Microbiological effects in patients with leg ulcers and diabetic foot treated with Lucilia sericata larvae

Abstract

Lucilia sericata bottle fly worms can be used to heal infected, chronic, or necrotic wounds, including those associated with ulceration and diabetic foot.The study aimed to evaluate changes in the microflora in patients treated with L sericata larvae due to leg ulcers and diabetic foot. One hundred twenty-nine patients diagnosed with lower limb ulceration and diabetic foot were enrolled in the study, of which 80 of them met the eligibility criteria for maggot debridement therapy (MDT). On the contrary, 49 unqualified patients were offered ozone therapy (22 with leg ulcers; 27 with diabetic foot). In each of these patients, a microbiological swab was performed before and after the start of therapy. The group of 80 patients was further divided into four equal groups in terms of the treated area (lower leg vs foot) and the number of larvae/cm 2 (5 vs 10). Twenty-three particular species of bacteria in the infected wound were studied microbiologically in terms of presence/absence within the wound environment before and after treatment of patients with diabetic foot and lower limb ulceration. It was noted that there was a more intensive bacterial accumulation in the feet of patients compared to legs; furthermore, this applies to almost all analysed species. Diabetes status is also a clinical factor that generates a lower chance of bacterial appearance in the wound environment. Densification of MDT larvae per wound area unit also reduced the chance of the presence of Corynebacterium species, Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus MSSA, and Streptococcus coagulase negativa; however, it increased the likelihood of occurrence for Proteus mirabilis and the Proteus species. A microbiological analysis in this non-reference study shows the efficacy of larval therapy for leg and foot ulcers. Rearrangement of the microflora within the wound has been reported as a result of the therapy.

Effectiveness of broad‐spectrum antiseptics in production of disinfected maggots of Lucilia sericata for use in wound debridement therapy

“…Commensal bacteria such as P. mirabilis are frequently isolated from L. sericata larvae 49 . P. mirabilis has been identified in diabetic foot ulcers after treatment of patients with medicinal maggots and attributed to L. sericata larval secretions released into the wounds 50 . This commensal bacterium has the ability to survive the fly's complex anti‐bacterial defence system; hence, a symbiotic association has been suggested 26 .…”

“…This commensal bacterium has the ability to survive the fly's complex anti‐bacterial defence system; hence, a symbiotic association has been suggested 26 . It has also been suggested that P. mirabilis has a beneficial role, because it contributes to the success of MDT 50 . It has been demonstrated that compounds called ‘mirabilicides’, produced by P. mirabilis , destroy bacteria and fungi such as B. subtilis and C. albicans 51 .…”

“…26 It has also been suggested that P. mirabilis has a beneficial role, because it contributes to the success of MDT. 50 It has been demonstrated that compounds called 'mirabilicides', produced by P. mirabilis, destroy bacteria and fungi such as B. subtilis and C. albicans. 51 Moreover, P. mirabilis can change the pH of a wound, eliminating other bacteria, including S. aureus.…”

“…49 P. mirabilis has been identified in diabetic foot ulcers after treatment of patients with medicinal maggots and attributed to L. sericata larval secretions released into the wounds. 50 This commensal bacterium has the ability to survive the fly's complex anti-bacterial defence system; hence, a symbiotic association has been suggested. 26 It has also been suggested that P. mirabilis has a beneficial role, because it contributes to the success of MDT.…”

Larvotherapy in the Treatment of Difficult-to-Heal Lesions: Integrative Review

“…Among the types of injury most cited by the studies analyzed, diabetic foot, venous ulcer and pressure injury were the main indications found, when it comes to etiology [16][17][18][19][21][22][23][24][25] . In addition, larval therapy was also highly oriented in cases of infected and/or necrotic wounds 16,17,19,21,25 .…”