ArticleInternational wound journal2017
Microscopy visualisation confirms multi-species biofilms are ubiquitous in diabetic foot ulcers.
Article in International wound journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 115 citations in OpenAlex.
- Effect on total microbial load and community composition with two vs six-week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers.International wound journal · 2019Trial
- An update on biofilms in acute and chronic wounds: Incidence, clinical evidence, diagnosis, prevention, and treatment.Journal of internal medicine · 2026Review
- Combined Effects of Amikacin and Methylene Blue-Mediated Photodynamic Therapy onPathogens (Basel, Switzerland) · 2026Article
- De Novo Design Strategies of Nanomedicines for Diabetic Wound Microenvironment Remodeling.BME frontiers · 2026Review
- Beyond susceptibility testing: traditional Chinese medicine-associated compounds as candidate antibiotic adjuncts in chronic-wound biofilms.Frontiers in cellular and infection microbiology · 2026Review
- A longitudinal profiling of microbiome of diabetic foot ulcers shows functional role of microbial communities in wound worsening and chronicity.Current research in microbial sciences · 2026Article
- Microbial Biofilms as Barriers to Chronic Wound Healing: Diagnostic Challenges and Therapeutic Advances.Journal of clinical medicine · 2025Review
- Clinical Signs and Symptoms of Biofilm in Chronic Wounds. What Do Practitioners Think? Consensus Through an Electronic Delphi Survey.International wound journal · 2025Article
- Functionally enriched human polymorphisms associate to species in the chronic wound microbiome.NPJ biofilms and microbiomes · 2025Article
- Current and Future Directions in Fluorescence Imaging-Guided Debridement.Advances in wound care · 2025Review
- A Scoping Review to Identify Clinical Signs, Symptoms and Biomarkers Reported in the Literature to Be Indicative of Biofilm in Chronic Wounds.International wound journal · 2025Article
- In Vivo Antimicrobial Activity of Nisin Z AgainstAntibiotics (Basel, Switzerland) · 2025Article
- Interactions between Helcococcus kunzii and Staphylococcus aureus: How a commensal bacterium modulates the virulence and metabolism of a pathogen in a chronic wound in vitro model.BMC microbiology · 2024Article
- Modulations of the skin microbiome in skin disorders: A narrative review from a wound care perspective.International wound journal · 2024Review
- Anaerobes in diabetic foot infections: pathophysiology, epidemiology, virulence, and management.Clinical microbiology reviews · 2024Review
- An Overview of Biofilm-Associated Infections and the Role of Phytochemicals and Nanomaterials in Their Control and Prevention.Pharmaceutics · 2024Review
- Next Steps: Studying Diabetic Foot Infections with Next-Generation Molecular Assays.Current infectious disease reports · 2023Article
- Lights, fluorescence, action-Influencing wound treatment plans including debridement of bacteria and biofilms.International wound journal · 2023Article
- A review of mechanism analysis methods in multi-species biofilm of foodborne pathogens.Food science and biotechnology · 2023Review
- Quantitative Insights and Visualization of Antimicrobial Tolerance in Mixed-Species Biofilms.Biomedicines · 2023Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Increasing evidence within the literature has identified the presence of biofilms in chronic wounds and proposed that they contribute to delayed wound healing. This research aimed to investigate the presence of biofilm in diabetic foot ulcers (DFUs) using microscopy and molecular approaches and define if these are predominantly mono- or multi-species. Secondary objectives were to correlate wound observations against microscopy results in ascertaining if clinical cues are useful in detecting wound biofilm. DFU tissue specimens were obtained from 65 subjects. Scanning electron microscopy (SEM) and peptide nucleic acid fluorescent in situ hybridisation (PNA-FISH) techniques with confocal laser scanning microscopy (CLSM) were used to visualise biofilm structures. Next-generation DNA sequencing was performed to explore the microbial diversity. Clinical cues that included the presence of slough, excessive exudate, a gel material on the wound bed that reforms quickly following debridement, poor granulation and pyocyanin were correlated to microscopy results. Of the 65 DFU specimens evaluated by microscopy, all were characterised as containing biofilm (100%, P < 0·001). The presence of both mono-species and multi-species biofilms within the same tissue sections were detected, even when DNA sequencing analysis of DFU specimens revealed diverse polymicrobial communities. No clinical correlations were identified to aid clinicians in identifying wound biofilm. Microscopy visualisation, when combined with molecular approaches, confirms biofilms are ubiquitous in DFUs and form either mono- or multi-species biofilms. Clinical cues to aid clinicians in detecting wound biofilm are not accurate for use in DFUs. A paradigm shift of managing DFUs needs to consider anti-biofilm strategies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.