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Investigating the Prevalence of Fungi in Diabetic Ulcers: An Under-Recognised Contributor to Polymicrobial Biofilms
Jontana Allkja1,2, Ahmed Bakri2, Bryn Short1
1Safeguarding Health Through Infection Prevention (SHIP) Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Abstract:
Diabetic foot ulcers (DFUs) are common complications for diabetic patients, often exacerbated by complex polymicrobial biofilm infections. While the majority of DFU studies are bacterial focused, fungi have also been identified. This study aims to investigate the prevalence of fungi in DFUs, as well as their potential role and influence on persistence and wound healing. Consecutive DFU swabs were collected from 128 patients (n = 349). Fungal positivity was assessed using enhanced culture and real-time qPCR. Routine microbiology cultures were carried out as part of standard care in the clinics, and their results were then compared to our laboratory investigation. Routine and enhanced culture resulted in similar rates of fungal detection (~9%), whereas qPCR resulted in a higher rate of detection (31%). Notably, the predominant yeast Candida parapsilosis was present in ischaemic and penetrating bone wounds. These findings support existing evidence of fungal presence in DFUs. We demonstrated that routine diagnostic methods are sufficient for fungal detection, but enhanced culture methods allow for more precise fungal identification. Finally, while fungal presence does not appear to impact patient outcomes in our study, their role within these infections remains poorly understood, and further studies are needed to fully understand their relationship to the microbiome.
Insights
Fungi are present in diabetic foot ulcers (DFUs), with qPCR detecting them more often than standard cultures. While not impacting outcomes in this study, their role in DFU infections requires further investigation.
Area of Science:
- Mycology
- Diabetic Medicine
- Infectious Diseases
Background:
- Diabetic foot ulcers (DFUs) are frequently complicated by polymicrobial infections.
- Fungal infections are increasingly recognized in DFUs, yet their prevalence and impact are not fully understood.
- Most DFU research focuses on bacteria, often overlooking fungal contributions.
Purpose of the Study:
- To determine the prevalence of fungal presence in diabetic foot ulcers.
- To compare the efficacy of different diagnostic methods for fungal detection in DFUs.
- To explore the potential role of fungi in DFU persistence and wound healing.
Main Methods:
- Collected 349 DFU swabs from 128 patients.
- Assessed fungal presence using routine culture, enhanced culture, and real-time quantitative PCR (qPCR).
- Compared laboratory findings with routine clinical microbiology results.
Main Results:
- Routine and enhanced cultures detected fungi in ~9% of samples.
- Real-time qPCR identified fungal presence in 31% of samples.
- Candida parapsilosis was the predominant yeast, found in ischemic and bone-penetrating wounds.
Conclusions:
- Fungal presence in DFUs is confirmed, with qPCR offering higher detection rates than standard cultures.
- Routine diagnostics are adequate for detection, but enhanced methods improve identification.
- Fungal presence did not significantly impact patient outcomes in this cohort, but their role in the DFU microbiome warrants further research.
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01:29Fungal Group Zygomycota
01:31Diabetic Foot Ulcer