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Related Concept Videos

Diabetic Foot Ulcer01:31

Diabetic Foot Ulcer

Definition A diabetic foot ulcer (DFU) is a chronic, non-healing wound that develops in individuals with diabetes. It typically occurs on pressure-bearing areas such as the heel, metatarsal heads, or hallux, and carries a high risk of infection and amputation.Pathophysiology • The development of DFUs can be explained by four interconnected mechanisms: neuropathy, ischemia, infection, and impaired wound healing. • Neuropathy is the most common factor. Sensory neuropathy reduces pain perception,...

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Pressure Ulcer Prevention at Home for People with Long-term Neurological Conditions, Carers and Personal Assistants: Synopsis - a Participatory, Qualitative study (PUP@Home1).

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Related Experiment Video

Updated: Jun 15, 2026

Prospective, Randomized, and Controlled Study of a Human Umbilical Cord Mesenchymal Stem Cell Injection for Treating Diabetic Foot Ulcers
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Prospective, Randomized, and Controlled Study of a Human Umbilical Cord Mesenchymal Stem Cell Injection for Treating Diabetic Foot Ulcers

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Swabs versus tissue samples for infected diabetic foot ulcers: the CODIFI2 RCT.

E Andrea Nelson1, Colin C Everett2, Henrietta Konwea3

  • 1Glasgow Caledonian University, Glasgow, UK.

Health Technology Assessment (Winchester, England)
|November 11, 2025
PubMed
Summary

Diabetic foot ulcer infections are common. Swab sampling for infection diagnosis was found to be less costly and associated with better quality of life compared to tissue sampling, though further research is needed.

Keywords:
COST-EFFECTIVENESSDIABETIC FOOT ULCERINFECTIONMICROBIOLOGYRANDOMISED CONTROLLED TRIAL

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Area of Science:

  • Diabetic foot ulcer infections
  • Microbiology techniques
  • Health economics

Background:

  • Diabetic foot ulcers frequently become infected, potentially leading to amputation.
  • Current practice involves empiric antimicrobial treatment and wound sampling for culture and sensitivity.
  • Swab sampling is easier but less sensitive than tissue sampling for pathogen identification.

Purpose of the Study:

  • To compare tissue sampling versus swab sampling for suspected diabetic foot ulcer infections.
  • To assess the impact on ulcer healing, antibiotic prescribing, costs, and patient safety.
  • To evaluate agreement between culture and sensitivity and molecular microbiology techniques.

Main Methods:

  • A randomized controlled trial comparing tissue versus swab sampling in 21 UK clinics.
  • Substudies included comparing microbiology techniques, health economic analysis, and clinician perspectives.
  • Primary outcome was time to ulcer healing; secondary outcomes included antibiotic usage and quality of life.

Main Results:

  • The trial was stopped early due to poor recruitment (149/730 participants).
  • No significant difference in wound healing was observed between tissue and swab sampling (HR 1.01).
  • Swab sampling was associated with higher quality-adjusted life-years and lower costs.

Conclusions:

  • Tissue sampling for diabetic foot ulcer infections appears costlier and linked to lower quality-adjusted life-years than swabbing.
  • Agreement between culture and sensitivity and molecular microbiology was low, impacting antimicrobial prescribing decisions.
  • Clinician confidence in molecular methods was limited due to unfamiliar reporting.