Diabetic Foot Ulcer Infections and Pseudomonas aeruginosa Biofilm Production During the COVID-19 Pandemic

Marwa A. Yakout,Ibrahim A. Abdelwahab

doi:10.22207/jpam.16.1.02

Abstract

During the different waves of the coronavirus (COVID-19) pandemic, there has been an increased incidence of diabetes mellitus and diabetic foot infections. Among gram-negative bacteria, Pseudomonas aeruginosa is the predominant causative agent for diabetic foot ulcer infections in low-resource countries. P. aeruginosa possesses a variety of virulence factors, including biofilm formation. Biofilm formation is an important benchmark characteristic in the pathophysiology of diabetic foot ulceration. The main objective of the current study was to identify the most commonly isolated organisms and their antibiotic susceptibility patterns in diabetic foot patients during the COVID-19 pandemic. We also determined the genes associated with bacterial persistence and biofilm formation in the predominantly isolated organism. Accordingly, 100 wound swab samples were collected from diabetic foot patients from different hospitals in Alexandria, Egypt. Through phenotypic detection of biofilm formation, 93% (40) of the 43 P. aeruginosa isolates examined were categorized as biofilm producers. Molecular detection of the biofilm-encoding genes among the 43 P. aeruginosa isolates was as follows: algD (100%), pelF (88%) and pslD (49.7%), and this highlights a need for biofilm formation inhibitors to prevent the persistence of bacterial pathogens, and thus achieve better clinical outcomes in diabetic foot ulcer infections.

Highlights

According to the International DiabetesFederation, there has been an increased incidence of diabetes mellitus (DM) during the different waves of the coronavirus (COVID-19) pandemic.[1,2,3,4] A study in Wuhan reported that diabetic patients constituted 2–20% of all positive cases, and accounted for 7.1% of intensive care unit admissions.[5,6] Another study in New York reported that 33.8% of COVID-19 positive patients were diabetic
Through phenotypic detection of biofilm formation, 93% (40) of the 43 P. aeruginosa isolates examined were categorized as biofilm producers
Molecular detection of the biofilm-encoding genes among the 43 P. aeruginosa isolates was as follows: algD (100%), pelF (88%) and pslD (49.7%), and this highlights a need for biofilm formation inhibitors to prevent the persistence of bacterial pathogens, and achieve better clinical outcomes in diabetic foot ulcer infections

Summary

Introduction

Federation, there has been an increased incidence of diabetes mellitus (DM) during the different waves of the coronavirus (COVID-19) pandemic.[1,2,3,4] A study in Wuhan reported that diabetic patients constituted 2–20% of all positive cases, and accounted for 7.1% of intensive care unit admissions.[5,6] Another study in New York reported that 33.8% of COVID-19 positive patients were diabetic. Several reports have attempted to determine the reason for the correlation between COVID-19 and DM. One hypothesis is that the angiotensin-converting enzyme 2 (ACE2) receptor necessary for the entry of SARS-CoV-2 is overexpressed in diabetic patients taking antidiabetic medications.[5,7,8,9] In addition, the use of corticosteroids in COVID-19 patients increases blood glucose levels in both diabetic and non-diabetic individuals.[5,10] diabetic patients are more vulnerable to viral and bacterial infections.[5, 11] The COVID-19 pandemic has posed many challenges for the diabetic community, such as lack of sufficient resources, overworked health care workers, and scarcity of proper care for diabetic patients to avoid the development of infections.[12, 13]

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Conclusion