The Role of Probiotics in Management of Infected Diabetic Foot Ulcers

 Diabetic foot ulcer (DFU) is one of the common reasons for non-traumatic amputation of the lower limbs, which requires proper diagnosis, proper collection of specimens, careful selection of antibiotics, treatment of infection based on the disease condition, quick decision about whether or not surgery is necessary and other types of wound care. Probiotics are suggested as non-pathogenic microorganisms due to antibiotic resistance in the treatment of DFU. The effects of probiotics on immune function, skin diseases, and diabetes have been studied and recent evidence suggests their effect on DFU through controlling hyperglycemia, improving immune function, and modulating the microbiota as possible mechanisms. In this review article, we discuss the role of probiotics in healing chronic infected wounds of the diabetic foot from several perspectives including the role of microbiota in glycemic control, the effect of probiotics on the immune system, inflammatory markers, wound healing acceleration, and infection control. Topical application and oral intake of probiotics, especially when used as adjunctive therapies with antibiotics, seems to facilitate the healing process of infected diabetic foot ulcers.