Real-time detection and monitoring of bacteria in diabetic wounds using bacterial fluorescence

Background Real-time monitoring of bacterial dynamics is essential for preventing the progression of diabetic foot infections (DFIs). This study characterizes bacterial fluorescence in infected diabetic wounds and evaluates its utility for real-time infection surveillance during antimicrobial treatment. Methods A diabetic rat model was established, and full-thickness wounds were inoculated with three representative bacterial species. Antimicrobial interventions were subsequently administered. Bacterial fluorescence, bacterial burden, and wound status were longitudinally assessed. Results Inoculation with 10 3 CFU was sufficient to establish infection, enabling in vivo visualization of bacterial fluorescence, which emerged 1–3 days prior to the onset of clinical signs. Fluorescence intensity showed a strong association with both swab- and tissue-derived bacterial burden, and persistent fluorescence was associated with sustained infection and delayed healing. In Escherichia coli and Staphylococcus aureus infections, both antibiotic therapy and debridement markedly reduced bacterial burden, decreased fluorescence intensity, attenuated inflammation, and improved wound healing with comparable efficacy. In contrast, Pseudomonas aeruginosa infections exhibited recurrent fluorescence and bacterial regrowth following antibiotic therapy, accompanied by persistent inflammation and impaired tissue repair, whereas debridement provided superior bacterial control and more favorable healing outcomes. Conclusion These findings elucidate the relationship between bacterial fluorescence and infection dynamics and suggest that fluorescence imaging may serve as a real-time, noninvasive tool for detecting and monitoring diabetic wound infections.