An Overview of Diabetic Foot Ulcers and Associated Problems with Special Emphasis on Treatments with Antimicrobials

Abstract

One of the most significant challenges of diabetes health care is diabetic foot ulcers (DFU). DFUs are more challenging to cure, and this is particularly true for people who already have a compromised immune system. Pathogenic bacteria and fungi are becoming more resistant to antibiotics, so they may be unable to fight microbial infections at the wound site with the antibiotics we have now. This article discusses the dressings, topical antibacterial treatment, medications and debridement techniques used for DFU and provides a deep discussion of DFU and its associated problems. English-language publications on DFU were gathered from many different databases, such as Scopus, Web of Science, Science Direct, Springer Nature, and Google Scholar. For the treatment of DFU, a multidisciplinary approach involving the use of diagnostic equipment, skills, and experience is required. Preventing amputations starts with patient education and the implementation of new categorization systems. The microbiota involved in DFU can be better understood using novel diagnostic techniques, such as the 16S-ribosomal DNA sequence in bacteria. This could be achieved by using new biological and molecular treatments that have been shown to help prevent infections, to control local inflammation, and to improve the healing process.

Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil

“…The finding of several microorganisms with different susceptibility profiles corroborates the strategy of broad-spectrum therapy with coverage for Gram-positive, Gram-negative and anaerobic pathogens. Coverage for anaerobic pathogens is always indicated because we know their importance in infections where there is a deficit of vascularization and necrosis and the difficulty of isolation of these pathogens in culture due to the conditions of anaerobiosis necessary for their survival [ 31 , 32 ].…”

Function and mechanism of mesenchymal stem cells in the healing of diabetic foot wounds

“…Furthermore, metabolic disorders of diabetes lead to degeneration of peripheral nerve axons and nerve membrane cells, motor, sensory, and autonomic nerves dysfunction, resulting in further decline of limb perfusion effect, sensory dysfunction, muscle atrophy, and tendon and ligament sclerosis ( 22 ), followed by foot deformities and increased pressure on the forefoot. Metabolic products cannot be excluded, while extremal ischemia and hypoxia, bacterial growth, extremal ulceration, wound healing is challenging, and foot infection can become worsened ( 23 ). As blood flow is impaired, it is often difficult for drugs to reach the affected area, and DFU can progress from a simple infection to widespread gangrene ( 24 ).…”

Herbal Products and Their Active Constituents for Diabetic Wound Healing—Preclinical and Clinical Studies: A Systematic Review

“…and Gram-positive bacteria (methicillin-susceptible S. aureus , methicillin-resistant S. aureus , β-hemolytic Streptococcus ), and deeply penetrating anaerobes ( Peptostreptococcus spp., Bacteroides spp., Prevotella spp., Clostridium spp.) [ 92 , 93 , 94 , 95 ]. Moreover, diabetic foot infections caused by bacteria such as P. aeruginosa , Escherichia coli , Citrobacter spp., Acinetobacter spp., and Staphylococcus aureus can develop into non-healing chronic wounds.…”