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Bacterial diversity and inflammatory response at first-time visit in younger and older individuals with diabetic foot infection (DFI)

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Abstract

Aim

Infection of a diabetic foot ulcer (DFU) is common. More than the half of DFUs become infected and 15–20% of them necessitate amputation in course of treatment. Diabetic foot infection (DFI) is therefore the major cause for non-traumatic lower limb amputation in Germany. Prompt and effective treatment of DFI is mandatory to safe limbs and lives. We investigated if there are relevant differences in evoked inflammatory response between different species and age-separated groups. We further investigated if there is an impact of ulcer localization on bacterial diversity.

Methods

For a 12-month period, we investigated 353 individuals with infected DFU, their laboratory results and bacterial diversity at first-time visit in a Diabetic Foot Care Center in Southern Germany.

Results

The ulcer microbiota was dominated by gram-positive species, primary Staphylococcus aureus. The gram-negative sector was mainly formed by Pseudomonas aeruginosa and Enterobacteriaceae (Proteus spp., Enterobacter spp., Escherichia coli and Klebsiella spp.). With increase in age, P. aeruginosa and S. aureus became more frequent, while Streptococci decreased. Ischemic and/or deep wounds were more likely to bear gram-negative species. Inflammatory response did not differ between gram-positive and gram-negative species, while Streptococci and Proteus spp. induced the highest serum inflammation reaction in their category. Streptococci, Enterobacter spp. and E. coli were more frequent in summer, while Enterococci spp., coagulase-negative Staphylococci and P. aeruginosa were more prevalent in winter half-year. DFIs of the forefoot and plantar side are mostly caused by gram-positive species, while Enterobacteriaceae were most frequent in plantar ulcerations.

Conclusion

Gram-positive species dominate bacterial spectrum in DFI. With increase in age, S. aureus, Streptococci and Pseudomonas aeruginosa became more frequent. The inflammatory response did not differ significantly between different species, but gram-negative species were slightly but not significant more frequent in ischemic wounds. Climatic distinction like summer or winter half-year as well as foot ulcer localization seems to influence bacterial diversity in DFUs.

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Abbreviations

DFU:

Diabetic foot ulcer

DFI:

Diabetic foot infection

S. aureus:

Staphylococcus aureus

P. aeruginosa:

Pseudomonas aeruginosa

E. coli:

Escherichia coli

CONS:

Coagulase-negative Staphylococci

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Funding

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Authors and Affiliations

  1. Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Prießnitzweg 24, 70374, Stuttgart, Germany

    Stefan Dörr, Florian Freier, Michael Schlecht & Ralf Lobmann

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  1. Stefan Dörr
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  2. Florian Freier
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  3. Michael Schlecht
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  4. Ralf Lobmann
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Contributions

Author contributions

SD and RL were involved in conceptualization and methodology; SD helped in validation; SD and FF contributed to formal analysis and data curation; SD, MS and FF were involved in investigation; SD and MS helped in resources; FF contributed to writing—original draft preparation; SD, FF and RL were involved in writing—review and editing; SD contributed to visualization; MS helped in supervision; and RL was involved in project administration.

Corresponding authors

Correspondence to Stefan Dörr or Ralf Lobmann.

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The authors declare no conflict of interest.

Ethical approval

This study was approved by the ethics committee of the Medical University of Tübingen (application number: 636/2020BO).

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Informed consent was obtained from the individual participant included in the study.

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Dörr, S., Freier, F., Schlecht, M. et al. Bacterial diversity and inflammatory response at first-time visit in younger and older individuals with diabetic foot infection (DFI). Acta Diabetol 58, 181–189 (2021). https://doi.org/10.1007/s00592-020-01587-5

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