Infected Diabetic Ulcers Research Articles

Infectious and Inflammatory Microenvironment Self-Adaptive Artificial Peroxisomes with Synergetic Co-Ru Pair Centers for Programmed Diabetic Ulcer Therapy.

Complex microenvironments with bacterial infection, persistent inflammation, and impaired angiogenesis are the major challenges in chronic refractory diabetic ulcers. To address this challenge, a comprehensive strategy with highly effective and integrated antimicrobial, anti-inflammatory, and accelerated angiogenesis will offer a new pathway to the rapid healing of infected diabetic ulcers. Here, inspired by the tunable reactive oxygen species (ROS) regulation properties of natural peroxisomes, this work reports the design of infectious and inflammatory microenvironments self-adaptive artificial peroxisomes with synergetic Co-Ru pair centers (APCR) for programmed diabetic ulcer therapy. Benefiting from the synergistic Co and Ru atoms, the APCR can simultaneously achieve ROS production and metabolic inhibition for bacterial sterilization in the infectious microenvironment. After disinfection, the APCR can also eliminate ROS to alleviate oxidative stress in the inflammatory microenvironment and promote wound regeneration. The data demonstrate that the APCR combines highly effective antibacterial, anti-inflammatory, and provascular regeneration capabilities, making it an efficient and safe nanomedicine for treating infectious and inflammatory diabetic foot ulcers via a programmed microenvironment self-adaptive treatment pathway. This work expects that synthesizing artificial peroxisomes with microenvironments self-adaptive and bifunctional enzyme-like ROS regulation properties will provide a promising path to construct ROS catalytic materials for treating complex diabetic ulcers, trauma, or other infection-caused diseases.

Periplaneta americana extract promotes infectious diabetic ulcers wound healing by downregulation of LINC01133/SLAMF9

Wound healing in diabetic ulcers remains a significant clinical challenge, primarily due to bacterial infection and impaired angiogenesis. Periplaneta americana extract (PAE) has been widely used to treat diabetic wounds, yet its underlying mechanisms are not fully understood. This study aimed to elucidate these mechanisms by analyzing long non-coding RNA (lncRNA) expressions in the wound tissues from diabetic anal fistula patients treated with or without PAE, using high-throughput sequencing. Peripheral blood monocytes from patients were differentiated into M0 macrophages with human macrophage colony-stimulating factor (hM-CSF) and subsequently polarized into M1 macrophages with lipopolysaccharide. The results indicated that LINC01133 and SLAMF9 were downregulated in wound tissues of patients treated with PAE. Furthermore, PAE suppressed M1 macrophage polarization and enhanced human umbilical vein endothelial cell (HUVEC) proliferation, migration, and angiogenesis. These effects were diminished when LINC01133 or SLAMF9 were overexpressed. Mechanistically, LINC01133 was shown to upregulate SLAMF9 through interaction with ELAVL1. Overexpression of SLAMF9 reversed the effects of LINC01133 silencing on macrophage polarization and HUVEC functions. In conclusion, PAE facilitates the healing of infected diabetic ulcers by downregulating the LINC01133/SLAMF9 pathway.

Early Outcomes and Complications of Surgically Treated Diabetic Hallucal Infection

ObjectiveSeverely infected diabetic ulcers of the big toe often necessitate surgical treatment. Depending on the wound stage and presence of osteomyelitis, conservative surgery and amputation are the main surgical treatments. Few articles reported the outcomes and complications of such procedures. This study is a preliminary comparative report on the early outcomes and complications of hallucal DFI treated with either conservative surgery or amputation. Setting and designThis is a retrospective comparative study comprising a continuous series of patients admitted at our hospital. Initially, all DFU were infected and at advanced stage (Wagner Grade 3 or 4). All clinically suspected cases of osteomyelitis were confirmed by bone pathology and microbiology culture. MethodsThe study included 37 patients diagnosed with DFI. Infection profile was as follows: 23 DFU with osteomyelitis (Wagner Grade 3 or 4) and 14 infected DFU (Wagner Grade 2). Twenty-four conservative procedures and 13 amputation surgeries were performed initially. The primary outcome was defined as the frequency of subsequent surgery (deep infection recurrence treated with surgery). Statistical analysis was used to look for significant difference between both groups. ResultsTen patients (27%) required additional surgeries because of deep infection recurrence. Four recurrences (16.7%) were observed in the conservative group and 6 (46%) in the amputation group (p = 0.054). Amputation rate as a subsequent procedure was 8.3% for the conservative group and the re-amputation rate for the amputation group was 23.1% (p = 0.2). ConclusionThe study findings would indicate that the more severe is the initial hallucal infection severity (higher Wagner grade), the higher is the frequency of early surgical complications mainly after an index amputation procedure. Our assessment tools of initial infection extent seems to be underperforming. A more aggressive treatment in the form of a more proximal cut with regard to MRI bone infection signal could be considered to minimize the risk of subsequent surgeries and re-amputations.

Examining the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients: A randomized control study.

One of the new types of dressings is the polyurethane dressing containing silver particles. This study was designed to evaluate the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients in a military hospital. This was a randomized clinical trial study on 48 patients with diabetic foot ulcers who were referred to the wound clinic of Shahid Dr. Chamran Hospital in 2022. The qualified samples were divided into two groups of silver polyurethane dressing and simple sterile dressing based on a randomization block method. The wounds of both groups of patients were initially cleaned with normal saline and in the first round of dressing, and a sample of tissue secretions was collected by the researcher using a sterile swab from the wounds of the patients on two occasions, superficially and deeply. The patients' wounds in the intervention group were dressed with polyurethane foam dressing containing silver particles, while the simple sterile routine dressing was used in the control group. The rate of infection and wound secretions were examined and recorded on the first, seventh, fourteenth, and twenty-first days from the start of dressing in both groups. To collect data, the IDSA tool was used. The rates of wound infection before the intervention showed no significant differences in the two groups (p = 0.242). However, these rates changed on the 7th, 14th, and 21st days after the intervention. Moreover, the infection rate was significantly lower in the polyurethane dressing group containing silver particles (p < 0.001 and F = 30.31). Using polyurethane dressing was proven to be more effective in this study on the rate of diabetic ulcer infection in patients compared to the simple sterile dressing. Thus, nurses can use this dressing for faster treatment of diabetic foot ulcers infection.

Progress of Hydrogel Dressings with Wound Monitoring and Treatment Functions.

Hydrogels are widely used in wound dressings due to their moisturizing properties and biocompatibility. However, traditional hydrogel dressings cannot monitor wounds and provide accurate treatment. Recent advancements focus on hydrogel dressings with integrated monitoring and treatment functions, using sensors or intelligent materials to detect changes in the wound microenvironment. These dressings enable responsive treatment to promote wound healing. They can carry out responsive dynamic treatment in time to effectively promote wound healing. However, there is still a lack of comprehensive reviews of hydrogel wound dressings that incorporate both wound micro-environment monitoring and treatment functions. Therefore, this review categorizes hydrogel dressings according to wound types and examines their current status, progress, challenges, and future trends. It discusses various wound types, including infected wounds, burns, and diabetic and pressure ulcers, and explores the wound healing process. The review presents hydrogel dressings that monitor wound conditions and provide tailored treatment, such as pH-sensitive, temperature-sensitive, glucose-sensitive, pressure-sensitive, and nano-composite hydrogel dressings. Challenges include developing dressings that meet the standards of excellent biocompatibility, improving monitoring accuracy and sensitivity, and overcoming obstacles to production and commercialization. Furthermore, it provides the current status, progress, challenges, and future trends in this field, aiming to give a clear view of its past, present, and future.

Should we resect more proximally? Outcomes of toe amputation versus ray resection in patients with infected diabetic ulcers and osteomyelitis. A preliminary study and new treatment algorithm

BackgroundThe treatment of severe diabetic toe infection complicated with osteomyelitis is often surgical. The decision on the level of amputation, when required, is difficult. Very few articles reported comparative outcomes between toe amputation and ray resection, and only in relation to the hallux. The aim of this preliminary report is to record the results of these procedures when performed on all toes. MethodsThis is a comparative retrospective study where the charts of a continuous series of 44 patients (48 procedures) with diabetic forefoot infection were analyzed. Only cases of severe infection with confirmed osteomyelitis were included. Two groups were compared based on the level of amputation: the toe amputation group (at and distal to the metatarsophalangeal joint) and the ray resection group (distal to tarsometatarsal joint). The primary outcomes were defined as osteomyelitis recurrence and re-amputation. ResultsOutcome comparison between toe amputation and ray resection; 47.3 % vs. 51.7 % had a recurrence of their osteomyelitis (p = 0.8), 36.8 % vs. 34.5 % had a re-amputation (p = 0.02). Re-amputation was needed in 25 % of cases following hallux/first ray index procedure while the same was required in 39 % of cases following lateral toes/rays index procedures (p = 0.4). Both primary outcomes were correlated to CDK, smoking and creatinine level. ConclusionsBone infection recurrence and re-amputation are highly prevalent in patients undergoing initial amputation for severe diabetic toe infection. A more aggressive approach in the form of a more proximal level of index amputation might be needed when treating severe toe infections with osteomyelitis in patients with diabetes.

2-Octylcyclopentanone Inhibits Beta Lactam Resistant Diabetic Wound Pathogens.

Microbial infection is a frequent complication of diabetic foot ulcers, with up to 82% of ulcers being infected at the initial stage of diabetes. Furthermore, the emergence of beta lactam resistant pathogens managed to eliminate the use of beta lactam antibiotics as a chemotherapeutic alternative. This further increases the amputation and mortality rate. Hence, the aim of this study is to evaluate antimicrobial efficacy of a ketone derivative 2-octylcyclopentanone against diabetic wound pathogens. The inhibitory activity of the compound was determined using disc diffusion and broth microdilution assay. Generally, 2-octylcyclopentanone showed broad-spectrum antimicrobial activity, particularly against beta lactam resistant pathogens. The compound showed comparably better antimicrobial activity than all reference antibiotics, including chloramphenicol, streptomycin, ampicillin and penicillin. In addition, the same compound also inhibits a clinically isolated Pseudonomas aeruginosa that was resistant to all reference antibiotics. The activity was microbicidal based on the low minimal lethality concentration recorded, particularly on MRSA, P. aeruginosa and Candida utilis. The killing efficiency of the compound was concentration dependent. During kill curve analysis, the inhibitory activity of 2-octylcyclopentanone was concentration and time-dependent. 99.9% of reduction of bacterial growth was observed. MRSA and P. aeruginosa, two significant diabetic wound infections, are totally inhibited by the molecule at a concentration of minimum lethality concentration. In short, 2-octylcyclopentanone exhibited significant inhibitory towards wide range of diabetic wound pathogens. Which is considered crucial since it will provide a safe and effective alternative treatment for diabetic ulcer infection.

A CO-mediated photothermal therapy to kill drug-resistant bacteria and minimize thermal injury for infected diabetic wound healing.

With an increasing proportion of drug-resistant bacteria, photothermal therapy (PTT) is a promising alternative to antibiotic treatment for infected diabetic skin ulcers. However, the inevitable thermal damage to the tissues restricts its clinical practice. Carbon monoxide (CO), as a bioactive gas molecule, can selectively inhibit bacterial growth and promote tissue regeneration, which may be coordinated with PTT for drug-resistant bacteria killing and tissue protection. Herein, a CO-mediated PTT agent (CO@mPDA) was engineered by loading manganese carbonyl groups into mesoporous polydopamine (mPDA) nanoparticles via coordination interactions between the metal center and a catechol group. Compared to the traditional PTT, the CO-mediated PTT increases the inhibition ratio of the drug-resistant bacteria both in vitro and in diabetic wound beds by selectively inhibiting the co-chaperone of the heat shock protein 90 kDa (Hsp90), and lowers the heat resistance of the bacteria rather than the mammalian tissues. Meanwhile, the tissue-protective proteins, such as Hsp90 and vimentin (Vim), are upregulated via the WNT and PI3K-Akt pathways to reduce thermal injury, especially with a laser with a high-power density. The CO-mediated PTT unified the bacterial killing with tissue protection, which offers a promising concept to improve PTT efficiency and minimize the side-effects of PTT when treating infected skin wounds.

1690. Assessing the safety of TP-102 bacteriophage treatment in the management of diabetic foot infections

Abstract Background Diabetic Foot Ulcers (DFU) are a major complication in patients with diabetes and affect globally 170 million patients. Approximately 28% of patients with infected DFU require amputation. Diabetic foot infections (DFI) caused by persistent or multidrug resistant organisms are a threat to the outcome of therapy. Infections are mostly polymicrobial, and major pathogens include Staphylococcus aureus and Pseudomonas aeruginosa. A promising new approach using phages may potentially be a novel modality to increase treatment success. TP-102 is an innovative bacteriophage cocktail for treatment of DFI, a diabetes related unmet need. Methods TP-102 comprised of 5 different phages, targeting S. aureus, P. aeruginosa and Acinetobacter baumannii. This study is a Phase I/II clinical trial performed in Israel looking at safety and tolerability. TP-102 bacteriophage cocktail was applied topically at a titer of 109 PFU/mL/cm3 of target ulcer. Two cohorts receive multiple doses of TP-102. In non-infected DFU (cohort 1) for 1 week and for 28 days in DFU with infection grade 2 or 3 (PEDIS classification, cohort 2). Treatment groups were TP-102 with standard of care versus placebo and standard of care. Outcomes include microbiologic data on the 3 target bacteria, ulcer healing characteristics, incidence and severity of TP-102-emergent solicited local and systemic adverse events, and their relationship to the treatment, from the first application of TP-102 until the end of study. Results For the evaluation of safety in patients with non-infected ulcers, eight patients were enrolled to the first cohort. Six were treated with TP-102 and 2 with placebo. TP-102-treated patients had no severe adverse events associated with the treatment. In the second cohort a total of 18 patients are currently being treated with TP-102 or placebo for 28 days, three times a week. Recruitment is ongoing and results of the trial will be presented. Conclusion TP-102 appeared to be safe when applied to patients with uninfected diabetic foot ulcers. The treatment is a potential new non-traditional antimicrobial for topical application. The efficacy of TP-102 in the treatment of infected diabetic ulcers is being assessed in an ongoing randomized clinical trial. Disclosures Ran Nir-Paz, MD, BiomX: Advisor/Consultant|Technophage: Advisor/Consultant Clara Leandro, PhD, Technophage: Employee Raquel Barbosa, PhD, Technophage: Employee Helena Dordio, PhD, Technophage S.A.: Employee Miguel Garcia, n/a, IBV Innovation Bioventures Lda: Board Member|IBV Innovation Bioventures Lda: Ownership Interest|LX Bio Pharmaceuticals SA: Board Member|LX Bio Pharmaceuticals SA: Ownership Interest|TechnoPhage, SA: Board Member|TechnoPhage, SA: Author of several patent applications|TechnoPhage, SA: Ownership Interest.

Evaluation of Adherence to the Oral Antibiotic Treatment in Patients With Diabetic Foot Infection.

Introduction: The knowledge about level of adherence to oral antibiotic treatment in diabetic patients with ulcer infection could be essential as a method of evaluation/monitoring of conservative treatment. Aim: To assess the adherence to oral antibiotic treatment in outpatients with diabetic foot infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale. Methods: cross-sectional study was carried out with 46 consecutive patients who had diabetic foot infection (soft tissue or bone infection) and required antibiotic oral treatment at outpatient clinical setting. Medication adherence was tested using the Spanish version of the validated eight-item self-report MMAS-8. Results: patients with diabetic ulcer infection, had well level of adherence to antibiotic medication (7 ± 1.2 vs. 7.4 ± 1.5). Patients with lower level of adherence had lower level of satisfaction with the antibiotic medication. The profile of the patients with lower level of adherence were patients with primary level of education and patient who required more help to take the medication. Conclusion: Patients with diabetic foot infection demonstrated well level of adherence to antibiotic medication, independently of type of infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale.

Management of Diabetic Leg Ulcers using Traditional Mixed DHSc dressing: A Case Study

The treatment of chronic wounds using honey has been widely studied, and sea cucumber has been used for the treatment of diabetic wounds. In addition, dates ( Phoenix dactylifera ) have been used for wound healing. This study applied a mixed dressing of these three ingredients, referred to as DHSc (dates, honey and sea cucumber). The aim of this study was to evaluate the speed and effectiveness of the use of DHSc dressings for healing diabetic wounds. A case of a male patient with an infected diabetic ulcer on the left lower tibia that extended to the dorsal area is presented. Results: Mixed DHSc dressings were found to be effective for the treatment of chronic wounds, and they achieved wound healing in less than 12 weeks. The wound bed showed good contraction and healthy granulation with no side effects, evidence of infection or maceration. Thus, researchers concluded that DHSc mixed dressings are suitable for the treatment of diabetic ulcer patients in a clinical setting.

Monitoring and Prevention the Risk of Diabetic Foot Ulcer Infection during Coronavirus Disease-19 Pandemic: A Narrative Review and Perspective Algorithm

BACKGROUND: The coronavirus disease (COVID)-19 pandemic leads to significant changes in the healthcare system and undermining best practices for maintaining a diabetic limb. A large number of patients with diabetic foot are left without timely medical care and are at increased risk of complications, hospitalization, lower limb amputation, and death. A new paradigm must be adopted for the transition from inpatient care to community-based care. The introduction of a pandemic remote management for patients with diabetic foot ulcer includes an assessment of the risk of complications through telemedicine and further stratification of patients according to the developed algorithm. METHODS: A literature review was performed for articles related to telemedicine. We used PubMed, Google Scholar, Cochrane Library, and Ovid MEDLINE to search published articles. We used the following keywords: “Telemedicine,” “diabetes mellitus,” “COVID-19,” “diabetic foot ulcer,” and “remote monitoring.” RESULTS: Implementation of the proposed pandemic care includes telemedicine for remote monitoring and treatment of patients with diabetic foot ulcers, as well as an algorithm for determining the risk of diabetic ulcer infection and patient management tactics according to the identified risk. CONCLUSION: The management of patients with diabetic foot ulcers during a pandemic includes the following goals – to reduce the burden on the health-care system, maintain the safety and functionality of diabetic foot at home, and reduce the risk of COVID-19 in patients with diabetic foot ulcers.

Analysis of antibiotics administration in diabetic ulcer patients at Panembahan Senopati regional hospital Bantul

Background: This study provides an overview of diabetic ulcer infection, antibiotic susceptibility patterns, the most common types of antibiotics, factors influence in antibiotics administrations, and verifying the guideline used of antibiotics.Methods: The research used descriptive analysis combined with interviews. The study was starting from February-March 2021. Eighty-six diabetic ulcer patients were selected considering the inclusion and exclusion criteria. We interviewed seven doctors.Results: 71 bacterias were found with a gram-negative bacteria count of 80.3%- higher than gram-positive bacteria (19.7%). The most common gram-negative bacteria found are Escherichia coli (12.7%) and show the most heightened sensitivity with imipenem (80.7%), while cefuroxime and trimethoprim-sulfamethoxazole show the highest resistance (64.9%). The most common gram-positive bacteria found are Staphylococcus aureus (14.1%), and vancomycin shows the most heightened sensitivity (100%), while penicillin shows the highest resistance (71.4%). The most common single antibiotic administration was ceftriaxone, as well as a combination of two antibiotics, namely ceftriaxone and metronidazole.Conclusions: Escherichia coli was the most gram-negative bacteria, which has the highest sensitivity with imipenem, while Staphylococcus aureus was the most gram-positive bacteria, which has the most heightened sensitivity with vancomycin. The most common single antibiotic administration was ceftriaxone, as well as a combination of two antibiotics, ceftriaxone and metronidazole. Factors that influence antibiotics administration are patient condition, susceptibility testing, training, and advice from colleagues. Every doctor uses different guidelines for diabetic foot ulcer.

Investigating auranofin for the treatment of infected diabetic pressure ulcers in mice and dermal toxicity in pigs

Bacterial infection of pressure ulcers (PUs) are a notable source of hospitalization for individuals with diabetes. This study evaluated the safety profile and efficacy of auranofin to treat diabetic PUs infected with methicillin-resistant Staphylococcus aureus (MRSA). PUs were infected with MRSA in diabetic TALLYHO/JngJ mice and then treated with topical auranofin (2%), topical mupirocin (2%), or oral clindamycin (30 mg/kg) for four days. PUs were harvested post-treatment to enumerate bacterial burden and determine expression of cytokines/growth factors. Landrace cross pigs were exposed topically to auranofin (1%, 2%, and 3%) for 4–14 days and evaluated for signs of localized or systemic toxicity. Auranofin eradicated MRSA in PUs within four days (7.92-log10 reduction) in contrast to mupirocin (2.15-log10 reduction) and clindamycin (0.73-log10 reduction). Additionally, auranofin treatment resulted in decreased expression of pro-inflammatory cytokines and increased expression of biomarkers associated with re-epithelization of wounded tissue, confirmed with histopathologic analysis. No significant histopathologic lesions were present on porcine skin sites exposed to topical auranofin. Additionally, minimal accumulation of plasma gold and no systemic toxicity was observed in pigs exposed to topical auranofin. Auranofin appears to be a potent and safe topical agent to further investigate for treatment of mild-to-moderate MRSA-infected diabetic PUs.

Antibiotics Susceptibility Pattern in Diabetic Ulcer Patients

Diabetic ulcers are a chronic complication of diabetes mellitus and have a high risk of infection. Severe ulcer infectionsare a significant cause of lower-extremity amputations in addition to trauma. Therefore, therapy for diabetic ulcer infectionsmust be performed immediately. This study aimed to determine the bacterial susceptibility pattern to the antibiotic indiabetic ulcer patients. This study was retrospective observational descriptive by taking the results of swab culture andantibiotic susceptibility patterns data in diabetic ulcer patients at Ulin General Hospital, Banjarmasin, in 2016-2018. Theresults showed 41 (62.1%) monomicrobial infections and 25 (37.9%) polymicrobial infections. The number of Gram-negativebacilli (57.4%) was higher than Gram-positive cocci (42.6%). The most common bacterial isolates on pus culture wereStaphylococcus aureus (26.6%), Klebsiella pneumonia (19.1%), and Escherichia coli (12.8%). Antibiotic susceptibility testresults showed that Gram-positive bacteria were sensitive to Tigecycline (100%), Nitrofurantoin (96.9%), and Linezolid(96.8%). Gram-negative bacteria were susceptible to Ertapenem (92.7%), Meropenem, and Amikacin (90.6%). S.aureusisolates were sensitive 100% to Meropenem and Tigecycline. K.peneumoniae and E.coli isolates were susceptible 100% toMeropenem and Amikacin. It was concluded in this study that the prevalence of Gram-negative bacteria in diabetic ulcerinfection was higher than Gram-positive bacteria. The most common isolated Gram-negative bacteria were K.pneumoniaeand E.coli, while the most common Gram-positive bacteria were S.aureus. The most sensitive antibiotics for K.pneumoniaeand E.coli were Meropenem and Amikacin, while the most sensitive antibiotics for S.aureus were Linezolid and Tigecycline.

Sprayed copper peroxide nanodots for accelerating wound healing in a multidrug-resistant bacteria infected diabetic ulcer.

Vascular dysfunction and bacterial infection are key factors for the non-healing of diabetic ulcers. Growth factors and antibiotics seem to effectively target both issues. However, the short half-life and high cost of growth factors and the antibiotics resistance of bacteria greatly limit their further widespread applications. Novel strategies or agents with both angiogenic and antibacterial activities are urgently desirable. Copper peroxide (CuO2) nanodots were reported to be decomposed into Cu2+ and H2O2 under mild acid conditions (pH 5.5). Considering that both decomposed products are acknowledged antibacterial agents (Cu2+, H2O2) and angiogenesis activator (Cu2+), we believe that CuO2 nanodots are suitable for diabetic ulcer treatment because the pathological environment of infected chronic wounds is mildly acidic with pH 5.5-5.6. As expected, in vitro experiments showed that CuO2 nanodots possessed excellent bactericidal properties against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and even methicillin-resistant Staphylococcus aureus (MRSA). CuO2 nanodots induced the high expression of hypoxia-inducible factor (HIF-1α) and vascular endothelial growth factor (VEGF) in human umbilical vein endothelial cells (HUVECs), subsequently promoting the cell migration and tube formation for angiogenesis. In particular, CuO2 nanodots exhibited good dispersibility and sprayable behavior in water. In vivo experiments demonstrated that the spayed CuO2 nanodots in the wound area could effectively combat MRSA, reduce inflammation, promote angiogenesis, and consequently accelerate wound healing. Moreover, the sprayed CuO2 nanodots in the wound sites caused negligible system toxicity. This study provides proof-of-principle evidence for applying the sprayed CuO2 nanodots for infected diabetic ulcer treatment.

Identification of biofilm-producing microorganism’s and drug susceptibility pattern from diabetic foot ulcer patients at Puducherry

Diabetes mellitus is a significant health problem worldwide that affects approximately 171 million people; severe complications lead to the development of diabetic foot ulcers. Diabetic ulcer infections are mainly polymicrobial in nature and multidrug-resistant (MDR), which is capable of forming a biofilm, which is the important virulence factor results in treatment failure. The main objectives of this study to investigate the etiologic agents of diabetic foot infections, their antimicrobial resistance and biofilm formation. A total of 200 patient samples were taken from diabetic foot ulcer patients between September 2015 and February 2016. Isolation and identification of microorganism were made according to standard microbiological procedures. Antibiotic Susceptibility testing performed by Kirby Bauer disc diffusion method and the biofilm production was performed by the tube method and Congo Red Method. Out of 200 samples processed, 110 (55%) were polymicrobial, 50 (25%) monomicrobial and 40(20 %)culture Sterile. The most common organism isolated were 82(39%) Pseudomonas aeruginosa,45(21%) Staphylococcus aureus, 48(23%) Candida sp followed by others. Biofilm production was seen in 112 (53%) of the isolates. Antimicrobial drug resistance was higher among 92(82%) biofilm producers than non-biofilm 20(18%) producing microorganisms. Organisms isolated from chronic diabetic foot ulcers cases were multidrug-resistant and biofilm producers. Our study shows the importance of biofilm screening with the usual antibiogram, as a routine technique in diabetic foot ulcers patients for effective treatment.

Intraoperative Site Vancomycin Powder Application in Infected Diabetic Heel Ulcers With Calcaneal Osteomyelitis.

Intraoperative site application of vancomycin powder has been found to be beneficial in foot and ankle surgery among diabetic patients undergoing elective procedures. However, there are concerns for risks such as selection of multidrug-resistant bacteria, local tissue irritation, and increased wound complications. The clinical utility of intraoperative site vancomycin powder application in infected diabetic foot ulcer surgery is unknown. We aimed to report the clinical outcomes of partial or total calcanectomy for diabetic heel ulcer (DHU) and determine if intraoperative site application of vancomycin powder placement at the time of wound closure leads to improved clinical outcomes. A current procedural terminology query (CPT 28120: partial excision bone; talus or calcaneus) was run that identified 35 patients representing 38 calcanectomies performed secondary to infected DHU with calcaneal osteomyelitis. An initial group of 25 patients did not receive intraoperative site vancomycin powder, whereas the following 13 cases received intraoperative site vancomycin powder. Demographics, clinical characteristics, comorbidities, operative complications, unexpected return to the operating room (RTOR), and revision amputations were recorded for each patient. Average follow-up was 26.1 (6.5-51.6) months. There was a significantly higher rate of RTOR among the vancomycin powder cohort (VANC) relative to the no-vancomycin cohort (No-VANC) (84.6% vs 36.0%, P = .038). Of the 13 VANC patients, 3 healed the wound and did not require RTOR, 2 underwent below-knee amputation (BKA), 2 received irrigation and debridement (I&D), and 6 underwent revision or total calcanectomies. Of the 25 No-VANC patients, 17 healed the wound, 4 underwent BKAs, 1 received an I&D, and 2 required revision or total calcanectomy. There was a trend toward increased rates of revision calcanectomy and BKA among the VANC cohort, but this was not statistically significant (61.5% vs 28.0%, P = .079). Partial or total calcanectomies for the management of infected DHU resulted in an overall healing rate of 50.0%, unplanned RTOR and revision calcanectomy rate of 39.5%, and a limb salvage rate of 82.6%. We found no clinical benefit with the intraoperative site application of vancomycin powder. Level III, retrospective case control study.

Intra-surgical Site Vancomycin Powder Application in Infected Diabetic Heel Ulcers with Calcaneal Osteomyelitis

Category:Diabetes; HindfootIntroduction/Purpose:The treatment of diabetic heel ulcers (DHU) with osteomyelitis is challenging, and dismal clinical results have been reported after calcanectomy, with reported revision rates of 0-63.5%. The topical application of vancomycin powder has reported to be beneficial in foot and ankle surgery amongst diabetic patients. However, no studies have examined the efficacy of intra-surgical site vancomycin powder application in DHU surgery. There are potential risks of intra-surgical site vancomycin powder application, such as the selection of gram-negative and multi-drug resistant bacteria, and increased wound complications. Thus, we aimed to 1) assess the clinical outcomes of calcanectomy for DHU and 2) investigate the clinical efficacy of intra-surgical site vancomycin powder application in patients who underwent partial- or total calcanectomies performed to treat infected DHU with osteomyelitis.Methods:This study was approved by our institution’s Research Subjects Review Board. Subjects were identified utilizing current procedural terminology code 28120 (Partial excision bone; talus or calcaneus) for partial or total calcanectomies performed at our academic institution. Thirty-eight calcanectomies performed secondary to DHU with osteomyelitis were identified. Patient demographics (age, sex, gender, body mass index), preoperative labs (hemoglobin A1c, blood glucose, white blood cell, erythrocyte sedimentation rate, C-reactive protein, serum creatinine, hemoglobin), ASA Class, peripheral arterial disease assessed by ankle-brachial index, Charleston Comorbidity Index, and intra-surgical site application of vancomycin powder were recorded. Duration of follow-up, type and quantity of systemic antibiotics administered during surgery, surgical complications, and return to the operating room (RTOR) were also recorded. There were two cohorts: those whose surgical wound was closed without vancomycin powder (initial 25 patients; ‘novancomycin’ group) versus those whose surgical site was closed with vancomycin powder (later 13 patients; ‘vancomycin’ group).Results:The average follow-up was 26.1 +- 15.0 months. Surgical pathology confirmed negative bone resection margins for all patients. Nineteen patients required an unplanned RTOR (50.0%). A revision amputation was performed in fifteen extremities (39.5%). Thirteen patients received intrawound vancomycin at closure, and 25 did not. Nine of thirteen (69.2%) patients who received vancomycin powder required RTOR. This includedTwo below-knee amputations (BKA), two irrigation and debridements (I&D), and six revision or total calcanectomies. There was a significantly higher rate of RTOR in the vancomycin cohort relative to the no-vancomycin cohort (76.9% vs 36.0%, p=0.038). Of the 25 no-vancomycin group, 17 did not return to the OR, 4 underwent BKA, 1 had I&D, and 2 required revision or total calcanectomy.Conclusion:In our cohort, calcanectomy performed for the surgical management of DHU with osteomyelitis yielded a high rate (50%) of unplanned follow-up procedures. Intra-surgical site vancomycin powder application during wound closure after calcanectomy did not result in clinical benefit and is likely unnecessary. The risk and benefit profile of intra-surgical site vancomycin powder application for diabetic foot infection surgery needs to be further investigated.

ANTIBACTERIAL ACTIVITY of COMBINATION COLD PLASMA and PARIJOTO (Medinilla speciosa) against Staphylococcus aureus and Pseudomonas aeruginosa on DIABETIC ULCER

This study aims to determine the potential of cold plasma (cold plasma) as an antibacterial if combined with Parijoto (Medinilla speciosa) extract against the dominant bacteria in diabetic ulcer infection, namely Gram-positive Staphylococcus aureus and Gram-negative bacteria Pseudomonas aeruginosa with a concentration of 25%, 50 %, 75%, and 100%. This study was an experimental test in vitro using the well diffusion method. The well diffusion method uses an MHA given a 5mm diameter and inserted a 100uL sample then incubates 35 ± 2 ° C for 16-18 hours. The results showed antibacterial activity from Cold Plasma with a 10 mm shot distance for 3 minutes with inhibitory zones against S. Aureus 3 mm and against P. aeruginosa 3.35 mm, a combination of Cold Plasma antibacterial activity with parijoto extract with a zone of inhibition of S. aureus 11.7 mm (25%), 14.1 (50%), 16.5 (75%), 17.1 (100%) and against P. aeruginosa 7.7 mm (25%), 9.3 mm (50%), 10.1 mm (75%), 11.7 (100%). the results of the Cold Plasma inhibition zone and Cold Plasma combination with parijoto extract 100% concentration of S. aureus were greater than the inhibition zone for P. aeruginosa. Cold Plasma combination inhibition zones with starch extracts against S. aureus compared to Vancomicin (VA) antibiotics with a 19.9 mm inhibition zone included in the intermediate category, Cold Plasma combination inhibition zone with parijoto juice against P. aeruginosa bacteria compared with Meropenem antibiotics ( MRP) with a 9.7mm inhibition zone included in the sensitive category