Infected diabetic foot ulcers decision making

NewsBot · Jun 29, 2026

Candida Drug Resistance in Patients With Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis
Mohammad Hossein Ekvan et al
Int Wound J. 2026 May;23(5):e70900.

Diabetic foot ulcers (DFUs) are one of the most serious and common complications that, if not treated properly, can lead to potential damage and even amputation. The aim of this systematic review and meta-analysis was to assess the drug-resistant Candida species in DFU. PubMed, Web of Science, Scopus and Google Scholar databases were systematically searched for eligible articles up to 22 June 2024. All articles on Candida diabetic foot infections that reported data on drug resistance were included in the study. In addition to general information, data on the type and number of fungi and the percentage of resistance to each drug were collected for analysis. A total of 238 studies were screened and finally, 16 articles were selected and analysed. Candida albicans was the most frequently isolated species in DFUs, followed by Candida tropicalis and Candida parapsilosis. For antifungal agents, the highest resistance was reported to Nystatin (32.48%, p-value = 0.30), Itraconazole (19.46%, p-value = 0.001) and Fluconazole (16.4%, p-value = 0.001). Miconazole (1.18%, p-value = 0.54) and Caspofungin (4.69%, p-value = 0.01) had the lowest resistance rates. For all drugs, resistance was higher in C. albicans than in non-albicans. This study found that antifungal drug resistance in Candida species is high in patients with DFUs, especially to itraconazole and fluconazole. Caspofungin, micafungin and voriconazole were more effective. Antifungal treatment in these patients should prioritize agents with lower resistance rates to improve outcomes and reduce the risk of treatment failure
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NewsBot · Jul 1, 2026

Representative Targeted Molecular And Genomic Characterization Of Virulence Genes In Staphylococcus aureus From Diabetic Foot Infections
Shaymaa H Al-Kubaisy et al
J Vis Exp. 2026 May 29231). doi: 10.3791/71373.

Diabetic foot infections (DFIs) represent a major public health concern, and methicillin-resistant Staphylococcus aureus (MRSA) is among the most clinically significant pathogens. This study investigated the prevalence of virulence genes (cna and hlg), antimicrobial resistance profiles, and representative genomic features of multidrug-resistant S. aureus isolates recovered from patients with DFIs. A cross-sectional observational study was conducted on 125 patients with diabetic foot infections between January and December 2024. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method and cefoxitin screening according to Clinical and Laboratory Standards Institute (CLSI) guidelines, with S. aureus ATCC 25923 used as the quality-control strain. Vancomycin susceptibility was confirmed by minimum inhibitory concentration (MIC) testing. Polymerase chain reaction (PCR) was used to detect the virulence genes (cna and hlg) and blaOXA-group I genes. Whole-genome sequencing (WGS) was performed on two representative isolates, including one multidrug-resistant (MDR) isolate and one extensively drug-resistant (XDR) isolate, using a de novo sequencing approach to generate draft genome assemblies. Among 125 clinical specimens, bacterial growth was observed in 90 samples (72%), of which 45 isolates (50%) were identified as S. aureus. Among these isolates, 35/45 (77.78%) were classified as MRSA, and 36/45 (80%) were multidrug resistant. The hlg gene was detected in all isolates, whereas the cna gene was identified in 13/45 (28.89%) isolates. No blaOXA-group I genes were detected. Genomic analysis identified multiple resistance-associated genes, including blaZ, tet(38), norA, and vanT, together with CRISPR-Cas elements and plasmid-associated resistance determinants. These findings highlight the high prevalence of multidrug-resistant S. aureus in DFIs and support the importance of continued genomic surveillance of clinically relevant resistant strains.
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NewsBot · Jul 6, 2026

Research on the Efficacy of Antibiotic-Loaded Bone Cement in Treating Diabetic Foot Ulcers with Infection: A Clinical Study on Surgical Outcomes and Recovery Strategies
Jiaqi Zhang et al
Int J Low Extrem Wounds. 2026 May 4:15347346261445773

ObjectiveThis study investigated the clinical value of antibiotic-loaded bone cement (ALBC) in managing infected diabetic foot ulcers (DFUs), aiming to address the limitations of conventional therapies such as slow healing and high recurrence rates.MethodsA retrospective analysis was conducted on 43 eligible DFU patients (21 males, 22 females) with infected ulcers who underwent debridement combined with ALBC implantation. Clinical data on infection control, wound healing, adverse events, and functional assessments were collected.ResultsThe results demonstrated effective local infection control: 90.7% of patients achieved normalized white blood cell counts and C-reactive protein levels within 1-2 weeks, with no observable pus secretion after 3 weeks. Wound healing outcomes were favorable, with an overall healing rate of 95.3% (41/43). The median healing time was 42 days (range: 30-63 days), and the average wound area reduction rate reached 85% at 4 weeks post-treatment. Only two cases experienced delayed healing due to poor glycemic control, with no reports of severe adverse reactions. Furthermore, all patients maintained basic ambulation without significant gait impairment during follow-up, as the ALBC was customized to minimize interference with foot function.ConclusionsALBC combined with debridement effectively controls infection, promotes wound healing, and exhibits a good safety profile in treating infected DFUs, without adversely affecting daily ambulation. This regimen represents a novel and cost-effective therapeutic option. Future prospective randomized controlled trials are warranted to validate these findings and optimize protocols for patients with poor baseline conditions
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NewsBot · Jul 11, 2026

More Detection, Better Decisions? Rethinking Pathogen-Driven Therapy in Diabetic Foot Infections
Irene Terzi et al
Int J Low Extrem Wounds. 2026 May 4:15347346261447707.

Pathogen-driven therapy is central to the management of diabetic foot infections (DFIs), where antimicrobial selection relies on microbiological identification. Over the past decade, diagnostic capabilities have expanded from conventional cultures to high-resolution molecular sequencing, substantially increasing pathogen detection. Whether this expansion translates into better therapeutic decisions, however, remains uncertain. This narrative review examines the roles and limitations of culture-based methods, antimicrobial susceptibility testing, targeted polymerase chain reaction panels, 16S rRNA gene sequencing, and shotgun metagenomics in DFIs. Culture remains the cornerstone of pathogen-directed therapy because it identifies viable organisms and provides phenotypic susceptibility data that inform antibiotic selection and de-escalation. Molecular techniques broaden detection and reveal polymicrobial complexity and resistance genes, yet increased analytical sensitivity does not consistently clarify pathogen prioritization, distinguish colonization from infection, or improve patient-centered outcomes. Intensified diagnostic strategies often lead to antimicrobial modification without clear gains in healing or cost-effectiveness. These findings underscore a persistent interpretative gap: detection capacity has advanced more rapidly than frameworks linking microbiological data to meaningful therapeutic action. Microbiology is indispensable but insufficient in isolation. Improved outcomes will depend less on detecting additional organisms and more on integrating microbiological findings with surgical management, vascular status, and multidisciplinary care.
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NewsBot · Jul 11, 2026

Microbiological and inflammatory profiles in diabetic foot infection: A severity-stratified analysis
Ya-Li Zhu et al
Medicine (Baltimore). 2026 Jul 10;105(28):e49558.

This study analyzed the bacterial spectrum, antibiotic susceptibility profiles, and serum levels of human neutrophil lipocalin (HNL) and procalcitonin (PCT) in patients with diabetic foot infection (DFI) stratified by infection severity. A retrospective analysis was conducted on clinical data from DFI patients admitted to the Department of Endocrinology and Metabolism at Yan'an University Affiliated Hospital between January 2018 and May 2024. Based on the 2015 Infectious Diseases Society of America/ International Working Group on the Diabetic Foot classification system, patients were classified into mild, moderate, and severe infection groups. Bacterial pathogen distribution, antibiotic susceptibility, and inflammatory markers (HNL [ng/mL] and PCT [ng/mL]) were compared across groups. Among 387 screened patients, 208 (53.8%) had positive bacterial cultures. Monomicrobial infections were identified in 160 cases (77.0%), while polymicrobial infections accounted for 44 (21.2%). Gram-positive (G+) bacteria constituted 58.2% (121/208) of isolates, and Gram-negative (G-) bacteria represented 18.8% (39/208). The predominant Gram-positive (G+) bacteria were Staphylococcus aureus (52.1%), Staphylococcus epidermidis (14.9%), Staphylococcus hominis (5.0%), and Staphylococcus haemolyticus (5.0%), with S aureus being significantly more frequent across all severity groups (P < .05). Common Gram-negative (G-) isolates included Escherichia coli (28.1%), Klebsiella pneumoniae (15.4%), and Klebsiella oxytoca (10.3%), with no significant differences among groups. Gram-positive (G+) isolates exhibited high susceptibility to gentamicin, vancomycin, oxacillin, and linezolid, with no intergroup differences. Vancomycin susceptibility was significantly higher in moderate and severe groups compared to the mild group (P < .05). Gram-negative (G-) bacteria showed consistent susceptibility to ampicillin, levofloxacin, ceftazidime, cefoperazone-sulbactam, and meropenem across severity groups. Levels of HNL (ng/mL), PCT (ng/mL), white blood cell count (109/L), neutrophil percentage (%), C-reactive protein (mg/L), and erythrocyte sedimentation rate (mm/h) increased significantly with infection severity (P < .05). However, high-sensitivity C-reactive protein (mg/L) did not differ significantly among groups. Although polymicrobial infections were increasingly observed in DFI, Gram-positive (G+) bacteria (especially S aureus) remain predominant. A shift toward Gram-negative (G-) pathogens was associated with higher infection severity. Empirical antibiotic treatment should be guided by local antimicrobial susceptibility patterns. The strong correlation of HNL and PCT with infection severity suggests their potential value in clinical assessment and management.
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NewsBot · Jul 20, 2026

A Retrospective Study of Infections and Antibiotic Susceptibility in Diabetic Foot Ulcers
Shuai Wang et al
Diabetes Ther. 2026 Jul 20.

Introduction: This study aimed to investigate the predominant pathogenic microorganisms, antimicrobial resistance patterns, and antibiotic sensitivity profiles of diabetic foot infections in the southern region of a province in central-eastern China, thereby providing evidence-based guidance for the rational use of antibiotics for treating foot infections in patients with diabetes.

Methods: A retrospective analysis was performed on the clinical data from patients with diabetic foot infections who were treated at a large tertiary hospital between 1 July 2019 and 31 July 2024. Wound specimens were collected for bacterial culture and antimicrobial susceptibility testing, and both clinical and microbiological data were analyzed.

Results: A variety of pathogenic microorganisms, predominantly Gram-positive (G+) and Gram-negative (G-) bacteria, were isolated. The top five pathogens identified were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Streptococcus agalactiae (group B), and Proteus mirabilis. As the Wagner grade increased, there was a shift in pathogens from G+ to G- bacteria, along with a rise in polymicrobial infections, primarily coinfections involving G+ and G- bacteria. The G+ bacteria exhibited high resistance to penicillin and certain cephalosporins but remained highly sensitive to vancomycin and linezolid. G- bacteria showed increased resistance to quinolones, carbapenems, and aminoglycosides while maintaining relative sensitivity to tigecycline and polymyxins. Fungal infections were highly sensitive to commonly used antifungal agents. Overall, significant variations in resistance to antimicrobials were observed among different strains, with some exhibiting notable multidrug resistance, underscoring the high risk of empirical monotherapy.

Conclusions: The issue of antimicrobial resistance in foot infections associated with diabetes mellitus is becoming increasingly severe. Clinical treatment should be guided by antimicrobial susceptibility testing to ensure rational antibiotic use, improve therapeutic outcomes, reduce the emergence of resistant bacteria, and lower recurrence rates.
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NewsBot · Jul 23, 2026

A Retrospective Study of Infections and Antibiotic Susceptibility in Diabetic Foot Ulcers
Shuai Wang, Zunjiang Zhao, Xiangjian Meng, Hongfei Guo, Yinqiao Sun & Dalun Lv
Diabetes Therapy

Introduction

This study aimed to investigate the predominant pathogenic microorganisms, antimicrobial resistance patterns, and antibiotic sensitivity profiles of diabetic foot infections in the southern region of a province in central-eastern China, thereby providing evidence-based guidance for the rational use of antibiotics for treating foot infections in patients with diabetes.
Methods

A retrospective analysis was performed on the clinical data from patients with diabetic foot infections who were treated at a large tertiary hospital between 1 July 2019 and 31 July 2024. Wound specimens were collected for bacterial culture and antimicrobial susceptibility testing, and both clinical and microbiological data were analyzed.
Results

A variety of pathogenic microorganisms, predominantly Gram-positive (G+) and Gram-negative (G−) bacteria, were isolated. The top five pathogens identified were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Streptococcus agalactiae (group B), and Proteus mirabilis. As the Wagner grade increased, there was a shift in pathogens from G+ to G− bacteria, along with a rise in polymicrobial infections, primarily coinfections involving G+ and G− bacteria. The G+ bacteria exhibited high resistance to penicillin and certain cephalosporins but remained highly sensitive to vancomycin and linezolid. G− bacteria showed increased resistance to quinolones, carbapenems, and aminoglycosides while maintaining relative sensitivity to tigecycline and polymyxins. Fungal infections were highly sensitive to commonly used antifungal agents. Overall, significant variations in resistance to antimicrobials were observed among different strains, with some exhibiting notable multidrug resistance, underscoring the high risk of empirical monotherapy.
Conclusions

The issue of antimicrobial resistance in foot infections associated with diabetes mellitus is becoming increasingly severe. Clinical treatment should be guided by antimicrobial susceptibility testing to ensure rational antibiotic use, improve therapeutic outcomes, reduce the emergence of resistant bacteria, and lower recurrence rates.
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NewsBot · Aug 2, 2026

Five-Year Evolution of the Microbiological Landscape of Diabetic Foot Infections (2021–2025): Rising Polymicrobial Gram-Negative Predominance and Emergence of Resistant Enterobacterales at a Single Large-Volume Outpatient Centre
Magdalena Maj et al
Antibiotics 2026, 15(8), 723; https://doi.org/10.3390/antibiotics15080723

Background/Objectives: Diabetic foot infections (DFI) drive most non-traumatic lower-limb amputations, and empirical regimens must track local microbiology, which is itself evolving under broad-spectrum antibiotic pressure. Methods: We retrospectively analysed all consecutive bacterial cultures from clinically infected diabetic foot lesions at a single Polish outpatient centre over 2021–2025. Isolates were identified by MALDI-TOF mass spectrometry and susceptibility was interpreted under contemporaneous EUCAST breakpoints (v12.0–v15.0). Results: A total of 274 cultures yielded 443 isolates (polymicrobial index 1.62). Staphylococcus aureus remained the most common pathogen but fell from 55.0% to 38.9% of cultures, while Enterobacterales rose from 36.1% to 47.7% of all isolates. Proteus mirabilis and Streptococcus agalactiae emerged as major contributors, and Enterobacter hormaechei showed an apparent increase (the apparent rise in E. hormaechei reflects, at least in part, improved species-level identification rather than a true increase in incidence). Methicillin-resistant S. aureus was first documented in 2025 (6/38; 15.8%). P. mirabilis showed deteriorating activity against trimethoprim–sulfamethoxazole and ciprofloxacin, the first meropenem-resistant isolate appeared in 2025, and two carbapenem-non-susceptible Enterobacterales were also detected (2/18 carbapenem-tested isolates in 2025; 11%). Conclusions: The DFI profile has shifted from an S. aureus-dominated Gram-positive ecology toward a polymicrobial, increasingly Gram-negative one, with the first documentation of MRSA (on reintroduction of routine oxacillin testing) and of carbapenem-non-susceptible Enterobacterales. Empirical policy for moderate-to-severe DFI should reliably cover Enterobacterales and methicillin-resistant Gram-positives while preserving carbapenems and glycopeptides through active stewardship.
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Infected diabetic foot ulcers decision making

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Dermomina® clay achieves high closure rates in non-infected diabetic foot ulcers

High Rates of Antibiotic Resistance in Infected Diabetic Foot Ulcers

Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

'Candle Wax' Applications for Infected Diabetic Foot Wounds

Photodynamic therapy for infected diabetic foot ulcers

Gender differences in infected diabetic foot ulcers

Insulin infusion for infected diabetic foot ulcers

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Infected diabetic foot ulcers decision making

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Dermomina® clay achieves high closure rates in non-infected diabetic foot ulcers

High Rates of Antibiotic Resistance in Infected Diabetic Foot Ulcers

Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

'Candle Wax' Applications for Infected Diabetic Foot Wounds

Photodynamic therapy for infected diabetic foot ulcers

Gender differences in infected diabetic foot ulcers

Insulin infusion for infected diabetic foot ulcers

Share This Page

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