Mechanisms of microbial infection and wound healing in diabetic foot ulcer: pathogenicity in the inflammatory-proliferative phase, chronicity, and treatment strategies
Summary: This narrative review examines how microbial infection disrupts the healing phases of diabetic foot ulcers (DFUs), particularly from inflammation to proliferation, and explores treatment strategies. The authors integrate microbial pathogenesis (e.g. virulence, biofilms, polymicrobial synergy) with wound biology to highlight how infection drives chronicity and delay. They also suggest multidimensional therapeutic approaches combining systemic and localized strategies.
Key Highlights:
- Pathogenesis of DFU/DFI: Infections impair healing by promoting persistent inflammation, extracellular matrix degradation, impaired angiogenesis, and immune dysregulation.
- Biofilms & virulence: Biofilm formation and microbial virulence factors shield pathogens, resist antibiotics, and perpetuate inflammatory stimuli.
- Polymicrobial dynamics: Gram-positive, gram-negative, anaerobes, and fungi interact within wound microbiomes, often synergistically worsening outcomes.
- Therapeutic strategy framework: The authors advocate a combined approach—glycemic control, antimicrobial therapy tailored to pathogens, debridement, offloading, vascular support, and intelligent dressings.
- Smart dressing evolution: Future wound dressings should integrate responsive systems (pH, ROS), controlled drug release, and functional enhancements like oxygen delivery or antimicrobial action.
Read the full article on Frontiers in Endocrinology
Keywords:
Qi Wang,
Chuyu Liu,
Jing An,
Jing Liu,
Yongpeng Wang,
Yulan Cai,
diabetic foot ulcer,
infection mechanisms,
chronic wounds,
smart dressings