Bacterial Diversity of Diabetic Foot Ulcers: Current Status and Future Prospectives

Heravi, Fatemah Sadeghpour; Zakrzewski, Martha; Vickery, Karen; Armstrong, David G.; Hu, Honghua

doi:10.3390/jcm8111935

Cited by 79 publications

(69 citation statements)

References 65 publications

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“…Progression of DFIs to more complicated scenarios, such as minor and major amputation of a lower limb occurs every 30 s in the world which can influence the quality of life in many diabetic people worldwide 1 . Identification of pathogenic bacteria is the first essential step to monitor and control the etiology of DFIs accurately (Sadeghpour Heravi et al, 2019). However, a large portion of bacterial species are not culturable using traditional methods (Suryaletha et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

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Metatranscriptomic Analysis Reveals Active Bacterial Communities in Diabetic Foot Infections

et al. 2020

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Despite the extended view of the composition of diabetic foot infections (DFIs), little is known about which transcriptionally active bacterial communities are pertinent to infection, and if any differences are associated with increased infection severity. We applied a RNA sequencing approach to analyze the composition, function, and pathogenicity of the active bacterial communities in DFIs. Taxonomic profiling of bacterial transcripts revealed the presence of 14 bacterial phyla in DFIs. The abundance of the Spiroplasma, Vibrio, and Mycoplasma were significantly different in different infection severities (P < 0.05). Mild and severe stages of infections were dominated by Staphylococcus aureus and Porphyromonas asaccharolytica, respectively. A total of 132 metabolic pathways were identified of which ribosome and thiamin being among the most highly transcribed pathways. Moreover, a total of 131 antibiotic resistance genes, primarily involved in the multidrug efflux pumps/exporters, were identified. Furthermore, iron acquisition systems (synthesize and regulation of siderophores) and pathways involved in the synthesis and regulation of cell-surface components associated with adhesion, colonization, and movement of bacterial cells were the most common virulence factors. These virulence factors may help bacteria compete for scares resources and survive the host wound proteases. Characterization of transcriptionally active bacterial communities can help to provide an understanding of the role of key pathogens in the development of DFIs. Such information can be clinically useful allowing replacement of DFIs empirical therapy with targeted treatment.

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Section: Discussionmentioning

confidence: 99%

“…Identification of pathogenic bacteria is the first essential step to monitor and control the etiology of DFIs accurately ( Sadeghpour Heravi et al, 2019 ). However, a large portion of bacterial species are not culturable using traditional methods ( Suryaletha et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Metatranscriptomic Analysis Reveals Active Bacterial Communities in Diabetic Foot Infections

et al. 2020

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“…low permeability to antibodies and neutrophils) and antibiotics. GBS has been reported as a prevalent microorganism in DFUs (8). However, the most common pathogen in DFU (with or without osteomyelitis) is S. aureus.…”

Section: Discussionmentioning

confidence: 99%

Fatal epidural abscess from diabetic foot disease

Sharma

Thaventhiran

Braggins

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Infection is a common complication of advanced diabetic foot disease, increasing the risk of acute admission and amputation. It is less well-known that foot ulceration and osteomyelitis may cause bacteraemia-associated hematogenous seeding and subsequent epidural abscess formation. Here we describe the case of a 57-year-old woman with known diabetic foot ulcer with underlying osteomyelitis admitted with backpain in the absence of trauma. Her condition deteriorated secondary to overwhelming sepsis. MRI of the spine confirmed spondylodiscitis and posterior epidural collection, not amenable to surgical intervention due to patient’s comorbidities and high surgical risk. Despite prolonged antibiotic therapy, the patient died following a hospital admission lasting 2.5 months. This case highlights the importance of regular contact with diabetes foot service for optimisation and prompt treatment of diabetic foot disease, which can be an underestimated potential source of remote site invasive systemic infection. Secondly, high clinical suspicion in admitting clinicians is imperative in ensuring timely diagnosis and early intervention to minimise fatal consequences. Learning points Approximately 10% of patients with diabetes will develop a foot ulcer in their lifetime. Spondylodiscitis (incorporating vertebral osteomyelitis, spondylitis and discitis) is a rare condition and diabetes is the most common predisposing risk factor. Spondylodiscitis often presents with no other symptom other than back pain. Neurological or infective symptoms can be present or absent. High clinical suspicion in clinicians is imperative in ensuring timely diagnosis and early intervention to minimise devastating consequences.

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“…Additionally, a wound model has shown that when grown in culture together, P. aeruginosa and S. aureus display an enhanced antibiotic tolerance [ 60 ]. Bacteroides fragilis has been reported in several studies as the predominant anaerobic bacteria isolated in DFIs [ 61 – 63 ], and is also important in community dynamics and biological interactions. Mastropaolo et al [ 64 ] demonstrated the effect of polymicrobial infection involving Escherichia coli , Bacteroides fragilis , and Clostridium perfringens in a mouse model of type 2 diabetes.…”

Section: The Dynamic Dfu Microbiomementioning

confidence: 99%

The dynamic wound microbiome

Chun-an

Ponsero

Armstrong

et al. 2020

BMC Med

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Background Diabetic foot ulcers (DFUs) account for the majority of all limb amputations and hospitalizations due to diabetes complications. With 30 million cases of diabetes in the USA and 500,000 new diagnoses each year, DFUs are a growing health problem. Diabetes patients with limb amputations have high postoperative mortality, a high rate of secondary amputation, prolonged inpatient hospital stays, and a high incidence of re-hospitalization. DFU-associated amputations constitute a significant burden on healthcare resources that cost more than 10 billion dollars per year. Currently, there is no way to identify wounds that will heal versus those that will become severely infected and require amputation. Main body Accurate identification of causative pathogens in diabetic foot ulcers is a critical component of effective treatment. Compared to traditional culture-based methods, advanced sequencing technologies provide more comprehensive and unbiased profiling on wound microbiome with a higher taxonomic resolution, as well as functional annotation such as virulence and antibiotic resistance. In this review, we summarize the latest developments in defining the microbiology of diabetic foot ulcers that have been unveiled by sequencing technologies and discuss both the future promises and current limitations of these approaches. In particular, we highlight the temporal patterns and system dynamics in the diabetic foot microbiome monitored and measured during wound progression and medical intervention, and explore the feasibility of molecular diagnostics in clinics. Conclusion Molecular tests conducted during weekly office visits to clean and examine DFUs would allow clinicians to offer personalized treatment and antibiotic therapy. Personalized wound management could reduce healthcare costs, improve quality of life for patients, and recoup lost productivity that is important not only to the patient, but also to healthcare payers and providers. These efforts could also improve antibiotic stewardship and control the rise of “superbugs” vital to global health.

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Bacterial Diversity of Diabetic Foot Ulcers: Current Status and Future Prospectives

Cited by 79 publications

References 65 publications

Metatranscriptomic Analysis Reveals Active Bacterial Communities in Diabetic Foot Infections

Metatranscriptomic Analysis Reveals Active Bacterial Communities in Diabetic Foot Infections

Fatal epidural abscess from diabetic foot disease

The dynamic wound microbiome

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