George Theodorakopoulos1,2,3,4,5,6 | David G. Armstrong7,8,9
1Wound and Foot Specialist, Athens, Greece | 2Technological Educational Institute of Patras, Patras, Greece | 3Queen Margaret University, Edinburgh, UK | 4University of West Attica, Aigaleo, Greece | 5University of Thessaly, Larisa, Greece | 6National and Kapodistrian University of Athens, Athens, Greece | 7Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, California, USA | 8Center to Stream Healthcare in Place (C2SHiP), Alexandria, Virginia, USA | 9Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Correspondence: George Theodorakopoulos (该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)
Received: 27 June 2025 | Revised: 29 October 2025 | Accepted: 6 November 2025
ABSTRACT
Biofilms are a key driver of chronicity and treatment failure in diabetic foot ulcers (DFUs), yet clinical evidence quantifying their impact and management remains fragmented. This systematic narrative review synthesised recent evidence (2015–2025) on the prevalence, diagnostics, and management of biofilm in DFUs. A Systematic Review of the Literature (SRL) was conducted following PRISMA 2020 guidelines across PubMed/MEDLINE, Scopus, Cochrane Library and ScienceDirect. Eligible studies included adults with DFUs reporting biofilm/bioburden metrics or interventions aimed at biofilm disruption. Risk of bias was assessed using RoB 2 for randomised trials and ROBINS-I for non-randomised studies. Data were narratively synthesised by evidence tier (Tier 1=clinical; Tier 2=preclinical/mechanistic). Of 600 records screened, 25 studies met inclusion criteria (Tier 1 n=9; Tier 2 n=5; reviews n=11). Over half of bacterial isolates in DFUs were biofilm producers, with multidrug resistance exceeding 90% in several cohorts. Fungi were detected in 31% of ulcers by qPCR but only 9% by culture. Tier 1 clinical evidence supports standard care components—debridement, antiseptics, and negative-pressure wound therapy—for improved healing, though direct anti-biofilm outcomes remain limited. Emerging strategies (enzymatic agents, peptides, cold plasma, smart dressings) show promise in vitro but lack clinical translation. Evidence for direct antibiofilm efficacy in DFUs remains scarce. Current data justify maintaining guideline-based care while prioritising trials that integrate validated biofilm endpoints, standardised microbiological methods, and antifungal components. Distinguishing established from experimental approaches is essential to advancing safe, evidence-based biofilm management in DFUs.
Basavraj Nagoba, Ajay Gavkare, Abhijit Rayate, Sachin Mumbre, Arunkumar Rao, Basavraj Warad, Neeta Nanaware, Nawab Jamadar
Basavraj Nagoba, Department of Microbiology, MIMSR Medical College, Latur 413512, Maharashtra, India
Ajay Gavkare, Department of Physiology, MIMSR Medical College, Latur 413512, Maharashtra, India
Abhijit Rayate, Basavraj Warad, Department of Surgery, MIMSR Medical College, Latur 413512, Maharashtra, India
Sachin Mumbre, Department of Community Medicine, Ashwini Rural Medical College, Solapur 413001, Maharashtra, India
Arunkumar Rao, Department of Orthopedics, MIMSR Medical College, Latur 413512, India
Neeta Nanaware, Department of Physiology, Government Medical College, Latur 413512, Maharashtra, India
Nawab Jamadar, Department of Anesthesiology, MIMSR Medical College, Latur 413512, Maharashtra, India
Corresponding author: Basavraj Nagoba, PhD, Assistant Dean, Research, Professor, Department of Microbiology, MIMSR Medical College, Vishwanathpuram, Ambejogai Road, Latur 413512, Maharashtra, India. 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。
Abstract
Management of diabetic foot ulcers is the biggest challenge to the clinician, as conventional antibiotic therapies and local wound care have their own limitations. They are not effective for control of infections and promotion of healing because of cytotoxic effects. In view of cytotoxicity of routinely used topical antiseptic agents, this article focuses on the search of an ideal topical antiseptic agent that is safe and effective in controlling infectious agents and also in promoting the healing process. This review focuses on the use of various acids such as citric, acetic, hyaluronic, and hypochlorous acids as topical agents in diabetic foot infections. This article also focuses on the different roles of acids in the treatment of diabetic foot infections.
Key Words: Diabetic foot ulcer; Infection; Management; Topical agents; Acids; Role of acids
Core Tip: Diabetic foot ulcer is the most serious complication of diabetes mellitus. The biggest challenge is to find an ideal topical antiseptic agent that is safe and effective in controlling infectious agents and promoting the healing process. This article focuses on
the use of acids as topical agents to control diabetic foot infections, with special emphasis on the different roles of citric, acetic, hyaluronic, and hypochlorous acids in the effective management of diabetic foot ulcers.
Citation: Nagoba B, Gavkare A, Rayate A, Mumbre S, Rao A, Warad B, Nanaware N, Jamadar N. Role of an acidic environment in the treatment of diabetic foot infections: A review. World J Diabetes 2021; 12(9): 1539-1549
原创:十六点五 中山二院糖尿病足中心
很多糖尿病人得了糖尿病足后,有很多后悔,其中一个就是“早知道有这么一个疾病,我就不应该吸烟”,“我要是早点戒烟就好了,免得受这种痛苦”。
糖尿病真是一种痛苦的疾病,不能吃、不能喝、常要动、老吃药等等,尤其是不能喝酒,对于一些病人真的的非常痛苦,而且在网上或者公众号还有很多关于糖尿病与喝酒的关系文章,其中有个重要的观点:喝酒可以降血糖?
糖尿病足患者是否应该运动、什么时候运动、做什么运动,目前在临床上有非常大的争议。
糖尿病足的病人临床上有一个显著的特点就是“低蛋白”血症。之前认为低蛋白血症的发病率非常高,经过对于我们医院及合作医院所有能够统计的病人进行分析,发现100%的糖尿病足(wagner分级2级以上),都会有不同程度的低蛋白血症。
伤口世界平台生态圈,以“关爱人间所有伤口患者”为愿景,连接、整合和拓展线上和线下的管理慢性伤口的资源,倡导远程、就近和居家管理慢性伤口,解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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