Current Therapeutic Strategies in Diabetic Foot Ulcers

Aim: This study was carried out on patients with diabetic foot ulcer (DFU) to assess the clinical characteristics, spectrum of microbial flora, antibiotic sensitivity, and devise an empiric antimicrobial therapy. Material Methods: Clinical data and tissue samples were collected from 105 diabetic foot ulcer patients between December 2018 and November 2019. The collected samples were processed as per Clinical and Laboratory Standards Institute guidelines and clinical and microbiological data was analyzed. Results: In this study of 105 patients, DFU was most common in males in 5 th and 6 th decade of life. Majority of patients had poor glycemic control and neuropathy. Of 110 bacterial isolates obtained from 97 samples, 73.7% were Gram-negative bacteria, and 27.3% were Gram-positive. Most of samples (48.6%) showed growth of single bacteria, growth of two bacteria and polymicrobial growth was seen in 28.6% and 15.2% of tissue samples respectively of which. Pseudomonas was predominant isolate (27.3%) sensitive to imipenem (90%), amikacin (86.6%), gentamicin (83.3%), and cefotaxime (80%) followed by Staphylococcus aureus (19.1%) sensitive to amikacin and gentamicin (100%), and ofloxacin (90%). Pseudomonas, E. coli, Proteus and Klebsiella were highly resistant to ampicillin and amoxicillin-clavulanic acid. Conclusion: This study showed DFU are common in 5 th and 6 th decades of life. Gram-negative bacteria are predominant infective organism. Most of both Gram-negative and Gram-positive bacteria are resistant to variable degrees to commonly used antibiotics and sensitive to aminoglycosides. Amikacin and gentamicin can be used as empiric antibiotics for treatment of DFU infections.

show abstract

“…[ 18 ] which is consistent with higher prevalence of Gram-negative pathogens in low income countries as reported by Perez-Fevila et al . [ 29 ]…”

Section: Discussionmentioning

confidence: 99%

A study on diabetic foot ulcers in Central rural India to formulate empiric antimicrobial therapy

Singh

Yeola

Singh

et al. 2020

J Family Med Prim Care

View full text Add to dashboard Cite

show abstract

“…Adequate care for DFUs should include a focus on appropriate wound debridement, infection control, relieving pressure while standing or walking, and optimizing blood flow. With technological advancement, a series of advanced therapies have been implemented, such as bioengineered skin substitutes, negative pressure wound therapy, and the development of new wound dressings [ 92 ]. Though these treatments have provided encouraging results, most of them are expensive, and some even have significant side effects that often result in non-compliance.…”

Section: Mcs-related Diabetic Wound Therapymentioning

confidence: 99%

Mast Cells in Diabetes and Diabetic Wound Healing

et al. 2020

View full text Add to dashboard Cite

Mast cells (MCs) are granulated, immune cells of the myeloid lineage that are present in connective tissues. Apart from their classical role in allergies, MCs also mediate various inflammatory responses due to the nature of their secretory products. They are involved in important physiological and pathophysiological responses related to inflammation, chronic wounds, and autoimmune diseases. There are also indications that MCs are associated with diabetes and its complications. MCs and MC-derived mediators participate in all wound healing stages and are involved in the pathogenesis of non-healing, chronic diabetic foot ulcers (DFUs). More specifically, recent work has shown increased degranulation of skin MCs in human diabetes and diabetic mice, which is associated with impaired wound healing. Furthermore, MC stabilization, either systemic or local at the skin level, improves wound healing in diabetic mice. Understanding the precise role of MCs in wound progression and healing processes can be of critical importance as it can lead to the development of new targeted therapies for diabetic foot ulceration, one of the most devastating complications of diabetes.

show abstract

“…Diabetes undermines skin cells physiology and progressively intoxicates the dermal layer by the accumulation of advanced glycation end products (AGEs) and free radicals derivatives ( 21 – 23 ). Accordingly, most if not all of the events encompassed within the cutaneous healing process including hemostasis, inflammation, matrix deposition, angiogenesis, contraction, remodeling, and re-epithelialization are somewhat buffeted by diabetes ( 20 , 24 ). Aside from the impaired healing response, a parallel dark arista of diabetic ulcer pathology is the high rate of ulcer recidivism after the primary wound closure ( 25 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

Cellular Senescence as the Pathogenic Hub of Diabetes-Related Wound Chronicity

et al. 2020

View full text Add to dashboard Cite

Diabetes is constantly increasing at a rate that outpaces genetic variation and approaches to pandemic magnitude. Skin cells physiology and the cutaneous healing response are progressively undermined in diabetes which predisposes to lower limb ulceration, recidivism, and subsequent lower extremities amputation as a frightened complication. The molecular operators whereby diabetes reduces tissues resilience and hampers the repair mechanisms remain elusive. We have accrued the notion that diabetic environment embraces preconditioning factors that definitively propel premature cellular senescence, and that ulcer cells senescence impair the healing response. Hyperglycemia/oxidative stress/mitochondrial and DNA damage may act as major drivers sculpturing the senescent phenotype. We review here historical and recent evidences that substantiate the hypothesis that diabetic foot ulcers healing trajectory, is definitively impinged by a self-expanding and self-perpetuative senescent cells society that drives wound chronicity. This society may be fostered by a diabetic archetypal secretome that induces replicative senescence in dermal fibroblasts, endothelial cells, and keratinocytes. Mesenchymal stem cells are also susceptible to major diabetic senescence drivers, which accounts for the inability of these cells to appropriately assist in diabetics wound healing. Thus, the use of autologous stem cells has not translated in significant clinical outcomes. Novel and multifaceted therapeutic approaches are required to pharmacologically mitigate the diabetic cellular senescence operators and reduce the secondary multi-organs complications. The senescent cells society and its adjunctive secretome could be an ideal local target to manipulate diabetic ulcers and prevent wound chronification and acute recidivism. This futuristic goal demands harnessing the diabetic wound chronicity epigenomic signature.

show abstract

Current Therapeutic Strategies in Diabetic Foot Ulcers

Cited by 125 publications

References 141 publications

A study on diabetic foot ulcers in Central rural India to formulate empiric antimicrobial therapy

A study on diabetic foot ulcers in Central rural India to formulate empiric antimicrobial therapy

Mast Cells in Diabetes and Diabetic Wound Healing

Cellular Senescence as the Pathogenic Hub of Diabetes-Related Wound Chronicity

Contact Info

Product

Resources

About