Microbiological characteristics of ulcerative lesions in t2dm with consideration of the Wagner classification model
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2026.3.16511Keywords:
Diabetes Mellitus, Diabetic Foot Syndrome, microorganisms, Wagner classification, microbiotaAbstract
According to monitoring studies, the number of patients with type 2 diabetes mellitus among the population of Ukraine increases annually by an average of 5–7 %, followed by the development of Diabetic Foot Syndrome, the pathogenesis of which is caused by massive microbial contamination. A comprehensive approach to the diagnosis and treatment of this pathology, incorporating both the microbiological aspect and the use of various classification scales, will facilitate the standardization of clinical assessment and simplify the selection of therapeutic strategies.
Objective of the study: to determine the relationship between the severity of purulent-necrotic lesions in Diabetic Foot Syndrome in patients with Type 2 Diabetes Mellitus and the degree of microbial contamination according to the Wagner classification. The study included wound exudate obtained from 75 patients with Type 2 Diabetes Mellitus complicated by Diabetic Foot Syndrome. The severity of soft tissue destruction was assessed by stratifying patients using the Wagner classification. Microbiological analysis was performed at the Department of Microbiology, Virology, and Immunology of I. Horbachevsky Ternopil National Medical University. The study findings demonstrated that the peak incidence of Diabetic Foot Syndrome was observed in the 61–70 age group: 34.6 % among men and 13.3 % among women. Assessment of the degree of carbohydrate metabolism compensation revealed a predominance of the subcompensation stage (78.6 %). According to the Wagner classification, grade IV lesions were predominant (82.7 %), in which strains of Klebsiella spp. and Pseudomonas aeruginosa were identified. According to the Wagner classification, a high frequency (82.7 %) of grade IV lesions was established, with a predominance of deep purulent-necrotic lesions associated with the presence of antibiotic-resistant strains of Klebsiella spp. and Pseudomonas aeruginosa.
References
1. Dawi J, Tumanyan K, Tomas K, Misakyan Y, Gargaloyan A, Gonzalez E, Hammi M, Tomas S, Venketaraman V. Diabetic Foot Ulcers: Pathophysiology, Immune Dysregulation, and Emerging Therapeutic Strategies. Biomedicines. 2025 Apr 29;13(5):1076. DOI: 10.3390/biomedicines13051076. DOI: https://doi.org/10.3390/biomedicines13051076
2. Packer CF, Ali SA, Manna B. Diabetic Foot Ulcer. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
3. National Institute for Health and Care Excellence. Diabetic foot problems: prevention and management. NICE guideline [NG19] [Internet]. London: NICE; 2015 [updated 2019 Oct; cited 2026 Jan 19].
4. Volch I, Mykhailyshyn H, Pokotylo O, Hetman U, Bukata, V. Microbiological analysis of wound content in patients with type 2 diabetes mellitus with diabetic foot syndrome. International Journal of Medicine and Medical Research. 2024;10(1):6-14. DOI: 10.61751/ijmmr/1.2024.06. DOI: https://doi.org/10.61751/ijmmr/1.2024.06
5. Soldevila-Boixader L, Carrera-Salinas A, Mur I, Morata L, Rivera A, Bosch J, et al. Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome. Antibiotics. 2025;14(7):724. DOI: 10.3390/antibiotics14070724. DOI: https://doi.org/10.3390/antibiotics14070724
6. Saleem MN, Mir A, Ullah U, et al. The Association of Wagner Classification, Microbial Resistance, Immune Markers, and Glycemic Control With Diabetic Foot Ulcer Severity: A Multi-disciplinary Approach to Predict Severity and Outcome. Cureus. 2025;17(8):e90914. DOI: 10.7759/cureus.90914. DOI: https://doi.org/10.7759/cureus.90914
7. Huang Y, Tang Y, Zhao X, Xu M, Chen M. Novel insights into the role of gut microbiota and its metabolites in diabetic chronic wounds. FASEB J. 2025;39(1):e70316. DOI: 10.1096/fj.202401478RR. DOI: https://doi.org/10.1096/fj.202401478RR
8. Shivani Reddy P, Durai Singh, C., Kumar, S., & Muthusamy, R.. Prevalence and Antibiotic Resistance of Klebsiella pneumoniae in Diabetic Foot Ulcer. Cureus. 2024;16(8), e67824. DOI: 10.7759/cureus.67824. DOI: https://doi.org/10.7759/cureus.67824
9. Huy TX. Overcoming Klebsiella pneumoniae antibiotic resistance: new insights into mechanisms and drug discovery. Beni-Suef Univ J Basic Appl Sci. 2024;13:8. DOI: 10.3390/bacteria5010009. DOI: https://doi.org/10.1186/s43088-024-00470-4
10. Golovakha M, Klyatsky Yu, Kozhemyaka M, Maslennikov S, Kosylo V. Justification of the complex treatment of purulous complications of foot injuries in patients with diabetes mellitus. East Ukr Med J. 2024;12(2):359-368. DOI: 10.21272/eumj.2024;12(2):359-68. DOI: https://doi.org/10.21272/eumj.2024;12(2):359-368
11. Polyovyy VP, Khorshani B, Petrynych VV, Kyfyak PV, Tkachuk OV, Sydorchuk RI. Features of the early process in diabetic foot syndrome. Khark. Surg. Sch. [Internet]. 2020Feb.28 [cited 2026Jun.10];0(2):21-5. DOI: 10.37699/2308-7005.2.2020.04. DOI: https://doi.org/10.37699/2308-7005.2.2020.04
12. Waghmare S, Meshram H, Mahey R, Shetty T, Singh A. Evaluation and management of diabetic foot according to Wagner’s classification. Int J Surg. 2019;3(3):197-201. DOI: 10.33545/surgery.2019.v3.i4d.239. DOI: https://doi.org/10.33545/surgery.2019.v3.i4d.239
13. Mrozikiewicz-Rakowska B, Jawień A, Szewczyk M, Sopata M, Korzon-Burakowska A, Dziemidok P, et al. [Management of a patient with diabetic foot syndrome - guidelines of the Polish Wound Management Association 2021: part 1]. Leczenie Ran. 2021;18(3):71-114. DOI: 10.15374/LR20015011.
14. Malka M, Krakowiecki A, Chojak M, Pławski M, Wądołek M, Wołowicz A, et al. The Pathogen Isolates in Chronic Wound Infections in Poland. Pol J Microbiol. 2023 Jun 14;72(2):133-42. DOI: 10.33073/pjm-2023-014. DOI: https://doi.org/10.33073/pjm-2023-014
15. Shah P, Inturi R, Anne D, Jadhav D, Viswambharan V, Khadilkar R, et al. Wagner’s Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital. Cureus. 2022 Jan 22;14(1). DOI: 10.7759/cureus.21501. DOI: https://doi.org/10.7759/cureus.21501
16. Gandhi C, Kadam P, Kamepalli V, Kadam Y. PEDIS grading and its role in diabetic foot ulcer management. International Surgery Journal. 2019 Jun 29;6(7):2548. DOI: 10.18203/2349-2902.isj20192990. DOI: https://doi.org/10.18203/2349-2902.isj20192990
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Iryna Volch, Halyna Mykhailyshyn, Andrii Ilnytskyi
This work is licensed under a Creative Commons Attribution 4.0 International License.
