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Diabetic Foot Ulcer Recurrence Due to History of Bacterial Biofilm
Mithun Sinha, Nandini Ghosh, Sashwati Roy, Gayle M Gordillo, Chandan K Sen
Indiana University School of Medicine
2020-02-14
Presenter: Mithun Sinha
Affidavit:
The work is original and contributed by Dr. Sinha
Director Name: Chandan K Sen
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Aesthetics
DIABETIC FOOT ULCER RECURRENCE DUE TO HISTORY OF BACTERIAL BIOFILM
Mithun Sinha, Nandini Ghosh, Sashwati Roy, Gayle Gordillo, Chandan K Sen
Division of Plastic Surgery, Indiana University
Background: Diabetic foot ulcers (DFU) are most common reasons for hospitalization of diabetic patients and frequently results in amputation of lower limbs. DFU recurrence rate is 40% within one year after closure. Polymicrobial biofilm aggregates have emerged as a major threat in wound healing outcomes as in this form microbes acquire more resistance to host defenses.
Methods: Patients with closed DFU were recruited at wound clinic. Trans-epidermal water loss (TEWL) at closed DFU-site of patients was measured using a hand held TEWL machine. Biofilm infection was determined structurally using Scanning Electron Microscopy (SEM) and validated using genetic tests (PCR for biofilm genes).
Results: High TEWL at the closed DFU-site was associated with DFU recurrence (N=28). High TEWL was defined as 37 g.m-2h-1 at the closed DFU-site based on receiver operating curve (ROC) analysis with Youden's index by correlating 75% sensitivity versus 85% specificity. Subjects showing high TEWL at the closed DFU-site had history of biofilm infection as validated through SEM.
Conclusion: This study associates history of biofilm infection to be a confounding factor for DFU-recurrence. The study suggests compromised skin barrier post-closure due to biofilm infection as the causative factor for recurrence. It emphasizes to determine the restoration of skin barrier as the primary endpoint for wound healing instead of the current clinical practice of skin closure without drainage as the healing endpoint.
