Infected diabetic foot ulcers decision making

NewsBot · Jan 11, 2025

Microbiology and Antimicrobial Resistance Profile in Patients with Diabetic Foot Sepsis at a Central Hospital in Johannesburg, South Africa
Simran Patel et al
Diagnostics (Basel). 2024 Dec 26;15(1):32.

Background: Diabetic foot sepsis (DFS) is the leading cause of lower extremity amputations and timely initiation of effective antimicrobial therapy is paramount during its management. This study investigated causative microorganisms and their antimicrobial susceptibility profile in patients with DFS. Materials and Methods: A retrospective review was conducted on patients who were 18-years and older admitted with DFS. Data collected included demographic information, comorbidities, clinical findings, types of specimens collected and results of microscopy, culture, and sensitivity (MC&S), treatment, and outcomes. Results: One hundred and sixty-eight records were found, of which 64.3% were of male patients. The median (IQR) age of males was 58 years (IQR 54-65) compared to 61 years (IQR 54-67) for females. Results of MC&S were available in 63.1% of the records, and E. faecalis was cultured in 16%, P. mirabilis in 10%, and S. aureus in 8% of cases. Amoxicillin/Clavulanic acid was prescribed in 69% of the cases. Resistance to at least one antimicrobial was shown in 88% of S. aureus and 80% of P. mirabilis species. Conclusions: The commonly cultured organisms in patients with DFS were E. faecalis 16%, P. mirabilis 10%, and S. aureus. Amoxicillin/Clavulanic was prescribed empirically in 69% of the cases despite high rates of resistance, and in 37% treatment was not preceded by collection of specimens for MC&S. We therefore recommend collection of specimens for MC&S before initiation of antimicrobial therapy in all patients with DFS.
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NewsBot · Jan 27, 2025

Diabetic foot infections in internal medicine services in spain (2018-2022)
C Fuentes Santos et al
Rev Clin Esp (Barc). 2025 Jan 24:S2254-8874(25)00010-4.

Introduction: Diabetic foot infections represent a common and serious complication of diabetes mellitus, with a wide range of clinical presentations. Despite their significance, uncertainties persist regarding their management and impact on Internal Medicine services.

Materials and methods: A retrospective cohort study was conducted using data from the Registry of Specialized Healthcare Activity (RAE-CMBD) over a five-year period (2018-22). Patients discharged from Internal Medicine with a diagnosis of diabetic foot were included. Demographic, clinical, and activity data were collected, and the cumulative incidence of diabetic foot, in-hospital mortality, need for amputation, and associated costs of hospitalization were analyzed.

Results: 15402 episodes with a diagnosis of diabetic foot were identified, representing 0.41% of Internal Medicine, which implies an age-adjusted incidence rate of between 2 and 3 cases per 1000 admissions in these services. These patients had a high in-hospital mortality rate (16%) and a significant percentage required amputation (8.25%). Advanced age, the presence of comorbidities, and complications during admission were associated with a higher risk of mortality and amputation. The average cost per admission is over €6000.

Conclusions: Diabetic foot is a pathology with a high impact on Internal Medicine services, both due to the volume of activity and the high mortality and cost generated by this condition.
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NewsBot · Feb 11, 2025

A systematic review and meta-analysis of randomized controlled trials of systemic antibiotics for diabetes-related foot infections
Mei-Chuan Lee et al
Diab Vasc Dis Res. 2025 Jan-Feb;22(1):14791641241311293.

Objective: Diabetes-related foot infections (DFIs) are prevalent in patients with diabetes mellitus, often leading to severe complications, including amputations. This study aims to assess the efficacy and safety of systemic antibiotics in DFI treatment.

Research design and methods: A systematic review was conducted by searching PubMed, Cochrane databases, and Embase for randomized controlled trials up to August 4, 2024, evaluating the clinical efficacy of systemic antibiotics for DFIs. Primary outcomes were clinical efficacy and safety, comparing different antibiotic classes to penicillins. Subgroup analysis was based on DFI severity.

Results: Of 24 studies, 16 were included in the meta-analysis. Linezolid showed a potential efficacy advantage over penicillins for DFIs but had more adverse effects. Clinical efficacy and safety were comparable across carbapenems and quinolones versus penicillins. Ertapenem showed no significant difference from piperacillin/tazobactam in treating moderate or severe DFIs.

Conclusion: In conclusion, while linezolid may offer a potential efficacy advantage over penicillins in treating DFIs, it is associated with a higher risk of drug-related adverse effects. Penicillins demonstrate comparable clinical efficacy and safety to carbapenems and fluoroquinolones for DFI management. For moderate to severe DFIs, piperacillin/tazobactam and ertapenem are viable options, though treatment should be guided by local antimicrobial resistance patterns.
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NewsBot · Apr 23, 2025

Bacteriological Profile of Diabetic Foot Ulcer With Special Reference to Biofilm Formation
Nitya Tirumala et al
Cureus. 2025 Mar 21;17(3):e80974.

Introduction Diabetes mellitus is a metabolic disorder characterized by abnormally high sugar levels in the blood for prolonged periods of time. The world's largest number of diabetics resides in India, making it the world's diabetic capital, with a diabetic foot ulcer (DFU) incidence of around 8-17%. Due to the polymicrobial and multidrug resistant (MDR) nature of DFUs, antimicrobial susceptibility testing is of high importance to help treat patients effectively and prevent the development of MDR bacteria. The ability to form biofilms is a significant additive to virulence of an organism that causes an able strain to be resistant to more antibiotics as compared to a free-living strain, thereby further delaying the healing of DFUs. Materials and methods This study included 74 samples collected from patients with DFUs, out of which 69 (93.24%) yielded growth on culture. Gram staining was done for the direct microscopy, isolation, and determination of organism, and the detection of biofilm formers using Congo Red Agar plates. Data were tabulated and statistically analyzed. Results Out of 74 samples collected, 69 (93.24%) yielded growth on culturing, with 5 (6.76%) cultures coming back negative. On Gram staining, 42 (56.8%) samples showed Gram-positive cocci and 53 (71.6%) showed Gram-negative bacilli. On isolating organisms from the samples, 16 (21.7%) samples had Pseudomonas aeruginosa, followed by Klebsiella pneumoniae at 13 (17.6%) and Proteus mirabilis and Escherichia coli at 11 each (14.9%), indicating a Gram-negative bacteria predominance. Of the Gram-positive bacteria isolated, Staphylococcus aureus stands at two (2.7%) and Streptococcus pyogenes at one (1.4%). The prevailing monomicrobiality could be attributed to antibiotic administration prior to sample collection. On antibiotic sensitivity of organisms tested against each antibiotic, more than 75% of tested samples were resistant to ampicillin, cefuroxime, and erythromycin, and around 70% and more of tested samples were sensitive to ertapenem, meropenem, amikacin, gentamicin, benzylpenicillin, vancomycin, and clindamycin. Out of the 69 positive cultures, 29 (42.03%) yielded biofilm formers. Pseudomonas aeruginosa was the predominant biofilm former with 10 (34.48%) of 29 of total biofilm-forming isolates, followed by E. coli and K. pneumoniae with five each (17.24%) and Proteus mirabilis with three samples (10.34%). Regarding strains forming biofilms according to bacterium species, S. aureus was predominant, with 100% (two out of two samples) of isolates forming biofilms. Staphylococcus aureus was followed by Pseudomonas aeruginosa with 62.5% (10 out of 16 samples), Acinetobacter baumannii (two out of four samples) and Enterobacter cloacae (one out of two samples) with 50% each, E. coli with 45.45% (5 out of 11 samples), and K. pneumoniae with 38.46% (5 out of 13 samples) of isolates forming biofilms. It should be noted that only two S. aureus, four A. baumannii, and two Enterobacter cloacae samples were isolated in comparison to a larger number of Gram-negative bacteria. This study has found that 100% of multidrug-resistant organisms (MDROs) are biofilm formers. Conclusion The ability to form biofilms adds immensely to the virulence and antibiotic resistance. Detection of biofilm formers is non-invasive and convenient to measure and would help provide insight into antibiotics to be administered to the patient, thereby reducing development of MDROs and reducing healing time.
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NewsBot · May 24, 2025

Antibacterial Properties of Polymeric Membranes Containing Doxycycline for Potential Applications in Foot Ulcer Treatment
Stevaly Pérez-Gutiérrez et al
Int J Mol Sci. 2025 Apr 1;26(7):3274.

Membranes made from biopolymers and loaded with doxycycline were investigated for potential use in the treatment of foot ulcers in diabetic patients. Carboxymethylcellulose (CMC) and chitosan (CHS) membranes were fabricated with 7% glycerol and 1% doxycycline (DOX). Their mechanical and physical properties, biocompatibility, and antimicrobial effects were thoroughly evaluated. The results demonstrated effective antibacterial activity against S. aureus and S. mutans. Based on the mechanical, physical, and hemolytic data, DOX-loaded CMC/CHS/G membranes show promise as a topical wound delivery system.
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NewsBot · Jun 5, 2025

Risk factors affecting the development of adverse outcomes in patients with diabetic foot infection
Rukiye İnan Sarikaya, Ömer Karaşahin
J Infect Dev Ctries. 2025 Apr 29;19(4):520-527

Introduction: Diabetic foot infection (DFI) can result in lower extremity amputation and death in patients with diabetes and is an important cause of morbidity and mortality. The purpose of this study was to identify predictive factors for adverse outcomes consisting of major lower extremity amputation and mortality in patients with DFI.

Methodology: One hundred and two patients diagnosed with DFI and followed up in a tertiary hospital between November 2022 and April 2023 were included in this prospective study. Demographic and diabetic foot characteristics at the time of presentation, degrees of DFI, and clinical and laboratory findings of all patients were recorded. Major amputation and/or mortality were regarded as adverse outcomes. The patients were followed up throughout hospitalization until discharge or mortality. Risk factors for adverse outcomes were identified using univariate and multivariate logistic regression analyses.

Results: The median age of the patients was 60.0 years, and the majority (72.5%) were men. Adverse outcomes developed in 11 patients during follow-up. The factors linked to adverse outcomes included fever; wound necrosis; isolation of Enterobacteriaceae species in wound culture; perfusion, extent, depth, infection, and sensation (PEDIS) grade 4; and blood urea nitrogen (BUN) elevation. Following multivariate logistic regression analysis, only BUN > 31 mg/dL and presence of necrosis emerged as significant independent predictive factors for adverse outcomes.

Conclusions: The findings show that the above factors may be useful in predicting adverse outcomes in patients with DFI. Early detection of these factors may be useful in preventing morbidity and mortality in these patients.
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NewsBot · Jun 26, 2025

In Vivo Antimicrobial Activity of Nisin Z Against S. aureus and Polyurea Pharmadendrimer PUREG4OEI48 Against P. aeruginosa from Diabetic Foot Infections
Isa Serrano et al
Antibiotics 2025, 14(5), 444; https://doi.org/10.3390/antibiotics14050444

Background/Objectives: Diabetic foot infections (DFIs) are commonly associated with frequent hospitalizations, limb amputations, and premature death due to the profile of the bacteria infecting foot ulcers. DFIs are generally colonized by a polymicrobial net of bacteria that grows in biofilms, developing an increased antimicrobial resistance to multiple antibiotics. DFI treatment is a hurdle, and the need to develop new therapies that do not promote resistance is urgent. Therefore, the antibacterial efficacy of Nisin Z (antimicrobial peptide), a core–shell polycationic polyurea pharmadendrimer (PUREG4OEI48) (antimicrobial polymer), and amlodipine (antihypertensive drug) was evaluated against S. aureus and P. aeruginosa isolated from a DFI and previously characterized. Methods: The antibacterial activity was analyzed in vitro by determining the minimal inhibitory concentration (MIC) and in vivo in a Galleria mellonella model by assessing the larvae survival and health index. Results: The results indicate that Nisin Z exhibited antibacterial activity against S. aureus in vivo, allowing larvae full survival, and no antibacterial activity against P. aeruginosa. Nisin Z may have reduced the antibacterial effectiveness of both PUREG4OEI48 and amlodipine. PUREG4OEI48 significantly increased the survival of the larvae infected with P. aeruginosa, while amlodipine showed no activity against both bacteria in vivo. Conclusions: These findings suggest that both Nisin Z and PUREG4OEI48 could potentially be used individually as adjunct treatments for mild DFIs. However, further studies are needed to confirm these findings and assess the potential toxicity and efficacy of PUREG4OEI48 in more complex models.
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NewsBot · Jul 4, 2025

Characterization of pathogenic microorganisms in diabetic foot infections and development of a risk prediction model
Shufang Yan et al
Sci Rep. 2025 Jul 2;15(1):23553.

This study aimed to investigate the distribution of pathogenic microorganisms in diabetic foot infections (DFIs) and develop a nomogram to predict DFIs. It included 136 diabetic foot (DF) patients hospitalized at Henan University Huaihe Hospital from November 2020 to November 2024, with 86 (63.23%) having confirmed infections. Infections were predominantly caused by Gram-positive cocci (54.65%) and Gram-negative bacilli (43.02%). The nomogram incorporated age, C-reactive protein (CRP), Wagner grade, lower extremity arterial disease (LEAD), and peripheral neuropathy (PN). The predictive model exhibited robust discriminatory capacity, achieving an area under the curve (AUC) of 0.803 (95% confidence interval (CI) 0.735-0.878) with internal cross-validation stability (AUC = 0.804). Goodness-of-fit was confirmed by the Hosmer-Lemeshow test (χ2 = 5.014, p = 0.756), with excellent net benefit shown by decision curve analysis. Our findings indicate a high infection rate in DF patients, mainly caused by Gram-positive cocci. The nomogram incorporating age, CRP, Wagner grade, LEAD, and PN parameters enables rapid DFIs screening, facilitating timely antibiotic initiation through early infection detection to enhance clinical management.
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NewsBot · Jul 5, 2025

Characterization of pathogenic microorganisms in diabetic foot infections and development of a risk prediction model
Shufang Yan, Xuemeng Zhu, Tong Yu, Dandan Li, Su Li & Lei Xue
Scientific Reports volume 15, Article number: 23553 (2025)

This study aimed to investigate the distribution of pathogenic microorganisms in diabetic foot infections (DFIs) and develop a nomogram to predict DFIs. It included 136 diabetic foot (DF) patients hospitalized at Henan University Huaihe Hospital from November 2020 to November 2024, with 86 (63.23%) having confirmed infections. Infections were predominantly caused by Gram-positive cocci (54.65%) and Gram-negative bacilli (43.02%). The nomogram incorporated age, C-reactive protein (CRP), Wagner grade, lower extremity arterial disease (LEAD), and peripheral neuropathy (PN). The predictive model exhibited robust discriminatory capacity, achieving an area under the curve (AUC) of 0.803 (95% confidence interval (CI) 0.735–0.878) with internal cross-validation stability (AUC = 0.804). Goodness-of-fit was confirmed by the Hosmer–Lemeshow test (χ2 = 5.014, p = 0.756), with excellent net benefit shown by decision curve analysis. Our findings indicate a high infection rate in DF patients, mainly caused by Gram-positive cocci. The nomogram incorporating age, CRP, Wagner grade, LEAD, and PN parameters enables rapid DFIs screening, facilitating timely antibiotic initiation through early infection detection to enhance clinical management.
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NewsBot · Jul 15, 2025

Bacteriological profiles of diabetic ulcers in cases of major limb amputation: insights from Solomon Islands
Maguire E Anuszewski et al
J Wound Care. 2025 Jul 1;34(Sup7):S13-S22. doi: 10.12968/jowc.2025.0201.

Objective: Solomon Islands, a Western Pacific nation, faces a growing burden of type II diabetes amid chronic healthcare shortages. Surgeons report increased incidence of diabetic amputations; however, data on infection rates and pathology remain scarce. This study describes the microbiology of diabetic ulcers in cases of major limb amputation.

Method: Demographic, microbiological and outcome data were extracted from records of patients with diabetes who underwent major limb amputation from 2018-2023 in Solomon Islands.

Results: Among 356 adults who underwent major limb amputation, microbiological data were available for 113 (32%). Pus and tissue cultures identified 20 bacterial species-predominantly Pseudomonas aeruginosa (n=27; 24%), mixed enteric organisms (n=25; 23%) and Klebsiella pneumoniae (n=18; 16%). Meticillin-resistant Staphylococcus aureus was identified in one patient. Antibiotic resistance was observed in 62 (55%) cultures, with the highest resistance rates against: ampicillin (31 cases); amoxicillin (31 cases); gentamicin (21 cases); and trimethoprim/sulfamethoxazole (21 cases). Escherichia coli, Klebsiella pneumoniae and Enterococcus spp. were significantly associated with resistance.

Conclusion: The bacterial diversity and high resistance rates identified in this study are concerning given limited access to next-generation antibiotics in Solomon Islands. Further research is needed to evaluate infection management, resistance drivers and clinical outcomes of antibiotic-resistant infections in Solomon Islands.
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NewsBot · Jul 23, 2025

BACTERIOLOGICAL PROFILE AND ANTIMICROBIAL SUSCEPTIBILITY IN DIABETIC FOOT ULCER PAITIENTS
Sumayya Aziz et al
Vol. 2 No. 1 (2025): Journal of Medical & Health Sciences Review

Diabetic foot ulcers (DFUs) affect 5-10% of diabetic patients and often arise from neuropathy, vascular insufficiency, and impaired immunity, complicating wound healing. Recurrence risk factors include gender, smoking, diabetes duration, prior ulceration, peripheral artery disease, and painful diabetic neuropathy. DFUs are frequently colonized by polymicrobial infections, with increasing antimicrobial resistance complicating treatment. Hospital-based studies show higher prevalence rates of DFUs compared to population-based studies, with a notable prevalence in male patients and those with type 2 diabetes mellitus. This study aimed to determine the frequency of bacterial infections and evaluate antimicrobial susceptibility patterns in DFUs at a tertiary care hospital in Rawalpindi. A cross-sectional study over six months September 2024-Feburary 2025 involved collecting tissue samples (n=225) from DFU patients. Bacterial cultures were analyzed using standard microbiological techniques, and antibiotic susceptibility was tested via the Kirby-Bauer method. Among the 225 samples, 170 were from males, with a mean age of 56.4 years. The microbial profile revealed a polymicrobial composition, predominantly Pseudomonas aeruginosa (24.9%) and E. coli (21.5%) as the most common gram-negative pathogens, while Staphylococcus aureus (21.5%) was the most prevalent gram-positive pathogen. Antibiotic susceptibility testing indicated Pseudomonas aeruginosa had high sensitivity to Tobramycin (60.9%) and Ciprofloxacin (60%), but resistance to Cefixime (64.7%). E. coli showed high responsiveness to piperacillin-tazobactam (91.8%) and resistance to tetracycline (83%). Staphylococcus aureus exhibited sensitivity to Tobramycin (70.6%) but resistance to tetracycline (58.8%). The findings highlight the diverse microbial environment and antimicrobial resistance in DFUs, emphasizing the need for susceptibility testing to guide effective therapy and tailored management strategies for improved treatment outcomes.
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NewsBot · Jul 23, 2025

Antimicrobial management of complex biofilms in diabetic foot ulcers: a microbiological perspective
Manuela Oliveira et al
Expert Rev Anti Infect Ther. 2025 Jul 23.

Introduction: Diabetic foot ulcers (DFUs) are a significant health concern, often complicated by biofilm formation which delays healing and increases the risk of diabetic foot infections (DFIs). Effective management of complex biofilms is crucial for improving patient outcomes and reducing the risk of amputation and premature death.

Areas covered: This review summarizes the current state of microbiological research on DFIs, focusing on bacterial populations, biofilm interactions, and their role in antibiotic resistance development, being based on a PubMed search from 1975 to 2025. It also explores recent advances in antimicrobial therapies, including phage therapy, antimicrobial peptides, and other novel treatments.

Expert opinion: Antimicrobial stewardship, broader access to medical resources, and improved sanitation are essential to diminish the impact of diabetes on healthcare systems. Furthermore, the development of a rapid tool to detect antibiotic-tolerant cells is fundamental to avoid DFIs relapse. The biofilms dynamics and the dual relationship between biofilms and the immune system should be further understood. While traditional antibiotics are essential to treat DFIs, a multi-combinatorial strategy combining conventional compounds with alternative therapies should be more effective to overcome resistance and promote wound healing in DFUs.
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NewsBot · Jul 27, 2025

A Molecular Investigation for Staphylococcus aureus in Diabetic Foot Ulcers
Sagia Abbas Gibar Aifari
Source

In Iraq, the high incidence and recurrence rates of diabetic foot ulcers (DFUs) underscore the need for a multifaceted approach to prevention and management. The study aims to direct molecularly detection of the prevalence of S. aureus among DFUs patients using molecular assay and then nucleotide sequencing of some local S. aureus isolates to be documented in the NCBI and identify its association with the GenBank-BLAST S. aureus isolates. Distribution of infection among the age and sex of the study population in addition to the type of medication(s) was also aimed. After disinfecting the skin surrounding the ulcer, pus samples were collected from 73 DFU patients using sterile swabs that were examined molecularly by the PCR assay. DNAs of some positive samples were sequenced and analysed phylogenetically. Targeting the 16S rRNA gene, 20.55% of DFU swabs had positive reactivity to S. aureus. Concerning age, significantly higher prevalence and risk of S. aureus were shown in patients aged ≥61 years old and to a lesser extent among 51- 60 years old when compared to other age groups: 41-50 and ≤40 years old. For sex, although no significant variation was seen among females and males, risk values revealed that males were at higher risk of S. aureus infection than females. Regarding the type of medication, DFU patients who received injectable medication have significantly higher values of prevalence rate and risks than those of oral and mixed medications. In relation to phylogeny, the sequenced data of six local S. aureus strains were submitted in the NCBI database under specified names (DFU1-DFU6) and GenBank IDs (PQ318365.1- PQ318370.1). The findings of phylogenetic tree analysis, homology sequence identity, and NCBI MSA viewer demonstrated that the local S. aureus strains were related to the NCBI-BLAST Iraqi isolate (LC576397.1) at an identity rate ranged from 98.65% to 99.79% and mutation/change at 0.02%. This study confirms, for the first time in Iraq, the phylogenetic linkage of S. aureus isolated from DFU patients to the NCBI-GenBank S. aureus isolates. This study also shows significant differences in prevalence rates and risks of S. aureus among various age and sex groups as well as among DFU patients who received different medications. Therefore, establishing the underlying causes of diabetes and developing effective interventions to prevent and manage its associated complications are crucial steps toward reducing the burden of this widespread disease. Additionally, the high incidence and recurrence rates of DFU underscore the need for a multifaceted approach to prevention and management.
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NewsBot · Jul 31, 2025

Microbiology of Diabetic Foot Infections in U.S. Veterans
Rebecca Winski et al
Clin Diabetes. 2025 Jan 29;43(3):366-370. doi: 10.2337/cd24-0086

This study examined the prevalence of various microbes isolated from diabetes-related foot infections (DFIs) within the U.S. veteran population. A total of 68 different microbes were identified. The most frequently isolated organisms were methicillin-sensitive Staphylococcus aureus (32.7%), coagulase-negative staphylococci (21.8%), methicillin-resistant S. aureus (15.9%), Enterococcus faecalis (14.6%), group B streptococci (12.4%), Pseudomonas aeruginosa (10.1%), Proteus mirabilis (8.1%), viridans streptococci (7.3%), Escherichia coli (6.5%), Enterobacter cloacae (5.9%), and Corynebacterium species (5.6%). A better understanding of common DFI pathogens may help to guide empiric antibiotic selection when treating DFIs.
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NewsBot · Aug 2, 2025

Bacterial profile and antimicrobial resistance in diabetic foot ulcer infections: a 10-year retrospective cohort study
Roberto Zambelli et al
Braz J Infect Dis. 2025 Jul 31;29(5):104570.

Introduction: Diabetic Foot Infections (DFI) are severe complications of diabetes, often resulting in poor clinical outcomes, including amputations. The objective of this study is to identify the main pathogens causing infections in the diabetic foot ulcers, as well as the antibiotic resistance profile.

Methods: This study included all patients treated for diabetic foot infections at a private tertiary hospital between 2013 and 2022. Demographic data, including age, sex, Body Mass Index (BMI), and the level of amputation were extracted from electronic medical records and collected for all patients. Microbiological and resistance patterns were evaluated following standardized protocols. Cases with incomplete demographic or microbiological data were excluded.

Results: This retrospective cohort study analyzed data from 459 diabetic patients, among them, 337 patients with positive cultures were included, resulting in 507 culture results from surgical samples. Gram-negative bacteria accounted for 55.2 % of isolates, with Enterobacterales (41 %) and non-fermenters (14.2 %) being most prevalent. Proteus sp. (10.3 %) and Escherichia coli (8.3 %) were the most common Gram-negative organisms, with significant resistance to ESBL (15.4 %) and quinolones (29.3 %). Among Gram-positive cocci (43.6 %), Staphylococcus aureus (16.8 %) showed 21.1 % methicillin resistance, while Enterococcus sp. exhibited vancomycin resistance (7 %). Multidrug resistance was identified in 16 % of Pseudomonas sp. and 63.6 % of Acinetobacter sp., raising concerns about limited therapeutic options.

Conclusion: The predominance of Gram-negative bacteria and high levels of antimicrobial resistance highlight the need for regular monitoring of local microbiological profiles. Targeted antimicrobial strategies can significantly reduce the morbidity associated with DFI and improve clinical outcomes in diabetic patients.
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NewsBot · Aug 6, 2025

Characterization of Microbial Profiles and Antimicrobial Resistance in Diabetic Foot Ulcers at a Tertiary Care Facility in Northern China
Fan Zhang et al
Diabetes Ther. 2025 Aug 4.

Introduction: There are differences in the microbiological and antimicrobial patterns of patients with diabetic foot infections (DFI) in different regions. Understanding the microbiological and antimicrobial patterns of patients with DFI in this region provides a basis for the empirical use of antibiotics in clinical practice.

Methods: This study retrospectively analyzed the clinical and laboratory characteristics and microbiological and antibacterial patterns of patients with DFI from January 2016 to December 2023.

Results: A total of 697 patients were included, with the majority being male (63.4%), and ages ranging from 50 to 75 years (59.3%). Most had poor blood sugar control (70.3%). Among them, 527 (75.6%) had single microorganism infections, while 170 (24.4%) had multiple microorganism infections. A total of 891 pathogenic strains were isolated, of which 419 (47.0%) were Gram-positive bacteria (GPB), 454 (51.0%) were Gram-negative bacteria (GNB), and 18 (2.0%) were fungi. The most common GPB is Staphylococcus aureus (196, 22.0%), while the most common GNB is Proteus mirabilis (70, 7.9%). GNB infections and multiple microorganism infections were more prevalent than GPB infections and single microorganism infections in Wagner grades 3-4. Patients with GNB infections had higher levels of ESR, WBC, NE, NEUT, PCT, and CRP, while ALB and Hb levels were lower. GPB were highly sensitive to teicoplanin (100%), followed by vancomycin (99.6%) and tigecycline (99.2%); GNB exhibited high sensitivity to sulperazon and amikacin (100%), followed by ertapenem (98.8%) and meropenem (98.6%).

Conclusion: The proportion of GNB is greater than that of GPB, primarily found in patients with moderate to severe DFI, who exhibit higher levels of inflammatory markers and more severe infections. However, S. aureus remains the most common microorganism in DFI. When using antibiotics, especially for patients with mild infections, coverage for common GPB, including S. aureus, should be considered, while for patients with moderate to severe infections, coverage should include common GNB.
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NewsBot · Aug 13, 2025

Bacterial profile and antimicrobial resistance in diabetic foot ulcer infections: a 10-year retrospective cohort study
Roberto Zambelli et al
The Brazilian Journal of Infectious Diseases Volume 29, Issue 5, September–October 2025, 104570

Introduction
Diabetic Foot Infections (DFI) are severe complications of diabetes, often resulting in poor clinical outcomes, including amputations. The objective of this study is to identify the main pathogens causing infections in the diabetic foot ulcers, as well as the antibiotic resistance profile.
Methods
This study included all patients treated for diabetic foot infections at a private tertiary hospital between 2013 and 2022. Demographic data, including age, sex, Body Mass Index (BMI), and the level of amputation were extracted from electronic medical records and collected for all patients. Microbiological and resistance patterns were evaluated following standardized protocols. Cases with incomplete demographic or microbiological data were excluded.
Results
This retrospective cohort study analyzed data from 459 diabetic patients, among them, 337 patients with positive cultures were included, resulting in 507 culture results from surgical samples. Gram-negative bacteria accounted for 55.2 % of isolates, with Enterobacterales (41 %) and non-fermenters (14.2 %) being most prevalent. Proteus sp. (10.3 %) and Escherichia coli (8.3 %) were the most common Gram-negative organisms, with significant resistance to ESBL (15.4 %) and quinolones (29.3 %). Among Gram-positive cocci (43.6 %), Staphylococcus aureus (16.8 %) showed 21.1 % methicillin resistance, while Enterococcus sp. exhibited vancomycin resistance (7 %). Multidrug resistance was identified in 16 % of Pseudomonas sp. and 63.6 % of Acinetobacter sp., raising concerns about limited therapeutic options.
Conclusion
The predominance of Gram-negative bacteria and high levels of antimicrobial resistance highlight the need for regular monitoring of local microbiological profiles. Targeted antimicrobial strategies can significantly reduce the morbidity associated with DFI and improve clinical outcomes in diabetic patients.
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NewsBot · Aug 29, 2025

Development of predictive nomogram for clinical use of special-grade antimicrobial agents in patients with diabetes foot infections
Qian Wang et al
Front Endocrinol (Lausanne). 2025 Aug 12:16:1578767.

Objective: To develop a predictive model to quantify the possibility of special-grade antimicrobial agents (SGAs) usage in patients with diabetes foot infections (DFIs), providing reference and guidance for clinical practice.

Methods: This is a cross-sectional study of 328 type 2 diabetes patients with DFIs. General clinical characteristics and biochemical indicators were extracted from the Hospital Information System (HIS) of Jinan Central Hospital in Shandong Province, China. Logistic regression analysis was performed to select predictors, and the nomogram was established based on selected viables visually. Then, the receive operating characteristic (ROC) curve, the calibration curve and the decision curve analysis (DCA) were used to evaluate the performance of this prediction model.

Results: 5 predictors were selected by univariate analysis from 21 variables, including duration of hospitalization, Neutrophil, DBIL, ALB and Wagner grade. The multivariate logical regression analysis illustrated that these 5 factors were independent risk factors for SGAs usage in patients with DFIs. The nomogram model developed by these 5 risk predictors exhibited good prediction ability, as shown by the area under curve (AUC) of ROC curve was 0.884 in the training set and 0.825 in the validation set. Calibration curve showed a good calibration degree of the predictive nomogram model. Moreover, DCA curve showed that the nomogram exhibited greater clinical application values when the risk threshold was between 3% and 63%.

Conclusion: Our novel nomogram model showed that duration of hospitalization, Neutrophil, DBIL, ALB and Wagner grade were the independent risk factors of SGAs usage in patients with DFIs. This prediction model behaved a great accurate value and provide reference of SGAs usage in clinic. Further validations are still needed to evaluate and improve the performance of this model.
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NewsBot · Sep 1, 2025

Sensitivity of Amoxicillin-Clavulanic Acid in Diabetic Foot Ulcers: A Cross-Sectional Study from Khyber Teaching Hospital, Peshawar.
Khan I, Alam I, Khan Z, Wazir ZM, Khalil A, Ullah I.
Life and Science. 2025; 6(3): 405-410.

Objective: This study aimed to determine the sensitivity of amoxicillin-clavulanic acid in Diabetic Foot Ulcer
patients admitted to the Department of Medicine, Khyber Teaching Hospital, Peshawar.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was conducted at the Department of Medicine, Khyber Teaching
Hospital, Peshawar, Pakistan from November 27, 2021, to May 26, 2022.
Methods: A total of 141 patients (aged 35–80 years) with type 2 diabetes and Diabetic Foot Ulcer of at least 2
weeks' duration were enrolled using a non-probability consecutive sampling technique. After obtaining ethical
committee approval and informed consent, culture specimens were collected from the ulcers and processed in
the hospital laboratory for culture and sensitivity testing. Data were analyzed using Statistical Package for Social
Sciences (SPSS) version 22.
Results: The study population had a mean age of 56.56 ± 15 years, with 59.6% males and 40.4% females. The
mean ulcer duration was 3.71 ± 2.8 weeks, and the mean HbA1c was 7.91 ± 1.9%. A majority (72.3%) of the
patients were classified as having long-standing diabetes. The most isolated organisms were Pseudomonas spp.
40 (28.4%), Staphylococcus aureus 38 (27%), Escherichia coli 30 (21.35%), Klebsiella spp. 15 (12.8%), and mixed
growth 8 (10.6%). Overall, sensitivity to amoxicillin-clavulanic acid was observed in 63.8% of the isolates.
Conclusion: Amoxicillin-clavulanic acid demonstrated moderate sensitivity against the microbial isolates from
DFUs in our cohort. These findings may assist clinicians in selecting appropriate empirical antibiotic therapy for
DFU management. Further studies are warranted to monitor changing microbial patterns and to assess the
clinical outcomes associated with antibiotic therapy.
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NewsBot · Oct 1, 2025

A Borate-Based Bioactive Glass Advances Wound Healing in Non-Healing Wagner Grade 1 Diabetic Foot Ulcers: A Randomised Controlled Clinical Trial
David G Armstrong et al
Int Wound J. 2025 Oct;22(10):e70763.

A novel advanced synthetic bioactive glass matrix was studied in patients with non-healing diabetic foot ulcers (DFUs). Bioactive glasses can be constructed to be biocompatible, with water-soluble materials in multiple geometries including fibre scaffolds that mimic the 3D architecture of a fibrin clot. In this trial, chronic, Wagner Grade 1 DFUs were randomised to receive borate-based bioactive glass Fibre Matrix (BBGFM) plus standard of care (SOC) therapy for 12 weeks or SOC alone. The primary study endpoint was the proportion of subjects that obtained complete wound closure at 12 weeks. Secondary endpoints included time to achieve complete wound closure at 12 weeks. In the modified intent-to-treat (mITT) analysis, 48% (32/67) treated with BBGFM plus SOC healed at 12 weeks compared to 24% (16/66) with SOC alone (p = 0.007). In the per protocol (PP) population, 73% (32/44) of subjects treated with BBGFM plus SOC healed versus 42% (16/38) in the SOC group (p = 0.007). Based on the success of this trial, BBGFM demonstrates faster healing of DFUs compared to SOC and should be considered in the treatment armamentarium for Wagner Grade 1 DFUs. Future trials should investigate the use of BBGFM for healing deeper chronic DFUs, other wound aetiologies, or complex surgical wounds.
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NewsBot · Oct 4, 2025

Characterization of Microbial Profiles and Antimicrobial Resistance in Diabetic Foot Ulcers at a Tertiary Care Facility in Northern China
Fan Zhang, Chuan Yang, Menghan Li, Yan Peng, Xiaoying Xie, Xia Ji & Shaona Niu
Diabetes Therapy

Introduction

There are differences in the microbiological and antimicrobial patterns of patients with diabetic foot infections (DFI) in different regions. Understanding the microbiological and antimicrobial patterns of patients with DFI in this region provides a basis for the empirical use of antibiotics in clinical practice.
Methods

This study retrospectively analyzed the clinical and laboratory characteristics and microbiological and antibacterial patterns of patients with DFI from January 2016 to December 2023.
Results

A total of 697 patients were included, with the majority being male (63.4%), and ages ranging from 50 to 75 years (59.3%). Most had poor blood sugar control (70.3%). Among them, 527 (75.6%) had single microorganism infections, while 170 (24.4%) had multiple microorganism infections. A total of 891 pathogenic strains were isolated, of which 419 (47.0%) were Gram-positive bacteria (GPB), 454 (51.0%) were Gram-negative bacteria (GNB), and 18 (2.0%) were fungi. The most common GPB is Staphylococcus aureus (196, 22.0%), while the most common GNB is Proteus mirabilis (70, 7.9%). GNB infections and multiple microorganism infections were more prevalent than GPB infections and single microorganism infections in Wagner grades 3–4. Patients with GNB infections had higher levels of ESR, WBC, NE, NEUT, PCT, and CRP, while ALB and Hb levels were lower. GPB were highly sensitive to teicoplanin (100%), followed by vancomycin (99.6%) and tigecycline (99.2%); GNB exhibited high sensitivity to sulperazon and amikacin (100%), followed by ertapenem (98.8%) and meropenem (98.6%).
Conclusion

The proportion of GNB is greater than that of GPB, primarily found in patients with moderate to severe DFI, who exhibit higher levels of inflammatory markers and more severe infections. However, S. aureus remains the most common microorganism in DFI. When using antibiotics, especially for patients with mild infections, coverage for common GPB, including S. aureus, should be considered, while for patients with moderate to severe infections, coverage should include common GNB.
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NewsBot · Oct 6, 2025

Optimisation of Levofloxacin-loaded electrospun fibres for diabetic wound treatment
Shangjie Lian et al
Int J Pharm. 2025 Oct 3:126253.

Foot ulcers are a common and serious diabetes complication, significantly affecting patients' quality of life. Chronic diabetic wounds are difficult to treat and often resist conventional therapies. Recently, materials developed through emerging techniques have gained attention for use in wound care and tissue regeneration. This study explores the development of nanofibres through electrospinning to create therapeutic patches for diabetic foot ulcers. Electrospinning allows control over fibres composition, orientation, and diameter, offering advantages such as simplicity and adaptability. Key process parameters, including flow rate, applied voltage, and polymer concentration, were optimized to produce defect-free fibres. The antibiotic levofloxacin was encapsulated in the fibres to assess its controlled release profile. Additionally, blends of chitosan and polycaprolactone (PCL) in various solvent systems were studied to enhance fibre characteristics. The combination leverages the elasticity, mechanical strength, biocompatibility, and versatility of PCL. The resulting composite fibres had an optimal diameter of 400 nm. Drug release analysis showed an initial peak-crucial for antibacterial efficacy-followed by a slower, sustained release phase. This biphasic release is beneficial in preventing infection while supporting prolonged therapeutic action. The findings demonstrate that a carefully designed formulation strategy can optimize fibres performance, making electrospun nanofibers patch a promising tool in the treatment of diabetic foot ulcers.
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NewsBot · Oct 29, 2025

Multifaceted Antibiotic Resistance in Diabetic Foot Infections: A Systematic Review
Weiqi Li et al
Microorganisms. 2025 Oct 6;13(10):2311.

Diabetic foot infections (DFIs) are a significant complication in patients with diabetes, often leading to severe clinical complications including amputation and increased mortality rates. The effective management of these infections is complicated by the rise in antibiotic resistance among the microbial populations involved. In this paper, we undertake a systematic review and meta-analysis to explore the bacterial profiles, as well as their antibiotic resistance patterns in DFIs, encompassing studies published between 2014 and 2024. A total of 28 studies were selected from several databases, including PubMed, Google Scholar, EBSCOhost, and ScienceDirect, published from 2014 to 2024, specifically focusing on diabetic foot infections and antibiotic resistance. Diabetic foot infections arise from a combination of factors, including peripheral neuropathy, poor circulation, and immune system impairment, making diabetic patients prone to unnoticed injuries, impaired wound healing, and a higher risk of infections. The severity of DFIs often depends on the size and depth of the ulcers, with larger, deeper ulcers posing additional risks of infection and complications, such as osteomyelitis and sepsis. Our study synthesizes information on the total isolates of microbes, their resistance to one or more groups of antibiotics, and resistance panel results across multiple antibiotics, including amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, ciprofloxacin, and others. We meticulously catalog the resistance of key bacterial strains-Escherichia coli, Enterobacter spp., Proteus spp., Pseudomonas spp., Staphylococcus aureus, and others-highlighting patterns of resistance to single and multiple antibiotic groups. This systematic review also analyzes the correlations of various comorbidities reported by the diabetic foot infection patient populations in the included studies with multiple antibiotic resistance patterns. Subsequently, this analytical review study addresses the rising prevalence of antibiotic-resistant pathogens and underscores the need for antibiotic stewardship programs to promote judicious use of antibiotics, reduce the spread of resistant strains, and enhance therapeutic outcomes. In addition, the review discusses the implications of resistance to empirical antibiotic treatments, underscoring the necessity for tailored antibiotic therapy based on culture and sensitivity results to optimize treatment outcomes.
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Infected diabetic foot ulcers decision making

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High Rates of Antibiotic Resistance in Infected Diabetic Foot Ulcers

Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

'Candle Wax' Applications for Infected Diabetic Foot Wounds

Photodynamic therapy for infected diabetic foot ulcers

Gender differences in infected diabetic foot ulcers

Insulin infusion for infected diabetic foot ulcers

Superoxidized solution for infected diabetic foot ulcers

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Infected diabetic foot ulcers decision making

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High Rates of Antibiotic Resistance in Infected Diabetic Foot Ulcers

Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

'Candle Wax' Applications for Infected Diabetic Foot Wounds

Photodynamic therapy for infected diabetic foot ulcers

Gender differences in infected diabetic foot ulcers

Insulin infusion for infected diabetic foot ulcers

Superoxidized solution for infected diabetic foot ulcers

Share This Page

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