The role of anaerobes in diabetic foot infections
Patrick G P Charles1, Ilker Uçkay2, Benjamin Kressmann3
1Infectious Diseases Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Austin Health, Heidelberg, Australia; Department of Medicine, University of Melbourne, Parkville, Australia.
Abstract:
Diabetic foot infections (DFI) are a common cause of morbidity and, on occasion, even mortality. Infection can be either mono- or polymicrobial, with a wide variety of potential pathogens. Anaerobes may be involved, particularly in wounds that are deeper or more chronic, and are more frequently identified when using modern molecular techniques, such as 16s PCR and pyrosequencing. It remains unclear whether the presence of anaerobes in DFI leads to more severe manifestations, or if these organisms are largely colonizers associated with the presence of greater degrees of tissue ischemia and necrosis. Commonly used empiric antibiotic therapy for diabetic foot infections is generally broad-spectrum and usually has activity against the most frequently identified anaerobes, such as Peptostreptococcus and Bacteroides species. Adequate surgical debridement and, when needed, foot revascularization may be at least as important as the choice of antibiotic to achieve a successful treatment outcome.
Insights
Diabetic foot infections (DFI) can involve various pathogens, including anaerobes. While their role is unclear, standard antibiotic therapy often covers them, alongside crucial surgical interventions.
Area of Science:
- Microbiology
- Infectious Diseases
- Podiatry
Background:
- Diabetic foot infections (DFI) are a significant cause of morbidity and mortality.
- Infections can be polymicrobial, involving a diverse range of bacteria.
- Anaerobic bacteria are increasingly identified in DFI, especially in chronic or deep wounds, using advanced molecular methods.
Purpose of the Study:
- To explore the role of anaerobic bacteria in diabetic foot infections.
- To investigate whether anaerobes contribute to DFI severity or are merely colonizers.
- To assess the implications for current treatment strategies.
Main Methods:
- Review of current literature on diabetic foot infections.
- Discussion of pathogen identification using molecular techniques (16s PCR, pyrosequencing).
- Analysis of the impact of tissue ischemia and necrosis on microbial presence.
Main Results:
- Anaerobes like Peptostreptococcus and Bacteroides are frequently found in DFI.
- The clinical significance of anaerobes in DFI (causative vs. colonizing) requires further investigation.
- Current broad-spectrum antibiotic regimens often provide coverage for common anaerobes.
Conclusions:
- The precise role of anaerobes in DFI pathogenesis remains to be fully elucidated.
- Surgical debridement and revascularization are critical components of DFI management.
- Antibiotic choice should consider potential anaerobic involvement, but surgical intervention is paramount.
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