Recently, research undertaken by the UK's House of Commons library at the request of the UK's Labor Party revealed that diabetic foot and toe amputations performed by the UK's National Health Service (NHS)
has risen by 26%. Between April 2010 and March 2013, minor amputations due to diabetes numbered 15,075. This has risen to 19,073 in the same 3-year period of 2014 - 2017. Though the Department of Health and Social Care acknowledge that the rate of minor amputations have increased, it is also important to note that they state that the number of major amputations (above the ankle) have decreased. Regardless, diabetic foot amputations are estimated to cost the NHS over £44 million just in the year 2016.
Patients typically arrive at the point of requiring a lower limb amputation due to tissue necrosis resulting from an infected diabetic foot ulcer (DFU). DFUs are hard to heal wounds that remain open for extended time. Thus, extra care is required in keeping the wound clean and in preventing infection. DFUs are formed in the first place due to ischemia and neuropathy, two side effects of poor blood glucose management.
Clearly, the best intervention is to prevent the formation of DFUs in the first place. This may begin in good management of blood glucose to prevent ischemia and neuropathy, though sensor technologies can also be used for the express purpose of preventing DFUs
. Once the wound is formed, preventing and treating any wound infection is critical. However, there are many factors that healthcare providers have to contend with during the treatment of DFUs.
Healthcare providers can choose to actively prevent wound infection using an advanced wound dressing. These wound dressings, which are more expensive than regular wound dressings, can be infused with silver nanoparticles, or with other positively charged materials that induce the breakage of the bacterial cell wall. There are a large number of advanced wound dressing options available, which can be found in IDTechEx
Research's report on Advanced Wound Care Technologies
. Additionally, frequent debridement, especially when guided by a bacterial imaging device
, can go a long way in the management of bacteria levels within the wound.
Typically, a healthcare provider begins treatment of an infected wound when the patient shows obvious clinical signs and symptoms of infection. However, in some cases, this is too late to prevent amputation. Rapid diagnostic of a wound's status may provide a solution to this conundrum. A test such as Woundchek's protease status biosensor detects high levels of protease activity from bacteria, which has been shown to be indicative of an infected wound, even before clinical signs and symptoms. Using this test, physicians may provide interventional care within the same appointment, thus preventing the escalation of the wound infection and subsequently, the prevention of amputations.
Though antibiotics may seem like an obvious choice in treating a wound infected with bacteria, bacteria within the wound is often resistant to the antibiotic, whether inherently, due to the possession of antibiotic resistance genes, or merely by the protection of bacterial biofilm. To address
the first problem, DNA-based diagnostic tests, such as those offered by CogenDx, can be used to identify the microbial species in the wound down to their antibiotic resistance with a 1 business day turnaround. By identifying the antibiotic resistance genes, a physician can treat a patient effectively without going through a lengthy trial and error of different antibiotics. The second problem of bacterial biofilm can be addressed by debridement, but also by biofilm dissolving and disrupting technologies.
Top image: Arditor