella specie constituted 14.29% of total microbial isolates. Most bacteria showed susceptibility to Imipenem, Vancomycin, Ciprofloxacin, and Clindamycin, but resistance to Cotrimoxazole and Ampicillin was noted. Short Conclusion We conclude that data on the microbiology of DFUs in Uganda is scarce; however, the bioburden of DFUs in the country is similar to those in other parts of the world, and MRSA poses a challenge to antibiotic therapy. Consequently, the continued use of swab samples and conventional culture and sensitivity methods may limit the isolation, identification, and presentation of other important isolates. We recommend characterization of bacterial isolates to better understand their genetic makeup, and the development of a national guideline for managing diabetic foot infections.
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Affiliation(s)
- Danladi Makeri
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
| | - Emmanuel Eilu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
| | - Martin Odoki
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
- Department of Microbiology and Immunology, School of Medicine, King Ceasor University, Kampala, Uganda
- Department of Applied Sciences, School of Sciences, Nkumba University, Entebbe, Uganda
| | - Ezera Agwu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
- Department of Microbiology and Parasitology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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18
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Alkhalfan Y, Lewis TL, Kavarthapu V, Hester T. Investigation and management of diabetic foot osteomyelitis: An update for the foot and ankle orthopaedic surgeon. J Clin Orthop Trauma 2024; 48:102330. [PMID: 38274641 PMCID: PMC10806189 DOI: 10.1016/j.jcot.2023.102330] [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: 09/28/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Diabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity. Effective management of DFO requires a multidisciplinary approach, involving endocrinologists, infectious disease specialists, vascular surgeons, orthopaedic surgeons, and wound care experts. Early diagnosis is paramount, facilitated by advanced imaging techniques such as magnetic resonance imaging (MRI) and bone scintigraphy. Once diagnosed, the treatment strategy hinges on a combination of medical and surgical interventions. Antibiotic therapy, guided by culture results, plays a central role in managing DFO. Tailored regimens targeting the specific pathogens involved are administered, often for prolonged durations. Surgical intervention becomes necessary when conservative measures fall short. Surgical approaches range from minimally invasive procedures, like percutaneous drainage, to more extensive interventions like debridement and bone resection. Prevention of DFO recurrence is equally vital, emphasising glycemic control, meticulous foot care, patient education, monitoring of at-risk signs, revascularization and early intervention when indicated. The management of diabetic foot osteomyelitis mandates a comprehensive strategy that addresses both the infectious and surgical aspects of the condition. A collaborative, interdisciplinary approach ensures timely diagnosis, tailored treatment, and holistic care. Further research into novel therapeutic modalities and long-term outcomes remains essential in refining the management of this complex and debilitating complication of diabetes.
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Affiliation(s)
- Yousif Alkhalfan
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | | | - Venu Kavarthapu
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, UK
| | - Thomas Hester
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, UK
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van Hoek ML, Alsaab FM, Carpenter AM. GATR-3, a Peptide That Eradicates Preformed Biofilms of Multidrug-Resistant Acinetobacter baumannii. Antibiotics (Basel) 2023; 13:39. [PMID: 38247598 PMCID: PMC10812447 DOI: 10.3390/antibiotics13010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
Acinetobacter baumannii is a gram-negative bacterium that causes hospital-acquired and opportunistic infections, resulting in pneumonia, sepsis, and severe wound infections that can be difficult to treat due to antimicrobial resistance and the formation of biofilms. There is an urgent need to develop novel antimicrobials to tackle the rapid increase in antimicrobial resistance, and antimicrobial peptides (AMPs) represent an additional class of potential agents with direct antimicrobial and/or host-defense activating activities. In this study, we present GATR-3, a synthetic, designed AMP that was modified from a cryptic peptide discovered in American alligator, as our lead peptide to target multidrug-resistant (MDR) A. baumannii. Antimicrobial susceptibility testing and antibiofilm assays were performed to assess GATR-3 against a panel of 8 MDR A. baumannii strains, including AB5075 and some clinical strains. The GATR-3 mechanism of action was determined to be via loss of membrane integrity as measured by DiSC3(5) and ethidium bromide assays. GATR-3 exhibited potent antimicrobial activity against all tested multidrug-resistant A. baumannii strains with rapid killing. Biofilms are difficult to treat and eradicate. Excitingly, GATR-3 inhibited biofilm formation and, more importantly, eradicated preformed biofilms of MDR A. baumannii AB5075, as evidenced by MBEC assays and scanning electron micrographs. GATR3 did not induce resistance in MDR A. baumannii, unlike colistin. Additionally, the toxicity of GATR-3 was evaluated using human red blood cells, HepG2 cells, and waxworms using hemolysis and MTT assays. GATR-3 demonstrated little to no cytotoxicity against HepG2 and red blood cells, even at 100 μg/mL. GATR-3 injection showed little toxicity in the waxworm model, resulting in a 90% survival rate. The therapeutic index of GATR-3 was estimated (based on the HC50/MIC against human RBCs) to be 1250. Overall, GATR-3 is a promising candidate to advance to preclinical testing to potentially treat MDR A. baumannii infections.
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Affiliation(s)
- Monique L. van Hoek
- Center for Infectious Disease Research, George Mason University, Manassas, VA 20110, USA
- School of Systems Biology, George Mason University, Manassas, VA 20110, USA
| | - Fahad M. Alsaab
- Center for Infectious Disease Research, George Mason University, Manassas, VA 20110, USA
- School of Systems Biology, George Mason University, Manassas, VA 20110, USA
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Al Ahsa 36428, Saudi Arabia
| | - Ashley M. Carpenter
- Center for Infectious Disease Research, George Mason University, Manassas, VA 20110, USA
- School of Systems Biology, George Mason University, Manassas, VA 20110, USA
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Pita-Vilar M, Concheiro A, Alvarez-Lorenzo C, Diaz-Gomez L. Recent advances in 3D printed cellulose-based wound dressings: A review on in vitro and in vivo achievements. Carbohydr Polym 2023; 321:121298. [PMID: 37739531 DOI: 10.1016/j.carbpol.2023.121298] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 08/12/2023] [Indexed: 09/24/2023]
Abstract
Chronic wounds, especially diabetic ulcers, pose a significant challenge in regenerative medicine. Cellulose derivatives offer remarkable wound management properties, such as effective absorption and retention of wound exudates, maintaining an optimal moisture environment crucial for successful chronic wound regeneration. However, conventional dressings have limited efficacy in managing and healing these types of skin lesions, driving scientists to explore innovative approaches. The emergence of 3D printing has enabled personalized dressings that meet individual patient needs, improving the healing process and patient comfort. Cellulose derivatives meet the demanding requirements for biocompatibility, printability, and biofabrication necessary for 3D printing of biologically active scaffolds. However, the potential applications of nanocellulose and cellulose derivative-based inks for wound regeneration remain largely unexplored. Thus, this review provides a comprehensive overview of recent advancements in cellulose-based inks for 3D printing of personalized wound dressings. The composition and biofabrication approaches of cellulose-based wound dressings are thoroughly discussed, including the functionalization with bioactive molecules and antibiotics for improved wound regeneration. Similarly, the in vitro and in vivo performance of these dressings is extensively examined. In summary, this review aims to highlight the exceptional advantages and diverse applications of 3D printed cellulose-based dressings in personalized wound care.
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Affiliation(s)
- Maria Pita-Vilar
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS), Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS), Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS), Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Luis Diaz-Gomez
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS), Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
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21
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Capanema NSV, Mansur AAP, Carvalho SM, Martins T, Gonçalves MS, Andrade RS, Dorneles EMS, Lima LCD, de Alvarenga ÉLFC, da Fonseca EVB, de Sá MA, Lage AP, Lobato ZIP, Mansur HS. Nanosilver-Functionalized Hybrid Hydrogels of Carboxymethyl Cellulose/Poly(Vinyl Alcohol) with Antibacterial Activity for Prevention and Therapy of Infections of Diabetic Chronic Wounds. Polymers (Basel) 2023; 15:4542. [PMID: 38231902 PMCID: PMC10708083 DOI: 10.3390/polym15234542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024] Open
Abstract
Diabetic foot ulcers (DFUs) are considered one of the most severe chronic complications of diabetes and can lead to amputation in severe cases. In addition, bacterial infections in diabetic chronic wounds aggravate this scenario by threatening human health. Wound dressings made of polymer matrices with embedded metal nanoparticles can inhibit microorganism growth and promote wound healing, although the current clinical treatments for diabetic chronic wounds remain unsatisfactory. In this view, this research reports the synthesis and characterization of innovative hybrid hydrogels made of carboxymethyl cellulose (CMC) and poly(vinyl alcohol) (PVA) chemically crosslinked by citric acid (CA) functionalized with silver nanoparticles (AgNPs) generated in situ using an eco-friendly aqueous process. The results assessed through comprehensive in vitro and in vivo assays demonstrated that these hybrid polymer hydrogels functionalized with AgNPs possess physicochemical properties, cytocompatibility, hemocompatibility, bioadhesion, antibacterial activity, and biocompatibility suitable for wound dressings to support chronic wound healing process as well as preventing and treating bacterial infections. Hence, it can be envisioned that, with further research and development, these polymer-based hybrid nanoplatforms hold great potential as an important tool for creating a new generation of smart dressings for treating chronic diabetic wounds and opportunistic bacterial infections.
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Affiliation(s)
- Nádia S. V. Capanema
- Center of Nanoscience, Nanotechnology, and Innovation—CeNanoI, Department of Metallurgical and Materials Engineering, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (N.S.V.C.); (A.A.P.M.); (S.M.C.); (T.M.)
| | - Alexandra A. P. Mansur
- Center of Nanoscience, Nanotechnology, and Innovation—CeNanoI, Department of Metallurgical and Materials Engineering, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (N.S.V.C.); (A.A.P.M.); (S.M.C.); (T.M.)
| | - Sandhra M. Carvalho
- Center of Nanoscience, Nanotechnology, and Innovation—CeNanoI, Department of Metallurgical and Materials Engineering, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (N.S.V.C.); (A.A.P.M.); (S.M.C.); (T.M.)
| | - Talita Martins
- Center of Nanoscience, Nanotechnology, and Innovation—CeNanoI, Department of Metallurgical and Materials Engineering, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (N.S.V.C.); (A.A.P.M.); (S.M.C.); (T.M.)
| | - Maysa S. Gonçalves
- Departamento de Medicina Veterinária, Universidade Federal de Lavras, UFLA, Lavras 37200-000, Brazil; (M.S.G.); (R.S.A.); (E.M.S.D.)
| | - Rafaella S. Andrade
- Departamento de Medicina Veterinária, Universidade Federal de Lavras, UFLA, Lavras 37200-000, Brazil; (M.S.G.); (R.S.A.); (E.M.S.D.)
| | - Elaine M. S. Dorneles
- Departamento de Medicina Veterinária, Universidade Federal de Lavras, UFLA, Lavras 37200-000, Brazil; (M.S.G.); (R.S.A.); (E.M.S.D.)
| | - Letícia C. D. Lima
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (L.C.D.L.); (M.A.d.S.)
| | - Érika L. F. C. de Alvarenga
- Department of Natural Sciences, Universidade Federal de São João Del-Rei, UFSJ, São João Del-Rei 36301-160, Brazil; (É.L.F.C.d.A.); (E.V.B.d.F.)
| | - Emanuel V. B. da Fonseca
- Department of Natural Sciences, Universidade Federal de São João Del-Rei, UFSJ, São João Del-Rei 36301-160, Brazil; (É.L.F.C.d.A.); (E.V.B.d.F.)
| | - Marcos Augusto de Sá
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (L.C.D.L.); (M.A.d.S.)
| | - Andrey P. Lage
- Departamento de Medicina Veterinária Preventiva, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (A.P.L.); (Z.I.P.L.)
| | - Zelia I. P. Lobato
- Departamento de Medicina Veterinária Preventiva, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (A.P.L.); (Z.I.P.L.)
| | - Herman S. Mansur
- Center of Nanoscience, Nanotechnology, and Innovation—CeNanoI, Department of Metallurgical and Materials Engineering, Federal University of Minas Gerais, UFMG, Belo Horizonte 31270-901, Brazil; (N.S.V.C.); (A.A.P.M.); (S.M.C.); (T.M.)
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22
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Li Z, Li T, Tang J, Huang L, Ding Y, Zeng Z, Liu J. Antibacterial Activity of Surfactin and Synergistic Effect with Conventional Antibiotics Against Methicillin-Resistant Staphylococcus aureus Isolated from Patients with Diabetic Foot Ulcers. Diabetes Metab Syndr Obes 2023; 16:3727-3737. [PMID: 38029000 PMCID: PMC10674630 DOI: 10.2147/dmso.s435062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The prevalence of diabetic foot ulcers (DFUs) is increasing, leading to a huge financial burden and human suffering. Furthermore, antibiotic resistance is an urgent problem in the realm of clinical practice. Antimicrobial peptides are an effective and feasible strategy for combating infections caused by drug-resistant bacteria. Therefore, we investigated the in vitro antimicrobial ability of the lipopeptide surfactin, either alone or in combination with conventional antibiotics, against the standard and clinical strains of Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), isolated from patients with DFUs. Methods The minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of surfactin on the selected strains were evaluated by a microbroth dilution technique. The growth curves of the selected strains with and without surfactin were measured, and transmission electron microscopy was used to observe the structure of surfactin-treated bacterial cells. The biofilm inhibitory abilities of surfactin were assessed by crystal violet staining. The antimicrobial interactions between surfactin and conventional antibiotics were established using a checkerboard assay, as well as determining the mutant prevention concentration. The inhibitory effect of surfactin on penicillinase was tested by iodometry. Results The MIC and MBC values of surfactin ranged from 512 to 1024 µg/mL and 1024 to 2048 µg/mL, respectively. Moreover, surfactin significantly prevented the S. aureus biofilm formation and displayed limited toxicity on human red blood cells. The synergies between surfactin and ampicillin, oxacillin, and tetracycline against S. aureus were revealed. In vitro resistance was not readily produced by surfactin. The action of surfactin may be by disrupting bacterial cell membranes and inhibiting penicillinase. Conclusion Surfactin appears to be a potential option for the treatment of DFUs infected with MRSA, as it is capable of improving antimicrobial activities and can be used alone or in combination with conventional antibiotics to prevent or postpone the emergence of resistance.
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Affiliation(s)
- Zhaoyinqian Li
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, People’s Republic of China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Tingting Li
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, People’s Republic of China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Department of Laboratory Medicine, West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jingyang Tang
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, People’s Republic of China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Li Huang
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, People’s Republic of China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Yinhuan Ding
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, People’s Republic of China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Zhangrui Zeng
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, People’s Republic of China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Jinbo Liu
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, Luzhou, People’s Republic of China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
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23
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Walczak-Skierska J, Monedeiro F, Maślak E, Złoch M. Lipidomics Characterization of the Microbiome in People with Diabetic Foot Infection Using MALDI-TOF MS. Anal Chem 2023; 95:16251-16262. [PMID: 37877781 PMCID: PMC10633811 DOI: 10.1021/acs.analchem.3c03071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/11/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
Lipidomic profiling has emerged as a powerful tool for the comprehensive characterization of bacterial species, particularly in the context of clinical diagnostics. Utilizing matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), this study aims to elucidate the lipidomic landscapes of bacterial strains isolated from diabetic foot infections (DFI). Our analysis successfully identified a diverse array of lipids in the cellular membranes of both Gram-positive and Gram-negative bacteria, revealing a total of 108 unique fatty acid combinations. Specifically, we identified 26 LPG, 33 LPE, 43 PE, 114 PG, 89 TAG, and 120 CLP in Gram-positive bacteria and 10 LPG, 14 LPE, 124 PE, 37 PG, 13 TAG, and 22 CLP in Gram-negative strains. Key fatty acids, such as palmitic acid, palmitoleic acid, stearic acid, and oleic acid, were prominently featured. Univariate analysis further highlighted distinct lipidomic signatures among the bacterial strains, revealing elevated levels of phosphatidylethanolamine (PE) and phosphatidylglycerol (PG) in Gram-negative bacteria associated with DFI. In contrast, Gram-positive strains demonstrated increased or uniquely fluctuating levels of triglyceride (TAG) and cardiolipin (CLP). These findings not only underscore the utility of MALDI-TOF MS in bacterial lipidomics but also provide valuable insights into the lipidomic adaptations of bacteria in diabetic foot infections, thereby laying the groundwork for future studies aimed at constructing microbial lipid libraries for enhanced bacterial identification.
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Affiliation(s)
- Justyna Walczak-Skierska
- Centre
for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4 Str., 87-100 Toruń, Poland
- Chair
of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus a Copernicus University in Toruń, Gagarina 7 Str., 87-100 Toruń, Poland
| | - Fernanda Monedeiro
- Centre
for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4 Str., 87-100 Toruń, Poland
| | - Ewelina Maślak
- Centre
for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4 Str., 87-100 Toruń, Poland
| | - Michał Złoch
- Centre
for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4 Str., 87-100 Toruń, Poland
- Chair
of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus a Copernicus University in Toruń, Gagarina 7 Str., 87-100 Toruń, Poland
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24
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Hosseinpoor S, Kalroozi F, Nezamzadeh M, Pishgooie SA. Examining the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients: A randomized control study. Health Sci Rep 2023; 6:e1733. [PMID: 38028699 PMCID: PMC10680056 DOI: 10.1002/hsr2.1733] [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: 08/19/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aims One of the new types of dressings is the polyurethane dressing containing silver particles. This study was designed to evaluate the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients in a military hospital. Methods This was a randomized clinical trial study on 48 patients with diabetic foot ulcers who were referred to the wound clinic of Shahid Dr. Chamran Hospital in 2022. The qualified samples were divided into two groups of silver polyurethane dressing and simple sterile dressing based on a randomization block method. The wounds of both groups of patients were initially cleaned with normal saline and in the first round of dressing, and a sample of tissue secretions was collected by the researcher using a sterile swab from the wounds of the patients on two occasions, superficially and deeply. The patients' wounds in the intervention group were dressed with polyurethane foam dressing containing silver particles, while the simple sterile routine dressing was used in the control group. The rate of infection and wound secretions were examined and recorded on the first, seventh, fourteenth, and twenty-first days from the start of dressing in both groups. To collect data, the IDSA tool was used. Results The rates of wound infection before the intervention showed no significant differences in the two groups (p = 0.242). However, these rates changed on the 7th, 14th, and 21st days after the intervention. Moreover, the infection rate was significantly lower in the polyurethane dressing group containing silver particles (p < 0.001 and F = 30.31). Conclusions Using polyurethane dressing was proven to be more effective in this study on the rate of diabetic ulcer infection in patients compared to the simple sterile dressing. Thus, nurses can use this dressing for faster treatment of diabetic foot ulcers infection.
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Affiliation(s)
| | - Fatemeh Kalroozi
- Department of Pediatric Nursing, College of NursingAja University of Medical SciencesTehranIran
| | - Maryam Nezamzadeh
- Department of Critical Care NursingAja University of Medical SciencesTehranIran
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25
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Castellino LM, McCormick-Baw C, Coye T, Crisologo PA, Hanna JJ, Lee F, Clark A, Fanning M, Killeen AL. Limited Clinical Utility of Routine Mycobacterial Cultures for the Management of Diabetic Foot Infections. Open Forum Infect Dis 2023; 10:ofad558. [PMID: 38023547 PMCID: PMC10655939 DOI: 10.1093/ofid/ofad558] [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: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Mycobacterial infections of the foot and ankle are uncommon. In a cohort of 2340 patients with diabetic foot infection (DFI) in a region with increased prevalence of mycobacterial disease, we identified no clinically significant positive cultures over a 3-year period. Routine mycobacterial culture of DFIs is of limited clinical utility.
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Affiliation(s)
- Laila M Castellino
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Clare McCormick-Baw
- Parkland Health, Dallas, Texas, USA
- Division of Pathology and Clinical Laboratory Service, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Tyler Coye
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, Texas, USA
| | - Peter A Crisologo
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - John J Hanna
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine and Clinical Informatics, UT Southwestern Clinical Informatics Center, Dallas, Texas, USA
| | - Francesca Lee
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- Division of Pathology and Clinical Laboratory Service, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Clark
- Division of Pathology and Clinical Laboratory Service, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Fanning
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amanda L Killeen
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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26
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Joseph WS, Kosinski MA, Rogers LC. Parenteral Vancomycin in the Treatment of MRSA-Associated Diabetic Foot Infections: An Unnecessary Risk. INT J LOW EXTR WOUND 2023:15347346231207553. [PMID: 37886812 DOI: 10.1177/15347346231207553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Diabetic foot infections (DFIs) are a common and costly complication of diabetes. Soft tissue and bone infections in DFIs frequently lead to amputation and/or sepsis which can be costly for both the patient and the healthcare system. Staphylococcus aureus is the most commonly identified causative agent in DFIs, and people with diabetes may have an increased risk of infection with methicillin-resistant Staphylococcus aureus (MRSA). In addition to increased susceptibility to severe infection, MRSA in DFIs is associated with high rates of treatment failure, morbidity, and hospitalization costs meaning appropriate treatment is a high priority. While hospitalized patients are usually treated with intravenous (IV) vancomycin, this can be costly in terms of inpatient stays, staffing costs, and adverse events. For example, vancomycin-associated acute kidney injury not only delays hospital discharge and increases costs but is also a particular concern for patients with diabetes who already have an increased risk of kidney problems. Vancomycin-resistant strains of S. aureus have also been identified, which means that alternative treatment options may need to be explored. Treatment alternatives to IV vancomycin, including oral antibiotics, have been shown to provide similar efficacy, with reduced costs, outpatient or home-based administration, and with fewer serious adverse effects. Although infectious disease specialists often use IV vancomycin alone, or in combination, as a first-line therapeutic option, they are increasingly seeing the value of outpatient or at-home oral antibiotics as an alternative. This manuscript reviews the evidence for true costs of vancomycin therapy for MRSA-associated DFIs and examines the alternatives.
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Affiliation(s)
- Warren S Joseph
- Arizona College of Podiatric Medicine, Midwestern University, Glendale, AZ, USA
| | - Mark A Kosinski
- Department of Medicine, New York College of Podiatric Medicine, New York, NY, USA
| | - Lee C Rogers
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA
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27
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Zhang XN, Wu CY, Wu ZW, Xu LX, Jiang FT, Chen HW. Association Between the Diabetic Foot Ulcer and the Bacterial Colony of the Skin Based on 16S rRNA Gene Sequencing: An Observational Study. Clin Cosmet Investig Dermatol 2023; 16:2801-2812. [PMID: 37841062 PMCID: PMC10576508 DOI: 10.2147/ccid.s425922] [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: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
Objective Microorganisms have been the main cause of refractory and high recurrence of diabetic foot ulcer (DFU). This study attempted to observe the skin bacterial colony in healthy skin, diabetic skin and DFU skin. Methods Forty-eight diabetes patients were recruited at Panyu Central Hospital from March 2021 to March 2022 and divided into DFU group (T group, n = 22), diabetes without foot ulcer group (TW group, n = 26). Besides, a healthy control group (H group, n = 10) was recruited at the same time. The swab samples of foot skin in the same position in the three groups were collected. The microorganisms obtained from the skin were analyzed by 16S rRNA gene sequencing. The composition of the skin microorganisms was determined, and the species diversity of the skin microbiota was analyzed by α and β diversity. The species differences in the skin microbiota and the relative abundance of different operational taxonomic units (OUTs) with the most significant abundance were analyzed by linear discriminant analysis effect size (LEfSe). Results Significant changes were found in the composition of the skin microbiota in the T and TW groups relative to the H group. However, the species diversity of the skin microbiota was significantly reduced in the T and TW groups, with the lowest one in the T group. The composition of microbial diversity in the T group was significantly different from that of the TW and H groups. Among the skin bacterial colonies, the abundance of Staphylococcus, Enhydrobacter, and Corynebacterium_1 was obviously reduced, while that of Escherichia coli and Pseudomonas was significantly increased. Conclusion Changes in the abundance of Staphylococcus, Enhydrobacter, Corynebacterium_1, Escherichia coli and Pseudomonas in the skin bacterial colonies can be the main causative factors for DFU. This study indicates that altering the microbiota composition of wounds may help the treatment of DFU.
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Affiliation(s)
- Xiu-Ni Zhang
- Department of Trauma Orthopedics, Panyu Central Hospital, Guangzhou, Guangdong, 511400, People’s Republic of China
| | - Cui-Yi Wu
- Department of Outpatient, Panyu Central Hospital, Guangzhou, Guangdong, 511400, People’s Republic of China
| | - Zhi-Wei Wu
- Department of Trauma Orthopedics, Panyu Central Hospital, Guangzhou, Guangdong, 511400, People’s Republic of China
| | - Li-Xian Xu
- Department of Endocrinology, Panyu Central Hospital, Guangzhou, Guangdong, 511400, People’s Republic of China
| | - Feng-Ting Jiang
- Department of Trauma Orthopedics, Panyu Central Hospital, Guangzhou, Guangdong, 511400, People’s Republic of China
| | - Han-Wei Chen
- Administrative Office, Panyu District Health Management Center, Guangzhou, Guangdong, 511400, People’s Republic of China
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28
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Moore J, Gooday C, Soliman R, Dhatariya K. Reduction in the prevalence of methicillin-resistant Staphylococcus aureus in tissue and wound swab samples taken from outpatients attending a specialist diabetic foot clinic 2005-2021. Diabet Med 2023; 40:e15081. [PMID: 36883882 DOI: 10.1111/dme.15081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/03/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023]
Abstract
AIMS To assess annual change in prevalence of methicillin resistant Staphylococcus aureus (MRSA) from tissue and wound swab samples from foot ulcers (DFUs) in people with diabetes between 2005 and 2021. METHODS A retrospective analysis of everyone with MRSA positive wound or tissue swabs taken from our specialist multidisciplinary foot clinic between July 2005 and July 2021. RESULTS A total of 406 MRSA positive isolates from DFU swabs were identified from 185 individuals attending the foot clinic. There were 22 hospital-acquired infections (HAIs) and 159 community-acquired infections (CAIs). Fifty-two per cent (n = 37) of these individuals from 2010 to 2021 (n = 71) had presence of at least three risk factors for MRSA. The total number of swabs sent was 6312 from 1916 individuals living with diabetes. Annual MRSA DFU prevalence peaked in 2008 at 14.6% (n = 38), decreased in 2013 to 5.2% (n = 20) and did not exceed 4% (n = 6) from 2015 to 2021. Hospital MRSA was lowest in 2021 (n = 211), a 76% fall from 2007 (n = 880). Incidence of MRSA HAI from 2015 to 2021 ranged from 5.4% (n = 14) in 2020 to 11.5% (n = 41) in 2018. CONCLUSIONS Prevalence of MRSA in DFU infections treated as outpatients is decreasing in line with falls in hospital acquired blood-borne infections and with overall hospital MRSA incidence. This is likely a reflection of the combination of interventions, including stringent antibiotic prescribing and decolonisation strategies. Reduction in prevalence should have positive impact on outcomes in people living with diabetes, reducing the complication of osteomyelitis and necessity for long-term antibiotic administration.
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Affiliation(s)
- James Moore
- Department of Medicine, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Catherine Gooday
- Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Reham Soliman
- Department of Microbiology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Ketan Dhatariya
- Department of Medicine, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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29
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Bowers DR. Treatment of Diabetic Foot Infections. Clin Diabetes 2023; 41:308-310. [PMID: 37092163 PMCID: PMC10115757 DOI: 10.2337/cd22-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dana R. Bowers
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Yakima, WA
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30
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Wada FW, Mekonnen MF, Sawiso ED, Kolato S, Woldegiorgis L, Kera GK, El-Khatib Z, Ashuro AA, Biru M, Boltena MT. Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2023; 13:14655. [PMID: 37670001 PMCID: PMC10480146 DOI: 10.1038/s41598-023-41882-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
The number of diabetic foot ulcer patients is substantially increasing, with the rapidly rising burden of diabetic mellitus in sub-Saharan Africa. The data on the regional prevalence of diabetic foot ulcer infecting bacteria and their antimicrobial resistance patterns is crucial for its proper management. This systematic review and meta-analysis determined the pooled prevalence of bacterial profiles and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa. A comprehensive search of the literature was performed on CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Critical appraisal was done using the Joanna Briggs Institute's tool for prevalence studies. A pooled statistical meta-analysis was conducted using STATA Version 17.0. The I2 statistics and Egger's test were used to assess the heterogeneity and publication bias. The pooled prevalence and the corresponding 95% confidence interval of bacterial profiles and their antimicrobial resistance patterns were estimated using a random effect model. Eleven studies with a total of 1174 study participants and 1701 bacteria isolates were included. The pooled prevalence of the most common bacterial isolates obtained from DFU were S. aureus (34.34%), E. coli (21.16%), and P. aeruginosa (20.98%). The highest pooled resistance pattern of S. aureus was towards Gentamicin (57.96%) and Ciprofloxacin (52.45%). E.coli and K. Pneumoniae showed more than a 50% resistance rate for the most common antibiotics tested. Both gram-positive and gram-negative bacteria were associated with diabetic foot ulcers in sub-Saharan Africa. Our findings are important for planning treatment with the appropriate antibiotics in the region. The high antimicrobial resistance prevalence rate indicates the need for context-specific effective strategies aimed at infection prevention and evidence-based alternative therapies.
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Affiliation(s)
- Fiseha Wadilo Wada
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
- Department of Medical Laboratory, College of Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
- Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | | | - Edlawit Desta Sawiso
- Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital (NEMMCSH), Wachemo University, Hossana, Ethiopia
| | - Sitotaw Kolato
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
- Department of Medical Laboratory, College of Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | | | | | - Ziad El-Khatib
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Montreal, QC, Canada
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Mulatu Biru
- USAID Eliminate TB Project, KNCV, Addis Ababa, Ethiopia
| | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
- Ethiopian-Evidence Based Health Care Centre: A JBI Center of Excellence, Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
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Cortes-Penfield NW, Armstrong DG, Brennan MB, Fayfman M, Ryder JH, Tan TW, Schechter MC. Evaluation and Management of Diabetes-related Foot Infections. Clin Infect Dis 2023; 77:e1-e13. [PMID: 37306693 PMCID: PMC10425200 DOI: 10.1093/cid/ciad255] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
| | - David G Armstrong
- Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Meghan B Brennan
- Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Maya Fayfman
- Division of Endocrinology and Metabolism, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Jonathan H Ryder
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tze-Woei Tan
- Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Marcos C Schechter
- Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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Young MJ, Hall LML, Merabishvilli M, Pirnay JP, Clark JR, Jones JD. Phage Therapy for Diabetic Foot Infection: A Case Series. Clin Ther 2023; 45:797-801. [PMID: 37442654 DOI: 10.1016/j.clinthera.2023.06.009] [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: 01/24/2023] [Revised: 04/28/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Infected diabetic foot ulcers can be difficult to treat and, despite appropriate antibiotic therapy, some diabetic foot infections (DFIs) require amputation. Bacteriophages (phages) are viruses that infect and kill bacteria. Phage therapy has been repeatedly used to successfully treat DFIs and other chronic wounds. METHODS This article reports the provision of topical adjunctive anti-staphylococcal phage therapy to 10 patients with DFI at high risk of amputation at two UK hospitals as part of clinical care; tolerability and efficacy were clinically assessed. FINDINGS The opinion of the experienced clinical teams caring for these patients was that 9 of the 10 patients appeared to benefit from adjunctive phage therapy. No adverse effects were reported by clinicians or patients. In 6 of 10 patients the clinical impression was that phage therapy facilitated clinical resolution of infection and limb salvage. Resolution of soft tissue infection was observed in a 7th patient but unresolved osteomyelitis required amputation. An 8th patient demonstrated eradication of Staphylococcus aureus from a polymicrobial infection and a 9th showed signs of clinical improvement before early cessation of phage therapy due to an unrelated event. One patient, with a weakly susceptible S aureus isolate, had no significant response. IMPLICATIONS This report describes the largest application of phage therapy in the United Kingdom to date and the first application of phage therapy for DFI in the United Kingdom and offers subjective hints toward impressive tolerability and efficacy. Phage therapy has the potential to transform the prevention and treatment of DFIs.
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Affiliation(s)
- Matthew J Young
- Diabetes Foot Clinic, Out Patient Department 2, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Lesley M L Hall
- Diabetes and Endocrinology, Queen Elizabeth University Hospital, Govan, Glasgow, United Kingdom
| | - Maya Merabishvilli
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
| | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
| | | | - Joshua D Jones
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom.
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Gramberg MCTT, Knippers C, Lagrand RS, van Hattem JM, de Goffau MC, Budding Budding AE, Davids M, Matamoros S, Nieuwdorp M, de Groot V, Heijer MD, Sabelis LWE, Peters EJG. Concordance between culture, Molecular Culture and Illumina 16S rRNA gene amplicon sequencing of bone and ulcer bed biopsies in people with diabetic foot osteomyelitis. BMC Infect Dis 2023; 23:505. [PMID: 37525143 PMCID: PMC10391922 DOI: 10.1186/s12879-023-08472-w] [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: 08/11/2022] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND In clinical practice the diagnosis of diabetic foot osteomyelitis (DFO) relies on cultures of bone or ulcer bed (UB) biopsies, of which bone biopsy is reference standard. The slow growth or fastidious nature of some bacteria, hamper expeditious detection and identification. Rapid molecular techniques may solve both issues, but their additional value for everyday practice is unknown. We investigated the concordance between conventional culture, the molecular techniques Molecular Culture (MC), and illumina 16S rRNA gene amplicon (16S) sequencing in people with DFO. METHODS In the BeBoP trial, bone and UB biopsies were obtained from people with DFO who visited Amsterdam UMC. These biopsies were analysed using 1) conventional culture, 2)MC, a rapid broad range PCR analysing the 16S-23S ribosomal-interspace-region, and 3) 16S sequencing, and evaluated concordance among these techniques. RESULTS We analysed 20 samples (11 bone and 9 UB) of 18 people. A total of 84 infectious agents were identified, 45 (54%) by all techniques, an additional 22 (26.5%, overall 80.5%) by both MC and 16S, and the remaining 16 species by culture and MC or 16S, or by a single method only. MC and 16S identified anaerobes not detected by culturing in 5 samples, and the presence of bacteria in 7 of 8 culture-negative (6 bone, 2 UB) samples. CONCLUSION The high level of concordance between MC and 16S and the additional ability of molecular techniques to detect various bacteria not detected by culturing opens up prospects for routine use of fast molecular techniques, in clinical settings including DFO. TRIAL REGISTRATION The BeBoP trial is retrospectively registered on 05-03-2019 in Netherlands Trial Register: NL 7582.
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Affiliation(s)
- Meryl Cinzía Tila Tamara Gramberg
- Department Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
- Amsterdam Infection & Immunity, Infectious Diseases, Amsterdam, The Netherlands.
- Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands.
| | - Carmen Knippers
- Department Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Rimke Sabine Lagrand
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands
| | - Jarne Marijn van Hattem
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marcus Christofoor de Goffau
- Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Amsterdam Medisch Centrum, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
- Sanger Institute, Cambridge, UK
| | | | - Mark Davids
- Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, The Netherlands
| | - Sebastien Matamoros
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands
- Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Academisch Medisch Centrum, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Louise Willy Elizabeth Sabelis
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands
| | - Edgar Josephus Gerardus Peters
- Department Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
- Amsterdam Infection & Immunity, Infectious Diseases, Amsterdam, The Netherlands.
- Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands.
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Gu S, Fan B, Wan F, Gao T, Qi Y, Zhou J, Zhang Y, Gu D, Xie W. Antibacterial Activity and Mechanism of Canagliflozin against Methicillin-Resistant Staphylococcus aureus. Molecules 2023; 28:5668. [PMID: 37570637 PMCID: PMC10420104 DOI: 10.3390/molecules28155668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Diabetic foot infection (DFI) is a common complication in diabetes patients, with foot infections being the leading cause of amputations. Staphylococcus aureus is frequently found in diabetic foot infections, of which methicillin-resistant Staphylococcus aureus (MRSA) has become a major clinical and epidemiological challenge. Since MRSA strains are resistant to most β-lactam antibiotics, and also partially resistant to other antibiotics, treatment is difficult and costly. The emergence of drug-resistant bacteria often arises from overuse or misuse of antibiotics. Clinically, canagliflozin is commonly used for the treatment of type 2 diabetes. On this basis, we investigated the antibacterial activity and mechanism of canagliflozin against MRSA, with the aim to discover novel functions of canagliflozin and provide new insights for the treatment of MRSA. Using the microbroth dilution method to determine the half maximal inhibitory concentration of drugs, we found that canagliflozin not only can inhibit the growth of methicillin-sensitive Staphylococcus aureus (MSSA) but also exhibits antibacterial activity against MRSA. The IC50 values, at approximately 56.01 μM and 57.60 μM, were almost the same. At 12 h, canagliflozin showed a significant antibacterial effect against MRSA at and above 30 μM. In addition, its combined use with penicillin achieved better antibacterial effects, which were increased by about three times. Additive antibacterial activity (FICI = 0.69) was found between penicillin and canagliflozin, which was better than that of doxycycline and canagliflozin (FICI = 0.95). Canagliflozin also affected bacterial metabolic markers, such as glucose, ATP, and lactic acid. The results of crystal violet staining indicate that canagliflozin disrupted the formation of bacterial biofilm. Our electron microscopy results showed that canagliflozin distorted the bacterial cell wall. The results of RT-PCR suggest that canagliflozin down-regulated the expressions of biofilm-related gene (clfA, cna, agrC, mgrA, hld) and methicillin-resistance gene (mecA), which was related to MRSA. Molecular docking also indicated that canagliflozin affected some interesting targets of MRSA, such as the sarA, crtM and fnbA proteins. In conclusion, canagliflozin exhibits antibacterial activity against MRSA by affecting bacterial metabolism, inhibiting its biofilm formation, distorting the bacterial cell wall, and altering the gene expression of biofilm formation and its virulence. Our study reveals the antibacterial activity of canagliflozin against MRSA, providing a new reference for treating diabetic foot infections.
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Affiliation(s)
- Siyao Gu
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China;
| | - Bing Fan
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China;
| | - Fang Wan
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Tong Gao
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Yuanyuan Qi
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Jin Zhou
- Institute for Ocean Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China;
| | - Yaou Zhang
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Dayong Gu
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China;
| | - Weidong Xie
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
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McNeil S, Waller K, Poy Lorenzo YS, Mateevici OC, Telianidis S, Qi S, Churilov I, MacIsaac RJ, Galligan A. Detection, management, and prevention of diabetes-related foot disease in the Australian context. World J Diabetes 2023; 14:942-957. [PMID: 37547594 PMCID: PMC10401446 DOI: 10.4239/wjd.v14.i7.942] [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: 12/23/2022] [Revised: 04/06/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023] Open
Abstract
Diabetes-related foot disease (DFD) is a widely feared complication among people who live with diabetes. In Australia and globally, rates of disability, cardio-vascular disease, lower extremity amputation, and mortality are significantly increased in patients with DFD. In order to understand and prevent these outcomes, we analyse the common pathogenetic processes of neuropathy, arterial disease, and infection. The review then summarises important management considerations through the interdisciplinary lens. Using Australian and international guidelines, we offer a stepwise, evidence-based practical approach to the care of patients with DFD.
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Affiliation(s)
- Scott McNeil
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Kate Waller
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Podiatry, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Yves S Poy Lorenzo
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Infectious Diseases Unit, Department of Medicine, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Pharmacy, St Vincent’s Hospital Melbourne, Fitzroy 3065, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, University of Melbourne, Fitzroy 3065, Victoria, Australia
| | - Olimpia C Mateevici
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Infectious Diseases Unit, Department of Medicine, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Stacey Telianidis
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Vascular Surgery, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Sara Qi
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Vascular Surgery, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Irina Churilov
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, University of Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Rehabilitation Medicine, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Richard J MacIsaac
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, University of Melbourne, Fitzroy 3065, Victoria, Australia
- the Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville 3010, Victoria, Australia
| | - Anna Galligan
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
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Mizusawa M, Carroll KC. Recent updates in the development of molecular assays for the rapid identification and susceptibility testing of MRSA. Expert Rev Mol Diagn 2023; 23:679-699. [PMID: 37419696 DOI: 10.1080/14737159.2023.2234823] [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] [Received: 03/15/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of healthcare- and community-associated infections. Nasal carriage of MRSA is a risk factor for subsequent MRSA infections. Increased morbidity and mortality are associated with MRSA infections and screening and diagnostic tests for MRSA play an important role in clinical management. AREAS COVERED A literature search was conducted in PubMed and supplemented by citation searching. In this article, we provide a comprehensive review of molecular-based methods for MRSA screening and diagnostic tests including individual nucleic acid detection assays, syndromic panels, and sequencing technologies with a focus on their analytical performance. EXPERT OPINION Molecular based-assays for the detection of MRSA have improved in terms of accuracy and availability. Rapid turnaround enables earlier contact isolation and decolonization for MRSA. The availability of syndromic panel tests that include MRSA as a target has expanded from positive blood cultures to pneumonia and osteoarticular infections. Sequencing technologies allow detailed characterizations of novel methicillin-resistance mechanisms that can be incorporated into future assays. Next generation sequencing is capable of diagnosing MRSA infections that cannot be identified by conventional methods and metagenomic next-generation sequencing (mNGS) assays will likely move closer to implementation as front-line diagnostics in the near future.
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Affiliation(s)
- Masako Mizusawa
- Monmouth Medical Center, Rutgers University Robert Wood Johnson Medical School, Long Branch, NJ, USA
| | - Karen C Carroll
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chen T, Xu H, Yao X, Luo Z. Role of sodium pyruvate in maintaining the survival and cytotoxicity of Staphylococcus aureus under high glucose conditions. Front Microbiol 2023; 14:1209358. [PMID: 37405167 PMCID: PMC10315490 DOI: 10.3389/fmicb.2023.1209358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Glucose is a crucial carbon source for the growth of Staphylococcus aureus, but an excess of glucose is detrimental and even leads to cell death. Pyruvate, the central metabolite of glycolysis, has been shown to have anti-inflammatory and antioxidant properties. This study aimed to investigate the protective effect of pyruvate on S. aureus under high glucose conditions. Sodium pyruvate greatly increased the cytotoxicity of S. aureus strain BAA-1717 to human erythrocytes and neutrophils in vitro. However, the cytotoxicity and survival of S. aureus were significantly reduced by high glucose, which was restored to normal levels by the addition of sodium pyruvate. The expression of hlg and lukS in S. aureus was higher in the LB-GP cultures than that in LB-G cultures, but there was no significant difference in cytotoxicity between LB-GP and LB-G cultures. Furthermore, the hemolytic activity of S. aureus supernatants could be inhibited by the cell-free culture medium (CFCM) of LB-G cultures, suggesting that high levels of extracellular proteases were presence in the CFCM of LB-G cultures, resulting in degradation of the hemolytic factors. The expression of sarA, which negatively regulates extracellular protease secretion, was higher in LB-GP cultures than that in LB-G cultures. Additionally, sodium pyruvate increased acetate production in S. aureus, which helps maintain cell viability under acidic environment. In conclusion, pyruvate plays an important role in the survival and cytotoxicity of S. aureus under high glucose conditions. This finding may aid in the development of effective treatments for diabetic foot infections.
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Affiliation(s)
- Ti Chen
- Department of Laboratory Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Huan Xu
- Department of Laboratory Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyan Yao
- Department of Medical Laboratory Science, School of Medicine, Hunan Normal University, Changsha, China
| | - Zhen Luo
- Department of Laboratory Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
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Abdalla MMI, Mohanraj J, Somanath SD. Adiponectin as a therapeutic target for diabetic foot ulcer. World J Diabetes 2023; 14:758-782. [PMID: 37383591 PMCID: PMC10294063 DOI: 10.4239/wjd.v14.i6.758] [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: 02/28/2023] [Revised: 03/25/2023] [Accepted: 04/24/2023] [Indexed: 06/14/2023] Open
Abstract
The global burden of diabetic foot ulcers (DFUs) is a significant public health concern, affecting millions of people worldwide. These wounds cause considerable suffering and have a high economic cost. Therefore, there is a need for effective strategies to prevent and treat DFUs. One promising therapeutic approach is the use of adiponectin, a hormone primarily produced and secreted by adipose tissue. Adiponectin has demonstrated anti-inflammatory and anti-atherogenic properties, and researchers have suggested its potential therapeutic applications in the treatment of DFUs. Studies have indicated that adiponectin can inhibit the production of pro-inflammatory cytokines, increase the production of vascular endothelial growth factor, a key mediator of angiogenesis, and inhibit the activation of the intrinsic apoptotic pathway. Additionally, adiponectin has been found to possess antioxidant properties and impact glucose metabolism, the immune system, extracellular matrix remodeling, and nerve function. The objective of this review is to summarize the current state of research on the potential role of adiponectin in the treatment of DFUs and to identify areas where further research is needed in order to fully understand the effects of adiponectin on DFUs and to establish its safety and efficacy as a treatment for DFUs in the clinical setting. This will provide a deeper understanding of the underlying mechanisms of DFUs that can aid in the development of new and more effective treatment strategies.
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Affiliation(s)
- Mona Mohamed Ibrahim Abdalla
- Department of Physiology, Human Biology Division, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Jaiprakash Mohanraj
- Department of Biochemistry, Human Biology Division, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Sushela Devi Somanath
- Department of Microbiology, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
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Rajab AAH, Hegazy WAH. What’s old is new again: Insights into diabetic foot microbiome. World J Diabetes 2023; 14:680-704. [PMID: 37383589 PMCID: PMC10294069 DOI: 10.4239/wjd.v14.i6.680] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/20/2023] [Accepted: 04/10/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians. The prevalence of diabetes in the global population continues to grow to alarming levels year after year, causing an increase in the incidence of diabetes complications and health care costs all over the world. One major complication of diabetes is the high susceptibility to infections especially in the lower limbs due to the immunocompromised state of diabetic patients, which is considered a definitive factor in all cases. Diabetic foot infections continue to be one of the most common infections in diabetic patients that are associated with a high risk of serious complications such as bone infection, limb amputations, and life-threatening systemic infections. In this review, we discussed the circumstances associated with the high risk of infection in diabetic patients as well as some of the most commonly isolated pathogens from diabetic foot infections and the related virulence behavior. In addition, we shed light on the different treatment strategies that aim at eradicating the infection.
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Affiliation(s)
- Azza A H Rajab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagzig 44511, Egypt
| | - Wael A H Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagzig 44511, Egypt
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Wright A, Wood S, De Silva J, Bell JS. Systemic Antimicrobial Therapy for Diabetic Foot Infections: An Overview of Systematic Reviews. Antibiotics (Basel) 2023; 12:1041. [PMID: 37370360 DOI: 10.3390/antibiotics12061041] [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: 04/19/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Diabetic foot infections (DFIs) are a common complication of diabetes; however, there is clinical uncertainty regarding the optimal antimicrobial selection. The aim of this review was to critically evaluate the recent systematic reviews on the efficacy and safety of systemic (parenteral or oral) antimicrobials for DFI. Medline, Embase, CENTRAL, and CINAHL databases and the PROSPERO register were searched from January 2015 to January 2023. Systematic reviews with or without meta-analyses on systemic antimicrobials for DFI, with outcomes of clinical infection resolution or complications, were included. Of the 413 records identified, 6 systematic reviews of 29 individual studies were included. Heterogeneity of individual studies precluded meta-analysis, except for ertapenem versus piperacillin-tazobactam (RR 1.07, 95% CI [0.96-1.19]) and fluoroquinolones versus piperacillin-tazobactam (RR 1.03, 95% CI [0.89-1.20]) in one review. The application of the AMSTAR-2 tool determined two reviews to be of high quality. There was no statistical difference in the clinical resolution of infections for 24 different antimicrobial regimens (penicillins, cephalosporins, carbapenems, fluoroquinolones, vancomycin, metronidazole, clindamycin, linezolid, daptomycin, and tigecycline). However, tigecycline did not meet non-inferiority against ertapenem ± vancomycin (absolute difference -5.5%, 95% CI [-11.0-0.1]) and was associated with a higher incidence of adverse drug events. There is minimal systematic review evidence to suggest one regimen is superior to another for DFI.
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Affiliation(s)
- Angela Wright
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia
- Pharmacy Department, Mackay Base Hospital, Mackay, QLD 4740, Australia
| | - Stephen Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia
| | - Janath De Silva
- Medicine Department, Mackay Base Hospital, Mackay, QLD 4740, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia
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Grealy L, Wilson P, Gillen C, Duffy É, Healy ML, Daly B, Polyzois I, Van Harten M, Dougall A, Brennan GI, Coleman DC, McManus BA. Immersion of debrided diabetic foot ulcer (DFU) tissue in electrochemically generated pH neutral hypochlorous acid significantly reduces the microbial bioburden: whole-genome sequencing of Staphylococcus aureus, the most prevalent species recovered. J Hosp Infect 2023:S0195-6701(23)00179-2. [PMID: 37308064 DOI: 10.1016/j.jhin.2023.06.006] [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: 05/22/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Diabetic foot ulcer infections (DFUIs) are the leading cause of lower limb amputations, mediated predominantly by Staphylococcus aureus. pH neutral electrochemically-generated hypochlorous acid (anolyte) is a non-toxic, microbiocidal agent with significant potential for wound disinfection. AIMS To investigate both the effectiveness of anolyte for microbial bioburden reduction in debrided ulcer tissues and the population of resident S. aureus. METHODS Fifty-one debrided tissues from 30 people with type II diabetes were aliquoted by wet weight and immersed in 1 or 10 ml volumes of anolyte (200 parts per million) or saline for three min. Microbial loads recovered were determined in colony forming units/g (CFU/g) of tissue following aerobic, anaerobic and staphylococcal-selective culture. Bacterial species were identified and 50 S. aureus isolates from 30 tissues underwent whole-genome sequencing (WGS). FINDINGS The ulcers were predominantly superficial, lacking signs of infection (39/51, 76.5%). Of the 42/51 saline-treated tissues yielding ≥105 CFU/g, a microbial threshold reported to impede wound-healing, only 4/42 (9.5%) were clinically-diagnosed DFUIs. Microbial loads from anolyte-treated tissues were significantly lower than saline-treated tissues using 1 ml (1065-fold, 2.0 log) and 10 ml (8216-fold, 2.1 log) immersion volumes (p<0.0005). Staphylococcus aureus was the predominant species recovered (44/51, 86.3%) and 50 isolates underwent WGS. All were meticillin-susceptible and comprised 12 sequence types (STs), predominantly ST1, ST5 and ST15. Whole-genome multilocus sequence typing identified three clusters of closely related isolates from 10 patients indicating inter-patient transmission. CONCLUSIONS Short immersions of debrided ulcer tissue in anolyte significantly reduced microbial bioburden: a potential novel DFUI treatment.
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Affiliation(s)
- Liam Grealy
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Pauline Wilson
- Department of Endocrinology & Diabetes, St. James's Hospital, Dublin, Ireland
| | - Corey Gillen
- Department of Endocrinology & Diabetes, St. James's Hospital, Dublin, Ireland
| | - Éilish Duffy
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Marie-Louise Healy
- Department of Endocrinology & Diabetes, St. James's Hospital, Dublin, Ireland
| | - Blánaid Daly
- Division of Public and Child Dental Health, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Ioannis Polyzois
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Maria Van Harten
- Division of Public and Child Dental Health, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Alison Dougall
- Division of Public and Child Dental Health, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Gráinne I Brennan
- National MRSA Reference Laboratory, St. James's Hospital, Dublin, Ireland
| | - David C Coleman
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Brenda A McManus
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland.
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Sultana R, Ahmed I, Saima S, Salam MT, Sultana S. Diabetic foot ulcer-a systematic review on relevant microbial etiology and antibiotic resistance in Asian countries. Diabetes Metab Syndr 2023; 17:102783. [PMID: 37257221 DOI: 10.1016/j.dsx.2023.102783] [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: 08/25/2022] [Revised: 04/15/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Diabetic foot ulcer (DFU) is one of the most common but uncontrolled health issues of diabetic patients that needs more therapeutic considerations. This systematic review aims to study the current status of the etiological agents responsible for DFU, their frequency in some of the most occurring Asian countries, and their antibiotic resistance pattern based on available studies. METHODS Here, the literature survey was conducted on all the DFU studies with the records of etiological agents and conventional therapeutic treatment published until March 2021 using Medical Literature Analysis and Retrieval System Online (MEDLINE) and Web of Science Core Collection (WoSCC) database. RESULTS Overall, in our study, a total of 73 studies representing 12 Asian countries worldwide have been included. We found that the highest number of studies were reported from India (45%) followed by Pakistan (11%), China, Iran and others. 71% of recent studies reported DFU being attributed to poly-microbial infections while the dominant position was significantly secured by Gram- negative bacteria (77%, p = 0.34). Staphylococcus aureus was found to be the most prevalent isolate followed by Pseudomonas and then Escherichia coli (mean value - 22%, 17%, and 15% respectively). Antibiotic sensitivity pattern was determined based on availability in terms of median resistance (MR) and interquartile range (IQR) which showed the growing resistance developed by both Gram-positive and Gram-negative isolates. Gram positive pathogens were still reported as susceptible to vancomycin (MR 0%, IQR 0-22.8%), linezolid (MR 0%, IQR 0-15.53%) and imipenem (MR 11%, IQR 0-23.53%). Carbapenem genera, colistin, and amikacin were the most effective drugs against Gram-negative pathogens. CONCLUSION The findings of this study highly recommend searching for alternative and complementary therapeutic regimens instead of prescribing conventional drugs blindly without investigating the progression of the stages of the ulcer, which may help reduce the medical and economic burden of this disease.
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Affiliation(s)
- Rokaia Sultana
- Institute of National Analytical Research and Service (INARS), Bangladesh Council of Scientific and Industrial Research (BCSIR), New Elephant Road, Dhaka, 1205, Bangladesh; Purdue University, West Lafayette, IN, 47907, USA.
| | | | - Sabera Saima
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh.
| | | | - Shahnaz Sultana
- Institute of National Analytical Research and Service (INARS), Bangladesh Council of Scientific and Industrial Research (BCSIR), New Elephant Road, Dhaka, 1205, Bangladesh.
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Shen JM, Chen J, Feng L, Feng C. A scientometrics analysis and visualisation of diabetic foot research from 1955 to 2022. Int Wound J 2023; 20:1072-1087. [PMID: 36164753 PMCID: PMC10031233 DOI: 10.1111/iwj.13964] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/28/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Diabetic foot (DF) has become a serious health problem in modern society, and it has been a hotspot of research for a long time. However, little scientometric analysis has been carried out on DF. In the present study, we analysed 8633 literature reports on DF in the Web of Science Core Collection from database inception until April 23, 2022. VOSviewer (Centre for Science and Technology Studies at Leiden University, Leiden, the Netherlands) and CiteSpace (College of Computing and Informatics, Drexel University, Philadelphia, United States) were employed to address high-impact countries and institutions, journals, references, research hotspots, and key research fields in DF research. Our analysis findings indicated that publications on DF have increased markedly since 2016 and were primarily published in the United States of America. The recent studies focus on the amniotic membrane, foot ulcers, osteomyelitis, and diabetic wound healing. The five keyword clusters, which included DF ulcer and wound healing therapies, management and guidelines, neuropathy and plantar pressure, amputation and ischemia, and DF infection and osteomyelitis, are helpful for enhancing prevention, standardising treatment, avoiding complications, and improving prognosis. These findings indicated a method for future therapies and research in DF.
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Affiliation(s)
- Jin-Ming Shen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jie Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Lei Feng
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Chun Feng
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Taki E, Jabalameli F, Tehrani MRM, Feizabadi MM, Halimi S, Sanjari M, Amini MR, Beigverdi R, Emaneini M. Molecular Characteristics of Staphylococcus aureus Strains Isolated from Nasal Cavity and Wound Infections Among Diabetic Patients. Curr Microbiol 2023; 80:147. [PMID: 36961628 DOI: 10.1007/s00284-023-03262-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Staphylococcus aureus is the most common pathogen contributing to diabetic foot infections (DFI). Nasal transmission of S. aureus potentially increases the risk of endogenous infection. The aim of this study was to determine the genetic diversity and antibiotic resistance profile of S. aureus isolates in nasal and wound samples from diabetic patients. A cross-sectional study was conducted from July 2018 to September 2019. S. aureus was isolated from the anterior nares and wounds of diabetic patients. All S. aureus isolates were characterized by detection of resistance and virulence genes (mecA, ermA, ermC, hla, hlb, hlg, sea, lukDE, pvl), staphylococcal cassette chromosome mec (SCCmec)-typing and staphylococcal protein A (spa)-typing. A total of 34 S. aureus were isolated from the wounds of 115 diabetic patients with DFI. Twenty-four S. aureus isolates were collected from the anterior nares of patients, and thirteen patients had concurrent S. aureus in nasal and wound specimens. The prevalence of methicillin-resistant S. aureus (MRSA) in nasal specimens was noticeable (41.7%), and the most common spa-type in nasal and wound specimens was t14870. Nearly half of the patients with concurrent S. aureus in wound and nasal specimens had similar isolates from both sites. Our data suggest that detection and screening of S. aureus colonization in the nasal cavity may prevent subsequent endogenous infections, particularly with MRSA strains.
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Affiliation(s)
- Elahe Taki
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Building No. 7, 100 Poursina St., Keshavarz Blvd, Tehran, 14167-53955, Iran
| | - Fereshteh Jabalameli
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Building No. 7, 100 Poursina St., Keshavarz Blvd, Tehran, 14167-53955, Iran
| | - Mohammad Reza Mohajeri Tehrani
- Diabetes Research Center, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Feizabadi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Building No. 7, 100 Poursina St., Keshavarz Blvd, Tehran, 14167-53955, Iran
| | - Shahnaz Halimi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Building No. 7, 100 Poursina St., Keshavarz Blvd, Tehran, 14167-53955, Iran
| | - Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Beigverdi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Building No. 7, 100 Poursina St., Keshavarz Blvd, Tehran, 14167-53955, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Building No. 7, 100 Poursina St., Keshavarz Blvd, Tehran, 14167-53955, Iran.
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Fathil MAM, Katas H. Antibacterial, Anti-Biofilm and Pro-Migratory Effects of Double Layered Hydrogels Packaged with Lactoferrin-DsiRNA-Silver Nanoparticles for Chronic Wound Therapy. Pharmaceutics 2023; 15:pharmaceutics15030991. [PMID: 36986852 PMCID: PMC10054788 DOI: 10.3390/pharmaceutics15030991] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Antimicrobial resistance and biofilm formation in diabetic foot infections worsened during the COVID-19 pandemic, resulting in more severe infections and increased amputations. Therefore, this study aimed to develop a dressing that could effectively aid in the wound healing process and prevent bacterial infections by exerting both antibacterial and anti-biofilm effects. Silver nanoparticles (AgNPs) and lactoferrin (LTF) have been investigated as alternative antimicrobial and anti-biofilm agents, respectively, while dicer-substrate short interfering RNA (DsiRNA) has also been studied for its wound healing effect in diabetic wounds. In this study, AgNPs were complexed with LTF and DsiRNA via simple complexation before packaging in gelatin hydrogels. The formed hydrogels exhibited 1668% maximum swellability, with a 46.67 ± 10.33 µm average pore size. The hydrogels demonstrated positive antibacterial and anti-biofilm effects toward the selected Gram-positive and Gram-negative bacteria. The hydrogel containing AgLTF at 125 µg/mL was also non-cytotoxic on HaCaT cells for up to 72 h of incubation. The hydrogels containing DsiRNA and LTF demonstrated superior pro-migratory effects compared to the control group. In conclusion, the AgLTF-DsiRNA-loaded hydrogel possessed antibacterial, anti-biofilm, and pro-migratory activities. These findings provide a further understanding and knowledge on forming multipronged AgNPs consisting of DsiRNA and LTF for chronic wound therapy.
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Matijević T, Talapko J, Meštrović T, Matijević M, Erić S, Erić I, Škrlec I. Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes. World J Clin Cases 2023; 11:1669-1683. [PMID: 36970006 PMCID: PMC10037285 DOI: 10.12998/wjcc.v11.i8.1669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.
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Affiliation(s)
- Tatjana Matijević
- Department of Dermatology and Venereology, University Hospital Center Osijek, Osijek 31000, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, Varaždin 42000, Croatia
- Institute for Health Metrics and Evaluation and the Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States
| | - Marijan Matijević
- Department of Surgery, National Memorial Hospital Vukovar, Vukovar 32000, Croatia
| | - Suzana Erić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Radiotherapy and Oncology, Clinical Hospital Center Osijek, Osijek 31000, Croatia
| | - Ivan Erić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Surgery, Osijek University Hospital Centre, Osijek 31000, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
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Miraj SS, Kurian SJ, Rodrigues GS, Saravu K, Rao M, Raychaudhuri SP, Downs BW, Bagchi D. Phytotherapy in Diabetic Foot Ulcers: A Promising Strategy for Effective Wound Healing. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2023; 42:295-310. [PMID: 35512780 DOI: 10.1080/07315724.2022.2034069] [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: 12/21/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
Despite the advancement in wound care, the effective therapy of chronic diabetic ulcers continues to be a challenge. Wound healing is a highly controlled process, which involves a sequence of complex overlapping steps. This healing pathway comprises of hemostasis, inflammation, proliferative, and remodeling phases. Recent evidence suggests that phytomedicines can prevent or repair different kinds of destructive cellular damage, including chronic wounds. Several phytochemicals such as polyphenols, alkaloids, flavonoids, terpenoids, and glycosides have pleiotropic effects, including stimulation of fibroblast proliferation, the main step in wound healing. Besides, the mechanism involves induction of collagen synthesis, migration, and reepithelization and their antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory actions. Similarly, the use of phytochemicals alone or as an adjuvant with standard therapy has demonstrated promising results in managing complications in the diabetic foot. For instance, the extract of Carica papaya has been shown antioxidant, antimicrobial, and anti-inflammatory, and immunomodulatory effects, which, together with proteolytic enzymatic activity, contributes to its wound healing property. It is generally believed that phytotherapy has no or minimal toxicity than synthetic therapeutic agents, favoring its use in diabetic foot ulcer management. The current review highlights the selected phytochemicals and their sources; and potential application in diabetic foot ulcer management.Key teaching points and nutritional relevanceCurrently, phytochemicals have been shown wide potential in disease. management including alleviating clinical manifestations, preventing degenerative disease, and curing illness.Increased evidence of phytochemical as anti-infective and anti-inflammatory suggests its role in the management of diabetic foot ulcer(DFU).Potential benefit along with minimal adverse effect favors its application as adjuvant therapy.Further research is needed to standardize its dose and formulation to enhance its clinical application in DFU management.
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Affiliation(s)
- Sonal Sekhar Miraj
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shilia Jacob Kurian
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gabriel Sunil Rodrigues
- Department of Surgery, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kavitha Saravu
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Infectious Diseases, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
| | - Siba Prasad Raychaudhuri
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, California, USA
- VA Medical Centre, Sacramento, California, USA
| | | | - Debasis Bagchi
- Department of R&D, VNI Inc, Bonita Springs, Florida, USA
- Department of Pharmaceutical Sciences, Texas Southern University, Houston, Texas, USA
- Department of Biology, Adelphi University, Garden City, New York, USA
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48
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Kale DS, Karande GS, Datkhile KD. Diabetic Foot Ulcer in India: Aetiological Trends and Bacterial Diversity. Indian J Endocrinol Metab 2023; 27:107-114. [PMID: 37292074 PMCID: PMC10245308 DOI: 10.4103/ijem.ijem_458_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 06/10/2023] Open
Abstract
Diabetes is one of the most prevalent epidemic metabolic disorders, responsible for a significant amount of physical, psychological and economic loss in human society. Diabetic foot ulcer (DFU) is one of the extreme pathophysiological consequences of diabetes. Bacterial infection is the most important cause of chronic DFU. Bacterial species or their biofilms show multidrug resistance, which complicates DFU and consequently leads to amputation of the infected part. Since the Indian population comprises diverse ethnic and cultural groups, this could influence the aetiology of diabetic foot infections and bacterial diversity. We reviewed 56 articles published from 2005 to 2022 on the microbiology of DFU and extracted the data on study location, number of patients analysed in the study, pathophysiological complications, age of the patients, sex of the patient, type of bacteria, type of infection (mono or polymicrobial), predominant bacteria (Gram-positive or Gram-negative), predominant isolates and multiple drug resistance (tested or not). We analysed data and described aetiological trends in diabetic foot infections and bacterial diversity. The study revealed that Gram-negative bacteria are predominant as compared to Gram-positive bacteria in individuals with diabetes with DFU in India. Escherichia coli, Pseudomonas aeruginosa, Klebsiella sp. and Proteus sp. were the most predominant Gram-negative bacteria, while Staphylococcus aureus and Enterococcus sp. were the major Gram-positive bacteria in DFU. We discuss bacterial infections in DFU in the context of bacterial diversity, sampling methods, demography and aetiology.
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Affiliation(s)
- Dipak S. Kale
- Department of Microbiology, Krishna Institute of Medical Sciences, Karad, Satara, Maharashtra, India
| | - Geeta S. Karande
- Department of Microbiology, Krishna Institute of Medical Sciences, Karad, Satara, Maharashtra, India
| | - Kailas D. Datkhile
- Department of Molecular Biology and Genetics, Krishna Institute of Medical Sciences, Karad, Satara, Maharashtra, India
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M S, Mulki SS, Shenoy S, Dhanashree B, M C, Bhat G. Heterogeneous Vancomycin Intermediate Staphylococcus aureus Infections in Diabetic and Non-Diabetic Patients - A Hospital-Based Comparative Study. Infect Drug Resist 2023; 16:9-17. [PMID: 36636375 PMCID: PMC9830051 DOI: 10.2147/idr.s393415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose To study the infections caused by methicillin resistant Staphylococcus aureus (MRSA) with emphasis on heterogeneous vancomycin intermediate S. aureus (hVISA) in diabetic and non-diabetic patients and their comparison. Patients and Methods S. aureus strains isolated from diabetic and non-diabetic patients admitted in four tertiary care hospitals in Coastal Karnataka, South India, were tested for methicillin resistance and included in the present study. Demographic and clinical data of the patients were collected using structured proforma. Antimicrobial susceptibility testing was done using the Kirby-Bauer disc diffusion method, and MLSB phenotypes were identified using the D-test. The minimum inhibitory concentration (MIC) of vancomycin was determined using agar dilution. MRSA isolates were tested for hVISA using vancomycin screen agar and population analysis profile - area under the curve (PAP-AUC) test. Statistical analysis of the results was done using the chi-square test. SPSS version 29.0 was used for this purpose. Results Out of 665 strains of S. aureus isolated, 220 (33.1%) were MRSA. Of these 220 MRSA strains, 122 (55.5%) and 98 (44.5%) were isolated from diabetic and non-diabetic patients, respectively. There was no significant difference in the antimicrobial resistance patterns of MRSA strains isolated from diabetic and non-diabetic patients. Foot infections and osteomyelitis caused by MRSA were significantly more among diabetic patients. Out of 220 strains of MRSA, 14 (6.4%) were hVISA. The rates of hVISA among MRSA isolated from diabetic and non-diabetic were 9.0% and 3.1%, respectively. This difference was statistically not significant. Conclusion The rate of hVISA among all MRSA isolates was 6.4%. The risk of hVISA infection was three times more in diabetic patients. The results emphasize the importance of the detection of hVISA among MRSA isolates especially from diabetic patients.
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Affiliation(s)
- Sreejisha M
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 575001, India
| | - Shalini Shenoy Mulki
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 575001, India
| | - Suchitra Shenoy
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 575001, India
| | - Biranthabail Dhanashree
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 575001, India
| | - Chakrapani M
- Department of Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 575001, India
| | - Gopalakrishna Bhat
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 575001, India,Correspondence: Gopalakrishna Bhat, Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India, Tel +91 9480424729, Email
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Almutairi L, Yu B, Dyne E, Ojaym A, Kim MH. Mild magnetic hyperthermia is synergistic with an antibiotic treatment against dual species biofilms consisting of S. aureus and P. aeruginosa by enhancing metabolic activity. Int J Hyperthermia 2023; 40:2226845. [PMID: 37369371 PMCID: PMC10406516 DOI: 10.1080/02656736.2023.2226845] [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: 04/20/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The wound biofilm infections that develop tolerance to standard-of-care antimicrobial treatment has been increasing. The objective of this study was to demonstrate a proof-of-concept of mild magnetic nanoparticle (MNP)/alternating magnetic field (AMF) hyperthermia as an anti-biofilm therapy against multispecies biofilm infections. METHODS Using both an in vitro cell culture and in vivo murine model of wound infection, we investigated whether MNP/AMF hyperthermia applied at a mild thermal dosage would be synergistically effective against dual species biofilm infection consisting of S. aureus and P. aeruginosa when combined with a broad-spectrum antibiotic, ciprofloxacin (CIP). RESULTS The combined treatment of MNP/AMF hyperthermia and CIP to the wounds of diabetic mice (db/db mice) significantly reduced the CFU number of S. aureus and P. aeruginosa by 2-log and 3-log, respectively, compared to the untreated control group, whereas either mild MNP/AMF hyperthermia or CIP treatment alone had little effect on the eradication of both bacteria. Our gene microarray data obtained from the culture of S. aureus biofilm suggest that mild MNP/AMF could shift the expression of genes for cellular respiration from anaerobic fermentation to an aerobic glycolytic/tricarboxylic acid cycle (TCA) pathway, implicating that the beneficial effect of mild MNP/AMF hyperthermia on the increased susceptibility of biofilm bacteria to an antibiotic treatment is associated with an increased metabolic activity. CONCLUSION Our results support the translational potential of mild MNP/AMF as an adjunctive therapy that can be combined with a broad-spectrum antibiotic treatment for the management of wound biofilm infections associated with multispecies bacteria.
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Affiliation(s)
- Layla Almutairi
- School of Biomedical Sciences, Kent State University, Kent, OH 44242 USA
- Department of Biology, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Bing Yu
- Department of Biological Sciences, Kent State University, Kent, OH 44242 USA
| | - Eric Dyne
- School of Biomedical Sciences, Kent State University, Kent, OH 44242 USA
| | - Alhussain Ojaym
- School of Biomedical Sciences, Kent State University, Kent, OH 44242 USA
| | - Min-Ho Kim
- School of Biomedical Sciences, Kent State University, Kent, OH 44242 USA
- Department of Biological Sciences, Kent State University, Kent, OH 44242 USA
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