Michigan Medicine, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Ann Arbor, MI, USA.
J Diabetes Sci Technol. 2022 Mar;16(2):353-363. doi: 10.1177/1932296821990097. Epub 2021 Feb 12.
One of the most prevalent complications of diabetes mellitus are diabetic foot ulcers (DFU). Diabetic foot ulcers represent a complex condition placing individuals at-risk for major lower extremity amputations and are an independent predictor of patient mortality. DFU heal poorly when standard of care therapy is applied. In fact, wound healing occurs only approximately 30% within 12 weeks and only 45% regardless of time when standard of care is utilized. Similarly, diabetic foot infections occur in half of all DFU and conventional microbiologic cultures can take several days to process before a result is known. DFU represent a significant challenge in this regard because DFU often demonstrate polymicrobial growth, become resistant to preferred antibiotic therapy, and do not inform providers about long-term prognosis. In addition, conventional culture yields may be affected by the timing of antibiotic administration and collection of tissue for analysis. This may lead to suboptimal antibiotic administration or debilitating amputations. The microbiome of DFU is a new frontier to better understand the interactions between host organisms and pathogenic ones. Newer molecular techniques are readily available to assist in analyzing the constituency of the microbiome of DFU. These emerging techniques have already been used to study the microbiome of DFU and have clinical implications that may alter standard of care practice in the near future. Here emerging molecular techniques that can provide clinicians with rapid DFU-related-information and help prognosticate outcomes in this vulnerable patient population are presented.
糖尿病最常见的并发症之一是糖尿病足溃疡（DFU）。糖尿病足溃疡是一种复杂的疾病，使患者面临下肢大截肢的风险，是患者死亡的独立预测因素。当应用标准治疗时，DFU 愈合不良。事实上，在 12 周内，只有大约 30%的伤口愈合，而无论何时应用标准治疗，只有 45%的伤口愈合。同样，一半的 DFU 会发生糖尿病足感染，而传统的微生物培养需要几天时间才能得出结果。DFU 在这方面构成了重大挑战，因为 DFU 通常表现出多种微生物生长，对首选抗生素治疗产生耐药性，并且不能为提供者提供长期预后信息。此外，常规培养的结果可能会受到抗生素给药时间和组织采集进行分析的影响。这可能导致抗生素给药不当或导致严重的截肢。DFU 的微生物组是一个新的前沿领域，可以更好地了解宿主生物和病原生物之间的相互作用。较新的分子技术可用于协助分析 DFU 微生物组的组成。这些新兴技术已经被用于研究 DFU 的微生物组，并且具有临床意义，可能在不久的将来改变标准治疗实践。本文介绍了一些新兴的分子技术，这些技术可以为临床医生提供与 DFU 相关的快速信息，并帮助预测这一脆弱患者群体的预后。
