A diabetic foot ulcer (DFU) is a major complication in patients with diabetes. Frequent wound infections and delayed wound healing increase the probability of diabetes-related amputations. The associated morbidity reduces quality of life and also increases mortality risk. Biofilms play a significant role in progression of the wound, development of antibiotic resistance and so make the wound harder to treat. The bacterial flora of DFU is polymicrobial and mainly comprises the commensal bacteria. Colonization and infection in the wound are precariously balanced. Some non-pathogenic bacteria may co-exist with pathogenic bacteria in the biofilm and the synergistic interaction between the two leads to chronic infection. The bacterial diversity causes a thicker biofilm, which enhances their survival and increases the severity of infection. The bacteria present in DFU are organized into functionally equivalent pathogroups that allow for close interactions between the pathogenic and commensal bacteria within the biofilm leading to a state of chronic infection.

Differentiating between infection and colonization in diabetic foot ulcer is challenging for the clinician. Inappropriate use of antibiotics may result in development of MDR bacteria, which is another major issue of concern in DFUs. This article discusses the current evidence about biofilms, their role in DFUs and the impact of diabetes on the formation of biofilms.  

Source: Pouget C, et al. Microorganisms. 2020 Oct 14;8(10):1580.