Abstract
Diabetic foot ulcers (DFU) represent a growing public health problem. The emergence of multidrug-resistant (MDR) bacteria is a complication due to the difficulties in distinguishing between infection and colonization in DFU. Another problem lies in biofilm formation on the skin surface of DFU. Biofilm is an important pathophysiology step in DFU and may contribute to healing delays. Both MDR bacteria and biofilm producing microorganism create hostile conditions to antibiotic action that lead to chronicity of the wound, followed by infection and, in the worst scenario, lower limb amputation. In this context, alternative approaches to antibiotics for the management of DFU would be very welcome. In this review, we discuss current knowledge on biofilm in DFU and we focus on some new alternative solutions for the management of these wounds, such as antibiofilm approaches that could prevent the establishment of microbial biofilms and wound chronicity. These innovative therapeutic strategies could replace or complement the classical strategy for the management of DFU to improve the healing process.
Highlights
Diabetic foot ulcers (DFU) have a lifetime prevalence of 15–25% (Armstrong et al, 2017)
We discuss current knowledge on biofilm in DFU and we focus on some new alternative solutions for the management of these wounds, such as antibiofilm approaches that could prevent the establishment of microbial biofilms and wound chronicity
Another in vitro study conducted on a novel wound-dressing material based on a matrix of the polysaccharides alginate, hyaluronic acid and Chitlac-silver nanoparticles concluded that hyaluronic acid was able to stimulate the wound healing simultaneously to the silver particles allowing efficient antibacterial activity against biofilms (Tarusha et al, 2018)
Summary
Diabetic foot ulcers (DFU) have a lifetime prevalence of 15–25% (Armstrong et al, 2017). Better understanding of the bacterial organization of biofilms in chronic wounds would allow development of tailored antimicrobial strategies and improving wound healing. In this context, a large majority of current fundamental studies on DFUs focuses on bacterial cooperation and the impact of local microenvironment on microorganisms. Debridement allows the reepithelialization of soft-tissue by eradication of (early or established) infection and reduction of bioburden, the improvement of local blood flow, and the revitalization of the wound bed. When it was performed correctly, it optimizes the diabetic wound healing. The definitive antibiotic treatment is changed according to the microbiological culture and the response of the TABLE 1 | In vitro and in vivo effects of the main alternative approaches studied
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