REPRESSION OF BACTERIAL BIOFILMS IN SUPPURATIVE NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME BY ULTRASOUND CAVITATION

Aim. Study of wound microbial landscape in suppurative necrotic complications in patients with diabetic foot syndrome (DFS), and a possibility of suppression of bacterial biofilm development in these wounds by ultrasound cavitation (USC). Materials and methods. 2 randomized groups of patients were included in the study: main group of 145 individuals with suppurative necrotic complications of DFS, who received ultrasound cavitation therapy, and comparison group of 86 patients who received basic therapy. In the main group Sonoca-180 (Söring, Germany) unit, that allows to combine the process of mechanical wound treatment with antibacterial action of low frequency ultrasound, was used for wound treatment. Quantitative and qualitative composition of wound microflora was studied by using bacteriological method with parallel utilization of transmission and scanning electron microscopy in the dynamic of USC treatment. Results. In patients with DFS bacterial biofilms containing congestions in the polysaccharide matrix and fixed at the surface of dense structure of periostenum wound were detected. In the microbial landscape in DFS patients in 21% of cases aerobic-anaerobic microflora was detected, while associations included mostly from 2 to 5 bacteria species — members of the Peptococcus, Peptostreptococcus, Prevоtella, Bacteroides genera. Bacteria of Staphylococcus, Acinetobacter, Pseudomonas, Escherichia and Klebsiella sp. genera were detected less frequently. Application of USC in the main group resulted in a decrease of microbial contamination of wounds in the short term. Conclusion. USC method, when compared with classical therapy approach in DFS complications, in patients with suppurative necrotic complications allows not only to remove mechanically the necrotic tissues but also to effectively suppress the bacterial biofilms that have formed in the wounds, this promotes the acceleration of recovery process and preparation of the patients for further plastic surgery intervention.

microbial landscape, bacterial biofilms, diabetic foot syndrome, therapy, ultrasound cavitation method