ANKMJ
Ankyra Medical Journal

Ankyra Medical Journal (AnkMJ), formerly known as the Journal of Translational and Practical Medicine, regularly publishes international quality issues in the field of Medicine in the light of current information.

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A syndromic review of the microbial features and patterns in diabetic foot ulcers
Abstract
Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus, frequently complicated by microbial infections that impede wound healing and substantially increase the risk of lower-extremity amputation and death. Understanding the microbial ecology, resistance patterns, and diagnostic landscape of DFUs is a clinical imperative. This syndromic review evaluates the significance of microbial infection in DFUs, appraises current diagnostic and therapeutic approaches, and explores how emerging strategies can improve clinical management outcomes. A comprehensive literature search was conducted across Scopus, PubMed, and Web of Science, supplemented by Google Scholar, yielding 55 relevant qualitative and mixed-method studies published between January 2000 and December 2025. Eligible studies presented primary microbiological characterization data, syndromic pattern descriptions, or antibiotic susceptibility findings. Studies not available in English, purely translational or laboratory-based findings without clinical correlates, and publications lacking a clear methodological framework were excluded. DFUs harbour diverse microbial communities, including Gram-positive cocci (principally Staphylococcus aureus, including methicillin-resistant strains), Gram-negative bacilli (Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae), obligate anaerobes (Bacteroides fragilis, Peptostreptococcus spp.), and fungi (Candida spp.). Biofilm formation is a central mechanism underlying chronicity and antibiotic resistance. Microbial profiles shift temporally from monomicrobial Gram-positive colonization in acute ulcers to polymicrobial, anaerobe-enriched communities in chronic wounds. Geographic variation is pronounced: high-income regions are dominated by Gram-positive pathogens, while low- and middle-income settings bear a disproportionate Gram-negative burden. Resistance rates are alarmingly high, with methicillin-resistant S. aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, and multidrug-resistant (MDR) Gram-negative rods posing the greatest therapeutic challenges. Advanced diagnostic tools—including 16S rRNA sequencing, shotgun metagenomics, MALDI-TOF mass spectrometry, and fluorescence imaging—are increasingly employed alongside conventional culture to improve microbial identification and therapeutic precision. A comprehensive understanding of the dynamic microbial ecology of DFUs—incorporating temporal shifts, resistance patterns, the role of biofilms, and emerging diagnostic technologies—is essential for guiding evidence-based therapeutic strategies. Integration of precision diagnostics and novel therapies, including bacteriophage therapy, antimicrobial peptides, and topical probiotics, holds meaningful promise for improving clinical outcomes in this high-risk population.

Keywords : Antibiotic resistance, biofilms, diabetic foot ulcers, diabetic foot infections, microbial ecology, MRSA, polymicrobial infections, wound microbiome

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Article available in :
Volume 5, Issue 3, 2026
Page : 80-91
https://doi.org/10.51271/ANKMJ-0072
Article Information
Received : 11 Nis 2026
Accepted : 15 May 2026
Published : 07 Tem 2026
Corresponding Author :

Patrick Ashinze: Department of Medicine, Faculty of Clinical Sciences, University of Ilorin Teaching Hospital, Ilorin, Nigeria

[email protected]
Citation : Ashinze P, Obinnakwelu FC, Noze-Otote O, et al. A syndromic review of the microbial features and patterns in diabetic foot ulcers. Ank Med J. 2026;5(3):80-91. doi:10.51271/ANKMJ-0072

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