Table of Contents
Overview of Diabetic Foot Infections and Their Risks
Diabetic foot infections (DFIs) pose a significant health risk for individuals with diabetes mellitus. These infections can lead to severe complications, including lower-extremity amputations, particularly for patients with poor glycemic control and associated comorbidities such as chronic kidney disease (CKD). The prevalence of diabetic foot ulcers is alarmingly high, affecting 19% to 24% of diabetic patients during their lifetime (Tarricone et al., 2025). The complications arising from these infections are not only physical but also psychological, leading to decreased quality of life and increased healthcare costs.
The pathophysiology of DFIs is complex and involves neuropathy, ischemia, and infection. Neuropathy leads to a loss of protective sensation in the feet, making patients unaware of injuries. Ischemia, often due to peripheral arterial disease (PAD), impairs wound healing and increases the risk of infection. Bacterial colonization of diabetic ulcers is common, with pathogens such as Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli frequently isolated in infected wounds (Iranian Journal of Microbiology, 2025).
Knowledge of these risks is crucial for healthcare providers, as early intervention and management can significantly improve outcomes for patients with DFIs. The identification of risk factors such as poor glycemic control, smoking, and advanced age is essential for developing effective preventative strategies.
Importance of Estimated Glomerular Filtration Rate (eGFR)
The estimated glomerular filtration rate (eGFR) is a critical biomarker in assessing kidney function and has significant implications for patients with diabetic foot infections. The severity of eGFR correlates with clinical outcomes in diabetic patients, particularly concerning wound healing and infection rates (Tarricone et al., 2025). In a study evaluating the association between eGFR and clinical outcomes in hospitalized patients with DFIs, it was found that lower eGFR values were linked to higher mortality rates and increased likelihood of re-hospitalization due to infections (1).
Patients with an eGFR of less than 30 mL/min exhibited significantly higher rates of comorbidities such as retinopathy and PAD, which are known to complicate diabetic foot infections. Moreover, the levels of inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were markedly elevated in patients with lower eGFR, indicating a stronger inflammatory response associated with poorer kidney function (Tarricone et al., 2025).
Table 1: Clinical Outcomes Based on eGFR Severity
| eGFR Group | Mortality Rate | Re-hospitalization Rate | Wound Healing Rate |
|---|---|---|---|
| ≥60 mL/min | 1.9% | 20.5% | 63.0% |
| 30–60 mL/min | 3.2% | 28.1% | 58.1% |
| <30 mL/min | 8.1% | 48.4% | 58.1% |
The data highlights the urgency of monitoring eGFR in diabetic patients, as it can serve as an important predictor of clinical outcomes and help guide treatment strategies.
Clinical Outcomes Associated with Diabetic Foot Infections
The clinical outcomes of DFIs are influenced by a variety of factors, including the severity of the infection, the presence of comorbidities, and the patient’s overall health status. Studies have shown that the risk of amputation is significantly higher in patients with both diabetes and CKD compared to those without these comorbidities (1).
Infections can range from mild cellulitis to severe osteomyelitis, and the time to healing can vary greatly. In a cohort study, it was observed that the average time to wound healing was significantly prolonged in patients with eGFR <30 mL/min, suggesting that kidney function plays a crucial role in the body’s ability to respond to and heal from infections (Tarricone et al., 2025).
Key Clinical Findings
- The presence of peripheral arterial disease is significantly associated with poor healing outcomes.
- Increased inflammatory markers, such as ESR and CRP, correlate with reduced eGFR levels and are indicative of a more severe infection.
- Patients with lower eGFR levels have a higher incidence of re-hospitalization for infections at different sites after initial treatment for DFIs.
Role of Coelomic Fluid in Treating Infections
Coelomic fluid derived from earthworms, particularly Eisenia fetida, has garnered attention for its potential antibacterial properties against pathogens commonly found in diabetic wounds. Research has demonstrated that coelomic fluid contains bioactive compounds with significant antimicrobial activity, making it a promising alternative to traditional antibiotics (Iranian Journal of Microbiology, 2025).
In vitro studies have shown that coelomic fluid exhibits strong antibacterial effects against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, the predominant bacteria involved in diabetic foot infections (2). The fluid’s protein content and antioxidant activities contribute to its efficacy in combating infections and promoting wound healing.
Antibacterial Activity of Coelomic Fluid
| Bacteria | Zone of Inhibition (mm) | Minimum Inhibitory Concentration (MIC, mg/ml) |
|---|---|---|
| Staphylococcus aureus | 12.5 | 0.312 |
| Pseudomonas aeruginosa | 14.2 | 0.208 |
| Escherichia coli | 11.3 | 0.625 |
| Bacillus subtilis | 10.0 | 0.833 |
The findings suggest that coelomic fluid could be developed into a therapeutic agent for diabetic foot infections, especially in the context of rising antibiotic resistance.
Innovative Approaches in Wound Care Management
Wound care management in diabetic foot infections has evolved significantly, incorporating innovative strategies and advanced technologies. This includes the use of bioengineered dressings, negative pressure wound therapy (NPWT), and the application of growth factors to enhance healing.
Advanced Wound Care Strategies
- Bioengineered Dressings: These dressings can provide a moist environment, promote cell migration, and deliver therapeutic agents directly to the wound site.
- Negative Pressure Wound Therapy (NPWT): NPWT has been shown to accelerate wound healing by applying suction to the wound bed, which reduces edema and enhances perfusion, leading to improved healing rates.
- Use of Growth Factors: Topical application of growth factors such as platelet-derived growth factor (PDGF) can stimulate tissue regeneration and enhance healing in chronic diabetic wounds.
Table 2: Comparison of Wound Care Techniques
| Technique | Benefits | Limitations |
|---|---|---|
| Bioengineered Dressings | Moist environment, drug delivery | Costly, may not be suitable for all wounds |
| NPWT | Accelerated healing, reduced edema | Requires specialized training to apply |
| Growth Factors | Stimulates tissue regeneration | Potential for allergic reactions |
The integration of these innovative wound care techniques into the management protocols for diabetic foot infections can significantly improve patient outcomes, reduce hospitalizations, and lower the risk of amputations.
Frequently Asked Questions (FAQ)
What are diabetic foot infections?
Diabetic foot infections are infections that occur in the feet of individuals with diabetes, often resulting from foot ulcers that can become infected due to neuropathy and poor blood flow.
How does estimated glomerular filtration rate (eGFR) impact diabetic foot infections?
Lower eGFR levels are associated with higher mortality rates, increased risk of re-hospitalization, and complications in diabetic foot infections, indicating a need for careful monitoring of kidney function.
What role does coelomic fluid play in wound care?
Coelomic fluid from earthworms contains antimicrobial properties that can effectively combat bacteria commonly found in diabetic wounds, presenting a potential alternative to traditional antibiotics.
What innovative strategies are used in treating diabetic foot infections?
Innovative strategies include the use of bioengineered dressings, negative pressure wound therapy (NPWT), and the application of growth factors to promote healing in diabetic foot ulcers.
References
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Tarricone, A., Coye, T. L., Gee, A., Najafi, B., Siah, M. C., & Lavery, L. A. (2025). The dialysis foot‐ the impact of presenting estimated glomerular filtration rate on clinical outcomes in patients hospitalized with diabetic foot infections. Int Wound J, 22(5), e70122
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Iranian Journal of Microbiology. (2025). In vitro investigations of coelomic fluid of Eisenia fetida: protein analysis, antioxidant activities and antibacterial effects on diabetic wounds’ bacteria. Iran J Microbiol, 17(1), 1-13
