The pH of Wound Fluid in Diabetic Foot Ulcers- the Way Forward in Detecting Clinical Infection?

Abstract

Infections within diabetic foot ulcers are often hard to detect and extremely difficult to treat. The normal signs and symptoms of infection including purulence, erythema, pain, tenderness, warmth and induration are frequently absent in such wounds necessitating exploration of other ways of rapidly and accurately detecting infection. This study considers diabetic wound fluid pH as a possible alternative means of monitoring infection status. CINAHL, Ovid SP and MEDLINE were searched for papers in English published between January 2004 to May 2014. Key search terms included wound fluid, exudate, wound, ulcer, diabetes, pH, healing, infection, bacteria. This paper considers the potential benefits of augmenting and supporting current clinical practice in the early determination of wound healing trajectory and infection status, by monitoring wound fluid pH. The evidence collected highlights the need for further research and suggests the potential of wound fluid analysis as a possible surrogate marker for detecting infection in diabetic foot ulcers.

The quest for tissue repair's holy grail: The promise of wound diagnostics or just another fishing expedition?

“…These studies, among others suggest that lowering the pH of wound fluid might improve healing rates in non-healing wounds [16][17][18]. Modulating the pH level may also be one rapid, accurate, and sensitive method of controlling the infectious bioburden of a chronic wound [15].…”

“…Can we effectively use something else as a diagnostic and clinical indicator for detecting an impending diabetic foot infection, as well as monitor wound healing status? McArdle and colleagues performed a 10-year literature review and evaluated pH of wound fluid in diabetic foot ulcers as one measurable modality in detecting clinical infection [15]. Their review supports early determination of wound infection status by monitoring infection related wound fluid parameters [15].…”

“…McArdle and colleagues performed a 10-year literature review and evaluated pH of wound fluid in diabetic foot ulcers as one measurable modality in detecting clinical infection [15]. Their review supports early determination of wound infection status by monitoring infection related wound fluid parameters [15]. Another study of acute and diabetic foot ulcers classified wounds as either unhealthy, granulating, or healing [16].…”

Stimuli‐Responsive Delivery of Growth Factors for Tissue Engineering

“…[ 9–15 ] As reported in previous studies, tissue injuries lead to site‐dependent environmental changes and abnormal cellular activity. Multiple factors, including enzymes, [ 16–36 ] reduction and oxidation (redox) reactions, [ 37–44 ] hypoxia, [ 32,45–49 ] pH, [ 47,50–54 ] temperature, [ 55–57 ] and the other characteristics, [ 42,58–60 ] become dysregulated at the onset of injury or during the progression of the healing ( Figure A). These hallmarks can be monitored to serve as a reference to evaluate the extent of injury, stage of wound healing, and necessity for treatment.…”

pH-Wert und mikrobielle Infektionen

“…Von besonders großem Nutzen könnte dies bei diabetischen Fußgeschwüren sein, bei denen die üblichen Infektionszeichen oft nicht vorliegen [39]. Ebenso erscheint es sinnvoll, bei der Behandlung nicht heilender chronischer Wunden die Erzeugung eines lokal begrenzten sauren Milieus in Betracht zu ziehen, und einige Studien bescheinigen diesem Vorgehen bereits Nutzen.…”