Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies

Abstract

Diabetic foot ulcers (DFUs) are a serious complication from diabetes mellitus, with a huge economic, social and psychological impact on the patients’ life. One of the main reasons why DFUs are so difficult to heal is related to the presence of biofilms. Biofilms promote wound inflammation and a remarkable lack of response to host defences/treatment options, which can lead to disease progression and chronicity. In fact, appropriate treatment for the elimination of these microbial communities can prevent the disease evolution and, in some cases, even avoid more serious outcomes, such as amputation or death. However, the detection of biofilm-associated DFUs is difficult due to the lack of methods for diagnostics in clinical settings. In this review, the current knowledge on the involvement of biofilms in DFUs is discussed, as well as how the surrounding environment influences biofilm formation and regulation, along with its clinical implications. A special focus is also given to biofilm-associated DFU diagnosis and therapeutic strategies. An overview on promising alternative therapeutics is provided and an algorithm considering biofilm detection and treatment is proposed.

Biofilms in Surgical Site Infections: Recent Advances and Novel Prevention and Eradication Strategies

“…Several antimicrobial compounds have been identified as potential biofilm eradicators, namely antimicrobial peptides (AMPs), EPS-targeting enzymes, antimicrobial lipids, quaternary ammonium compounds (QACs), nitric-oxide-releasing antibiotics, and others [ 8 ]. Nanotechnology-based approaches, predominantly different types of NPs, metal organic frameworks (MOFs), and other nanomaterials, are also amongst the most studied line of attack to deal with pathogenic biofilms [ 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. Natural plant-based products are being developed to help overcome the problem with multidrug-resistant bacteria, namely plant extracts and isolated compounds, as well as essential oils that contain large amounts of phytochemicals [ 33 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ].…”

Leveraging Potential of Nanotherapeutics in Management of Diabetic Foot Ulcer

“…Indeed, 80 % of lower-limb amputations in diabetic patients are preceded by biofilm-infected foot ulceration. Infected wounds result in an increased risk of death within 18 months [19]. The host-microorganism interface plays a major role in DFU development.…”

Self-redox reaction driven in situ formation of Cu2O/Ti3C2Tx nanosheets boost the photocatalytic eradication of multi-drug resistant bacteria from infected wound

“…Antimicrobial resistance (AMR), gave rise to the situation of global health emergency [ 2 ]. Once bacteria come in contact with an exposed wound, they consume nutrients from surrounding and initiate the formation of biofilm at an alarming rate, which is much faster in diabetic patients [ 3 ]. Conventional antibiotics such as streptomycin and vancomycin combat bacterial infections by causing irreparable damage to the bacteria through various mechanisms like inhibition of essential proteins [ 4 ].…”