LOWER LIMB SKIN MICROBIOME AND DIABETIC FOOT ULCER: A PERSPECTIVE ON THE PROBLEM
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i4.15580Keywords:
diabetic foot ulcer, skin microbiome of the lower extremities, virulence, biofilmsAbstract
Summary. Diabetic foot ulcer (DFU) is one of the most dangerous and traumatic complications of diabetes mellitus (DM). In a study conducted in the United States, the risk of hospitalization and amputation of the lower extremities among diabetics was three times higher among those who had a foot infection. All researchers, regardless of which hypothesis of the influence of the microbiome of the skin of the lower extremities they are supporters of, agree that its structure has a decisive influence on the infection of the ulcer surface in DM.
The aim – to analyze foreign and domestic publications in the PubMed, Scopus and Web of Science databases, devoted to research using various methods of the skin microbiome of the lower extremities and its role in the development of DFU.
Material and Methods. An analysis of literature sources from the PubMed, Scopus and Web of Science databases was conducted.
Results. The structure of the microbiome of the skin of the lower extremities has a decisive influence on the infection of the ulcer surface. The leading genera of microorganisms that are most often detected are Staphylococcus spp., Pseudomonas spp., Corynebacterium spp., Escherichia coli. Molecular methods based on the amplification of the 16S rRNA gene show that Staphylococcus spp. constitutes 70 % of the normal microbiome of the skin of the plantar zone of the foot (mainly coagulase-negative staphylococci). However, in patients with DFU, their proportion on intact skin is reduced to 7 %, which may indicate the loss of these protective bacteria or their replacement by other species, in particular S. aureus, which is a precursor to clinically pronounced infection. The virulence of opportunistic representatives of the skin microbiota, such as S. aureus, P. aeruginosa, E. coli, increases due to the formation of biofilms, which allows them to avoid the immune response of the macroorganism and increases their resistance to antimicrobial agents.
Conclusions. DFU is a dangerous complication of diabetes. Its development is closely related to the state of the skin microbiome of the lower extremities. Normal flora microorganisms can become pathogenic under the influence of such factors of diabetes as the level of glycemia, neuro- and angiopathy, as well as the duration and compensation of the disease. The formation of biofilms significantly increases the virulence of opportunistic bacteria (S. aureus, P. aeruginosa, E. coli). PCR is recognized as the most informative method for studying the microbiome, provided that the material is correctly collected and delivered.
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