Diabetic Foot Infections: Update on Management

Nikoloudi, Maria; Eleftheriadou, Ioanna; Tentolouris, Anastasios; Kosta, Ourania; Tentolouris, Nikolaοs

doi:10.1007/s11908-018-0645-6

Cited by 23 publications

(20 citation statements)

References 77 publications

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“…Infections in diabetic foot lesions do not heal well because of factors such as an impaired vascular supply, increased inflammation, metabolic abnormalities, neuroses, and edema [8]. Additionally, the foot has a specific anatomical structure that allows an infection to reach other areas [9, 10]. Therefore, accurate analysis of wound infection is essential for improving the prognosis of diabetic foot as a problematic chronic infectious wound.…”

Section: Introductionmentioning

confidence: 99%

Influence of Microbiota on Diabetic Foot Wound in Comparison with Adjacent Normal Skin Based on the Clinical Features

Park

Lee

et al. 2019

BioMed Research International

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Diabetic foot ulcer (DFU) is a complication experienced by diabetic patients and does not heal well in an altered wound environment. Although diverse microbes in DFU were detected, little is known about their influences on diabetic foot wound (DFW) and the association with the skin microbiota in normal tissue from the same patients according to clinical features. We aimed to analyze the microbiota in normal skin and DFW tissue from the same subject and predict their roles based on clinical features. We analyzed the microbiota in normal skin and DFW tissue from the same subject and compared the associated members of microbiota with clinical parameters. The diversity of skin microbiota was higher than that of DFW tissues, along with compositional differences. In addition, different microbes were associated with clinical features. The proportions of Bacteroidetes, Prevotella, Peptoniphilus, Porphyromonas, and Dialister were higher in the severe groups than of the mild groups, whereas that of Firmicutes was lower in the severe groups. According to wound severity, the microbiota could be related to inflammation, damaging host cell membrane, and pathogenicity through lipopolysaccharide biosynthesis, cellular antigens, and protein digestion metabolism. The predicted DFW microbiota functions according to systemic diabetic status defined by ESRD and HbA1c, differed from those presented by wound severity. Results indicate that the microbiota in normal skin is related to the colonizing microbes in DFW tissue according to clinical features and the different microbes can play important roles in DFW prognosis. This information can be applied to prevent and manage DFW by modulating the microbiota.

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Section: Introductionmentioning

confidence: 99%

Influence of Microbiota on Diabetic Foot Wound in Comparison with Adjacent Normal Skin Based on the Clinical Features

Park

Lee

et al. 2019

BioMed Research International

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“…Moreover, it has also been described that recognition of Pathogen-Associated Molecular Patterns (PAMP) by endogenous Pattern Recognition Receptors (PRR), such as Toll-Like Receptors (TLR), induces increased IL-10 production in the elderly compared with younger adults, increasing their susceptibility to bacterial infections [261][262][263][264][265]. Interestingly, this ability of elder individuals to produce higher levels of IL-10 upon microbial/mitogenic stimulus is shared by neonates and may be due to the increased numbers of B-1 or marginal-zone B lymphocyte sub-populations [261,266,267].…”

Section: Vaccination As a Strategy To Slow Immune Agingmentioning

confidence: 99%

“…Lipid emulsions, analogs of Lipopolysaccharide (LPS) or even agonists of TLR are already being used, inducing very strong immunization responses without the exacerbated peak of inflammation seen with Alum [271][272][273]. Also, bacterial infections, namely those caused by multi-drug resistant strains of Staphylococcus aureus, are known to be responsible for serious complications in diabatic patients [260,267]. Again, a successful new vaccination approach would be the best-case scenario to avoid complications caused by infection, which would decrease the degree of inflammation and, in turn, would also reduce the tendency of a skewed lymphocyte repertoire.…”

Section: Vaccination As a Strategy To Slow Immune Agingmentioning

confidence: 99%

Immune aging in diabetes and its implications in wound healing

Moura

Madureira

Leal

et al. 2019

Clinical Immunology

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Immune systems have evolved to recognize and eliminate pathogens and damaged cells. In humans, it is estimated to recognize 10 9 epitopes and natural selection ensures that clonally expanded cells replace unstimulated cells and overall immune cell numbers remain stationary.But, with age, it faces continuous repertoire restriction and concomitant accumulation of primed cells. Changes shaping the aging immune system have bitter consequences because, as inflammatory responses gain intensity and duration, tissue-damaging immunity and inflammatory disease arise.During inflammation, the glycolytic flux cannot cope with increasing ATP demands, limiting the immune response's extent. In diabetes, higher glucose availability stretches the glycolytic limit, dysregulating proteostasis and increasing T-cell expansion. Long-term hyperglycemia exerts an accumulating effect, leading to higher inflammatory cytokine levels and increased cytotoxic mediator secretion upon infection, a phenomenon known as diabetic chronic inflammation.Here we review the etiology of diabetic chronic inflammation and its consequences on wound healing.

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“…De acordo comNikoloudi et al (2018), existem cinco pontos básicos de prevenção de complicações dos MMII, sendo eles: inspeção dos pés e dos calçados; identificação do paciente de alto risco; educação do paciente, da família e dos profissionais de saúde; uso de calçados apropriados e tratamento de alterações, tais como calos e infecções fúngicas de unhas. O cuidado com os pés é capaz de evitar diversos agravos e eventos estressantes, pois o impacto causado reflete em incapacitações físicas e sociais, dor, perda na qualidade de vida e ansiedade (SILVA et al, 2015).É importante destacar que o autocuidado deve ser despertado no indivíduo com diagnóstico de DM, sensibilizando-o para sua importância, e isso deve partir inicialmente dos profissionais de saúde envolvidos no tratamento, sobretudo o enfermeiro, que exerce a função profissional de orientador e educador, para favorecer o interesse por práticas de autocuidado e, consequentemente, a prevenção de maiores agravos evitáveis (NEHRING et al, 2014).Kaya et al (2018) destacam que o uso constante de calçados confortáveis é considerado como fator indispensável para a prevenção de lacerações nos pés.…”

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