Diabetes and foot infection: more than double trouble

BACKGROUND: Infection of foot ulcers is a common, often severe and costly complication in diabetes. Many factors linked to the host, mainly immune defects, neuropathy and arteriopathy, as well as bacteria-related factors, interact in a complex way and account for the susceptibility of diabetic individuals to foot infections, the severity of such infections and difficulty to treat them. METHODS: This article reviews these factors, in the light of data from the literature and from our own results. RESULTS: DFIs are not as simple as previously suggested, and new concepts must be considered, especially the virulence potential of isolates and bacterial communications through biofilms. CONCLUSION: The development of new tools from molecular biology is a critical step to better understand and manage these infections.