Abstract
Diabetic patients are more prone to the development of foot ulcers, because their
underlying tissues are exposed to colonization by various pathogenic organisms. Hence,
biofilm formation plays a vital role in disease progression by antibiotic resistance
to the pathogen found in foot infections. The present study has demonstrated the correlation
of biofilm assay with the clinical characteristics of diabetic foot infection. The
clinical characteristics such as the ulcer duration, size, nature, and grade were
associated with biofilm production. Our results suggest that as the size of the ulcer
with poor glycemic control increased, the organism was more likely to be positive
for biofilm formation. A high-degree of antibiotic resistance was exhibited by the
biofilm-producing gram-positive isolates for erythromycin and gram-negative isolates
for cefpodoxime. Comparisons of biofilm production using 3 different conventional
methods were performed. The strong producers with the tube adherence method were able
to produce biofilm using the cover slip assay method, and the weak producers in tube
adherence method had difficulty in producing biofilm using the other 2 methods, indicating
that the tube adherence method is the best method for assessing biofilm formation.
The strong production of biofilm with the conventional method was further confirmed
by scanning electron microscopy analysis, because bacteria attached as a distinct
layer of biofilm. Thus, the high degree of antibiotic resistance was exhibited by
biofilm producers compared with nonbiofilm producers. The tube adherence and cover
slip assay were found to be the better method for biofilm evaluation.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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