Alternative Approaches for the Management of Diabetic Foot Ulcers

Abstract

Diabetic foot ulcers (DFU) represent a growing public health problem. The emergence of multidrug-resistant (MDR) bacteria is a complication due to the difficulties in distinguishing between infection and colonization in DFU. Another problem lies in biofilm formation on the skin surface of DFU. Biofilm is an important pathophysiology step in DFU and may contribute to healing delays. Both MDR bacteria and biofilm producing microorganism create hostile conditions to antibiotic action that lead to chronicity of the wound, followed by infection and, in the worst scenario, lower limb amputation. In this context, alternative approaches to antibiotics for the management of DFU would be very welcome. In this review, we discuss current knowledge on biofilm in DFU and we focus on some new alternative solutions for the management of these wounds, such as antibiofilm approaches that could prevent the establishment of microbial biofilms and wound chronicity. These innovative therapeutic strategies could replace or complement the classical strategy for the management of DFU to improve the healing process.

Novel Amoxicillin-Loaded Sericin Biopolymeric Nanoparticles: Synthesis, Optimization, Antibacterial and Wound Healing Activities

“…Diabetic wounds are considered an major cause of amputations in diabetic patients [ 1 ]. The wound healing process is usually complicated, even in nondiabetic patients [ 2 ].…”

“…Wound infection may lead to improper collagen deposition, fester at the wound site and delaying of the wound healing process [ 5 ]. The progressive emergence of multidrug-resistant (MDR) bacteria (caused by the excessive use of antibiotics) is a major obstacle hindering the appropriate wound healing mechanism [ 1 ], with Staphylococcus aureus ( S. aureus ) and Pseudomonas aeruginosa ( P. aeruginosa ) being the major causes of bacterial wound infections [ 6 ]. The pharmaceutical industry’s efforts to generate new highly potent antibacterial agents, with novel mechanisms of action to combat MDR bacteria, have weakened dramatically over the last three decades for economic, scientific or strategic reasons [ 7 , 8 ].…”

Four in one—Combination therapy using live Lactococcus lactis expressing three therapeutic proteins for the treatment of chronic non-healing wounds

“…In addition to known local site reactions, which are somewhat expected, there are also risks due to bacterial translocation or colonization potentially leading to AUP1602-C related local or general infections. Bacterial colonization and related biofilm formation in chronic wounds is one of the key factors causing delayed wound healing and impairment of the wound healing process into the inflammatory phase [ 3 , 65 , 66 ]. Up to 80% of chronic wounds contain bacterial material structures in a biofilm, as e.g.…”

Bacteriophage Therapy for Staphylococcus Aureus Infections: A Review of Animal Models, Treatments, and Clinical Trials

“…This novel approach demonstrates the advantages of a novel strategy to treat SSTI caused by MRSA, combining vectorization and phage delivery. DFI are usually polymicrobial, yet, S. aureus is the most commonly found pathogen (Lipsky et al, 2020;Pouget et al, 2021). Recent research by Albac et al evaluated the in vivo effectiveness of a cocktail of three phages (PP1493, PP1815 and PP1957) in comparison to linezolid in diabetic and non-diabetic mouse models of methicillin-susceptible S. aureus (MSSA) foot infection (Albac et al, 2020).…”