Treating infected diabetic feet requires new approaches. The number of people with diabetes and its complications is growing, and diabetic foot infections are increasingly unresponsive to traditional antibiotics. This leads to an increase in amputations and mortality. In search of new treatments for infected ulcers in diabetic foot patients, doctors have turned to bacteriophages.

Diabetic foot syndrome is a pathological condition of the feet of patients with diabetes mellitus that occurs due to damage to the peripheral nerves, blood vessels, skin, soft tissues, bones, and joints. This creates the conditions for the development of acute and chronic ulcers, bone and joint lesions, and purulent-necrotic processes. Infection plays a key role in the pathogenesis of diabetic foot. Patients with purulent-necrotic forms of diabetic foot often harbor opportunistic microorganisms resistant to most commonly used antibiotics, including Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Streptococcus haemolyticus, Enterococcus sp ., and others.

The article by Fish R, Kutter E et al., 2016 * describes the experience of topical use of antistaphylococcal bacteriophage that lyses methicillin-resistant strains of Staphylococcus aureus in patients with infected foot ulcers with severe angiopathy and bone lesions, in the absence of a response to antibiotic therapy.

Nine patients for whom amputation was the only option were given bacteriophages as part of a compassionate use trial. The commercially available anti-staphylococcal phage Sb-1, with a fully sequenced genome, was used. The phage solution was applied topically to the ulcer once a week, followed by standard wound care. The volume of solution applied depended on the ulcer area.

All cases responded to antimicrobial treatment with bacteriophages: the ulcers healed in an average of seven weeks. In one patient with severe foot ischemia, treatment took 18 weeks.

The authors believe that the success of phage therapy in these cases is the basis for conducting large-scale clinical trials of phage preparations for the treatment of infected diabetic foot, including cases of impaired blood supply to the foot, bone involvement in the process, and the ineffectiveness of antibiotic therapy.

* Fish R, Kutter E, Wheat G, Blasdel B, Kutateladze M, Kuhl S. Bacteriophage treatment of intransigent diabetic toe ulcers: a case series // J Wound Care, 2016, 25 Suppl 7 : S27-33 . doi: 10.12968/jowc.2016.25.7.S27.