Foot infections are the main disabling complication in patients with diabetes mellitus. These infections can lead to lower-limb amputation, increasing mortality and decreasing the quality of life. Biofilm formation is an important pathophysiology step in diabetic foot ulcers (DFU)—it plays a main role in the disease progression and chronicity of the lesion, the development of antibiotic resistance, and makes wound healing difficult to treat. The main problem is the difficulty in distinguishing between infection and colonization in DFU. The bacteria present in DFU are organized into functionally equivalent pathogroups that allow for close interactions between the bacteria within the biofilm. Consequently, some bacterial species that alone would be considered non-pathogenic, or incapable of maintaining a chronic infection, could co-aggregate symbiotically in a pathogenic biofilm and act synergistically to cause a chronic infection. In this review, we discuss current knowledge on biofilm formation, its presence in DFU, how the diabetic environment affects biofilm formation and its regulation, and the clinical implications.

中文翻译：

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糖尿病足溃疡中的生物膜：意义和临床意义。

足部感染是糖尿病患者的主要致残并发症。这些感染可导致下肢截肢，死亡率增加和生活质量下降。生物膜形成是糖尿病足溃疡（DFU）的重要病理生理步骤-它在疾病进展和病变的慢性，抗生素耐药性的发展中起主要作用，并使得伤口愈合难以治疗。主要问题是难以区分DFU中的感染和定植。DFU中存在的细菌被组织成功能上等同的病原体，这些病原体允许生物膜内细菌之间的紧密相互作用。因此，仅被认为是非致病性的或不能维持慢性感染的一些细菌物种可以在病原生物膜中共生共聚并协同作用以引起慢性感染。