• Diabetic Foot Ulcers(DFU)review articles
  • Melika Sahebanolahadi,1 Saman Hakimian,2,*
    1. Bachelor student of Microbiology Falavarjan Azad University, Isfahan, IRAN
    2. M.sc student of Microbiology Islamic Azad University Central Tehran Branch,Iran,Tehran


  • Introduction: Diabetes, a disease related to lifestyle, is characterized by chronic hyperglycemia and imposes serious problems. The prevalence of diabetes is rapidly increasing worldwide and a real epidemic of the disease is expected in this century. Egypt is ranked the eighth country worldwide in the number of diabetic patients, and by 2045 it is expected to be the sixth country. Diabetes is a systemic disease that affects almost every part of the body, and the feet are frequently the first to suffer. The proportion of male patients was greater than females, and it was noted that the age group (51-68 years) was more affected by diabetic foot. Diabetic foot infection (DU) was considered to be one of the most common and dangerous diabetes complications. So, the most common cause of hospitalization and non-traumatic lower limb amputation is diabetic foot ulcer. It could lead from soft tissue infection to bone infection and is a leading cause of lower limb amputation. DFU patients have a 2.5 times higher risk of death compared to diabetic patients without foot ulcers. Diabetic foot ulcers, fi left untreated, can become infected and cause other complications, such as gangrene, osteomyelitis, and amputation. Surgery and antibiotic therapy are the options used to control this infection.
  • Methods: In patients with a healed DFU, significant independent risk factors for DFU recurrence during a 3-year follow-up period, despite intensive foot care, were: plantar ulcer location, presence of osteomyelitis, HbA1c>7.5%, and C-reactive protein (CRP>5mg/I. The major predisposing factor to foot ulceration leading to infection is usually related to peripheral neuropathy. Mostly the diabetic foot infections are mixed bacterial infections and the proper management of these infections requires appropriate antibiotic selection based on culture and antimicrobial susceptibility. The presence of drug-resistant bacteria in diabetic foot ulcers creates a big challenge during the treatment, so nanotechnology has been applied to find an alternative solution instead of antibiotics. Silver metal has been used in medicine since around 4000 B.C, even before it was recognized that bacteria constitute the primary cause of infection. The aim of this study, is comparing the antibacterial activity of silver nitrate and silver nanoparticles, finding that AgNPs had a high antibacterial effect against isolated bacteria more than AgNO3, primarily due to their nano-size.
  • Results: aureus (26%) was the most common bacteria isolated, followed by E. coli (20%) and Enterococcus spp (15 percent). Extended- spectrumbeta-lactamase (ESBL) producers made up 53% of the Gram-negative bacteria, Methicillin -resistant staphylococcus aureus (MRSA) made up 41%, and Vancomycin- resistant enterococci (VRE). made up 19%. Herbal products through different mechanisms of action, including antimicrobial, anti-inflammatory, antioxidant activity, stimulation of angiogenesis, production of cytokines and growth factors, keratinocytes, and fibroblast migration and proliferation may be considered as an important support during conventional therapy or even as a substitute for synthetic drugs used for diabetic wound treatment.
  • Conclusion: aureus is the most common cause of diabetic foot ulcers. Due to Staphylococcal surface proteins such a s (protein A) assist the bacteria to cling to the skin and facilitate the bacterial colonization in the diabetic foot, and then release many of the virulence factors that invade the immune system such as 3-hemolysin.
  • Keywords: DFU, staphylococcus aureus, Infection, Diabetic Foot Infection, Diabetic Foot Ulcers, Hyperglycemia