BIOFILM IN CHRONIC DIABETIC FOOT ULCER-CASE REPORT

  • Julija Mitrova Telenta University Clinic of Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Liljana Labacevska Gjatovska Institut of Microbiology and Parasitology, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, North Macedonia
  • Marko Kostovski Institut of Microbiology and Parasitology, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, North Macedonia
  • Maja Dimova University Clinic of Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Ivana Dohceva Karajovanov University Clinic of Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Suzana Nikolovska University Clinic of Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Silvija Duma University Clinic of Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Hristina Breshkovska University Clinic of Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Nikola Panovski Institut of Microbiology and Parasitology, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, North Macedonia

Abstract

Diabetic foot ulcers(DFUs) as one of the most common complications in patients with diabetes mellitus are usually chronic wounds.The reason for its chronicity are infections and biofilm formation. We present a patient with diabetic foot neuropathic ulcer on the right foot. Microbiological swab showed isolates of  bacteria and fungi, Candida albicans,Enterococcus and Acinetobacter which were tested for biofilm formation with microtiter plate assay. Biofilm mass was evaluated spectrophotometrically by measuring the absorbence of crystal violet. Enterococcus was with high potential of biofilm formation. Wound surface was measured every week for a period of one month and it was reduced for 23.93%. Ulcer was treated with peroral antibiotic and antifungal medications and standard wound care was performed. Microorganisms isolated from wound swabs showed mixed bacterial and fungal components. Current sudies show that relation in between this biofilm is still unclear. All of this is a key role in treating chronic wounds, making it a challenge for everyone not only in the field of making  diagnosis , but also in the field of treatment.


 Key words: diabetic foot ulcers(DFUs),bacteria, fungi, biofilm


 

References

1. Afonso AC, Oliveira D, Saavedra MJ, Borges A, Simões M. Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies. International Journal of Molecular Sciences. 2021; 22(15):8278. https://doi.org/10.3390/ijms22158278.
2. Geerlings SE. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol. Med. Microbiol.1999;26:259–265.
3. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, Lefrock JL, Lew DP, Mader JT, Norden C, et al. Diagnosis and Treatment of Diabetic Foot Infections. Clin. Infect. Dis. 2004;39: 885–910.
4. Noor S, Zubair M, Ahmad J. Diabetic foot ulcer—A review on pathophysiology, classification and microbial etiology. Diabetes Metab. Syndr. Clin. Res. Rev. 2015; 9: 192–199.
5. Pouget C, Dunyach-Remy C, Pantel A, Schuldiner S, Sotto A, Lavigne JP. Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance. Microorganisms 2020;8: 1580.
6. Versey Z, Nizer WSDC, Russell E, Zigic S, DeZeeuw KG, Marek JE, Overhage J, Cassol E. Biofilm-Innate Immune Interface: Contribution to Chronic Wound Formation. Front. Immunol. 2021;12.
7. Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet. 2001; 358: 135–138.
8. Stewart PS. Mechanisms of antibiotic resistance in bacterial biofilms. Int. J. Med. Microbiol. 2002;292: 107–113.
9. Fux C, Costerton J, Stewart P, Stoodley P. Survival strategies of infectious biofilms. Trends Microbiol.2005;13: 34–40.
10. Price BL, Morley R, Bowling FL, Lovering AM, Dobson C. Susceptibility of monomicrobial or polymicrobial biofilms derived from infected diabetic foot ulcers to topical or systemic antibiotics in vitro. PLoS ONE.2020; 15: e0228704.
11. Christensen GD, Simpson WA, Bismo AL, Beachery EH. The adherence of the
slime- producing strains of Staphylococcus epidermidis to smooth surfaces. Infect immune. 1982;37:318–26
12. Stepanovic S, VukovicD, HolaV, Bonaventura G, Djukic S, Irkovic IC, RuzickaF.
Quantification of biofilm in microtiter plates: overview of testing conditions and practical
recommendations for assessment of biofilm production by staphylococci. APMIS. 2007; 71
(5), 687-690.
13. Olsson M, et al.The humanistic and economic burden of chronic wound:a systematic review.Wound Repair regen.2019;27:114-125.
14. Artinengo L, et al.Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies.Ann.Epidemiol.2019;29:8-15
15. Eriksson E, Liu PY, Schultz GS, et al. Chronic wounds: Treatment consensus. Wound
Rep Reg. 2022; 30( 2): 156- 171. doi:10.1111/wrr.12994
16. Verbanic S, Shen Y, Lee J, Deacon J, Chen I. Microbial predictors of healing and
short-term effect of debridement on the microbiome of chronic wounds. Biofilms
Microbiomes 2020; 6: 21. https://doi.org/10.1038/s41522-020-0130-5.
17. Rodrigues M, Kosaric N, Bonham CA, Gurtner GC. Wound healing: a cellular
perspective. Physiol. Rev 2019; 99(1): 665-706. doi: 10.1152/physrev.00067.2017
18. Londahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy
facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care
2010; 33: 998-1003. doi: 10.2337/dc09-1754.
19. James GA, Ge Zhao A, Usui M, Underwood RA, Nguyen H, Beyenal H, et al.
Microsensor and transcriptomic signatures of oxygen depletion in biofilms associated
with chronic wounds. Wound Repair Regen 2016; 24(2): 373-83. doi: 10.1111/wrr.12401.
20. Morgan SJ, Lippman SI, Bautista GE, Harrison JJ, Harding CL, Gallagher LA, et al.
Bacterial fitness in chronic wounds appears to be mediated by the capacity for high-
density growth, not virulence or biofilm functions. PLoS Pathog 2019; 15: e1007511.
https://doi.org/10.1371/journal.ppat.1007511
21. Mikamo H, Kawazoe K, Izumi K, Watanabe K, Ueno K, Tamaya T. Studies on the
pathogenicity of anaerobes, especially Prevotellabivia, in a rat pyometra model. Infect
Dis Obstet Gynecol 1998; 6(2): 61-65. doi: 10.1002/(SICI)1098-0997(1998)6:2<61::
AID-IDOG6>3.0.CO;2-A.
22. Kalan L, Loesche M, Hodkinson BP, Heilmann K, Ruthel G, Gardner SE, et al.
Redefining the chronic-wound microbiome: fungal communities are prevalent, dynamic,
and associated with delayed healing. mBio 2016; 7(5): e01058-16. doi: 10.1128/
mBio.01058-16.
23. Chellan G, Shivaprakash S, Ramaiyar SK, Varma AK, Varma N, Sukumaran MT, et
al. Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in
patients with type 2 diabetes. J Clin Microbiol 2010; 48(6): 2097-2102. doi: 10.1128/
JCM.02035-09.
24. Kalan L, Grice EA. Fungi in the Wound Microbiome. Adv Wound Care (New
Rochelle) 2018; 7(7): 247-255. doi: 10.1089/wound.2017.0756.
25. Townsend EM, Sherry L, Kean R, Hansom D, Mackay WG, Williams C, et al.
Implications of antimicrobial combinations in complex wound biofilms containing
fungi. Antimicrob Agents Chemother 2017; 61(9): e00672. doi: 10.1128/AAC.00672-17.
Published
2023-12-27
How to Cite
TELENTA, Julija Mitrova et al. BIOFILM IN CHRONIC DIABETIC FOOT ULCER-CASE REPORT. Journal of Morphological Sciences, [S.l.], v. 6, n. 3, p. 246-250, dec. 2023. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol6no3-31>. Date accessed: 02 mar. 2024.
Section
Articles