Correlation Between Bacteria Count Using a Rapid Bacterium Counting System and Changes in Wound Area on Diabetic Foot Ulcers in Indonesia: A Prospective Study
Restricted accessResearch articleFirst published online June, 2025
Correlation Between Bacteria Count Using a Rapid Bacterium Counting System and Changes in Wound Area on Diabetic Foot Ulcers in Indonesia: A Prospective Study
This study aimed to clarify the correlation between changes in bacterial number and wound area in diabetic foot ulcers (DFUs). This study used a prospective longitudinal cohort design. A total of 30 participants met the inclusion criteria. Changes in bacterial number and wound area were evaluated weekly until week 4. The chi-square test indicated no significant correlation between biofilm formation and wound area (p = 0.32) but a significant correlation between bacterial count and wound area (p = 0.05). Logistic regression analysis showed a significant correlation between bacterial count and changes in wound area (odds ratio, 0.60; 95% confidence interval [CI], 0.372-0.997; p = 0.04). The receiver operating characteristic analysis showed an area under the curve of 0.660 (95% CI, 0.52-0.79; p = 0.03) with a sensitivity of 97% and specificity of 88%. The present prospective longitudinal cohort study demonstrated the correlation between bacterial count changes and wound area in DFUs. Our results suggest that changes in bacterial count could help wound healing evaluations.
ZhangPLuJJingYTangSZhuDBiY. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-116. doi:10.1080/07853890.2016.1231932
3.
YusufSOkuwaMIrwanM, et al.Prevalence and risk factor of diabetic foot ulcers in a regional hospital, eastern Indonesia. Open J Nurs. 2016;6(January):1-10. doi:10.4236/ojn.2016.61001
4.
MoxeyPWGogalniceanuPHinchliffeRJ, et al.Lower extremity amputations - a review of global variability in incidence. Diabet Med. 2011;28(10):1144-1153. doi:10.1111/j.1464-5491.2011.03279.x
5.
GdeTPemayunDNaibahoRM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in semarang, Indonesia. Diabet Foot Ankle. 2017;8(1):1–8. doi:10.1080/2000625X.2017.1312974
6.
CrockerRMPalmerKNBMarreroDGTanT-W. Patient perspectives on the physical, psycho-social, and financial impacts of diabetic foot ulceration and amputation. J Diabetes Complications. 2021;35(8):107960. https://doi.org/10.1016/j.jdiacomp.2021.107960
YangWDallTMHalderP, et al.Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033-1046. doi:10.2337/dc12-2625
9.
Sukmawati, Laitung B, Irwan M, Rassa S, Yusuf S. Analisa beban biaya dan waktu perawatan Luka Kaki Diabetes (LKD) gangren unit pelayanan home care: retrospective cohort study. J Luka Indones. (Indonesian) 2016;2(1):65–70.
GriceEASegreJA. Interaction of the microbiome with the innate immune response in chronic wounds. Adv Exp Med Biol. 2012:55–58. 2012; doi:10.1007/978-1-4614-0106-3_4
12.
CeilleyGHR. Chronic wound healing: a review of current management and treatments. Adv Ther. 2017;34(3):599-610. doi:10.1007/s12325-017-0478-y
13.
PanuncialmanJFalangaV. The science of wound be d preparation. Surg Clin North Am. 2009;89(3):611-626. doi:10.1016/j.suc.2009.03.009
14.
HaalboomMBlokhuis-ArkesMHEBeukRJ, et al.Wound swab and wound biopsy yield similar culture results. Wound Repair Regen. 2018;26(2):192-199. https://doi.org/10.1111/wrr.12629
15.
BillTJRatliffCRDonovanAMKnoxLKMorganRFRodeheaverGT. Quantitative swab culture versus tissue biopsy: a comparison in chronic wounds. Ostomy Wound Manage. 2001;47(1):34-37. 11889654
NakagamiGYoshidaSMatsumotoM, et al.A new objective evaluation method for PU cleansing using a rapid bacteria counting system. J Wound Care. 2013;22(5):278–281. doi:10.12968/jowc.2013.22.5.278
18.
KunimitsuMNakagamiGKitamuraA, et al.The combination of high bacterial count and positive biofilm formation is associated with the inflammation of pressure ulcers. Chronic Wound Care Manag Res. 2019;6:1–7. doi:10.2147/cwcmr.s187733
19.
DaviesCEHillKENewcombeRG, et al.A prospective study of the microbiology of chronic venous leg ulcers to reevaluate the clinical predictive value of tissue biopsies and swabs. Wound Repair Regen. 2007;15(1):17-22. doi:10.1111/j.1524-475X.2006.00180.x
20.
IiJCLMarstonWAFarberAKirsnerRS. The influence of patient and wound variables on healing of venous leg ulcers in a randomized controlled trial of growth-arrested allogeneic keratinocytes and fi broblasts. J Vasc Surg. 2013;58(2):433-439. doi:10.1016/j.jvs.2012.12.055
21.
InternationalW. Infection update. 2012;3(2):2–6.
22.
HaryantoHOgaiKSuriadiS, et al.A prospective observational study using sea cucumber and honey as topical therapy for diabetic foot ulcers in Indonesia. J Wellness Heal Care. 2017;41(2):41-56.
23.
HamadaRSuehiroJNakanoM, et al.Development of rapid oral bacteria detection apparatus based on dielectrophoretic impedance measurement method. IET Nanobiotechnol. 2011;5(2):25–31. doi:10.1049/iet-nbt.2010.0011
24.
KikutaniTTamuraFTakahashiYKonishiKHamadaR. A novel rapid oral bacteria detection apparatus for effective oral care to prevent pneumonia. Gerontology. 2011;29(2):e560–e565
25.
HaryantoHArisandiDSuriadiS. Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study. Int Wound J. 2017;14(3):1742-4801. doi:10.1111/iwj.12638
26.
NakagamiGSchultzGGibsonDJ, et al.Biofilm detection by wound blotting can predict slough development in pressure ulcers: a prospective observational study. Wound Repair Regen. 2017;25(1):131-138. doi:10.1111/wrr.12505
27.
LaveryLABarnesSAKeithMSSeamanJWAmstrongDG. Prediction of healing for postoperative diabetic foot wounds based on early wound area progression. Diabetes Care. 2008;31(1):26-29. doi:10.2337/dc07-1300.L.L
28.
OuseyKChadwickPJawienA, et al.Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives. J Wound Care. 2018;27(5):S1-S52. doi:10.12968/jowc.2018.27.Sup5.S1
29.
NoorSKhanRUAhmadJ. Understanding diabetic foot infection and its management. Diabetes Metab Syndr Clin Res Rev. 2016;11(2);149–156. doi:10.1016/j.dsx.2016.06.023
30.
ZubairMMalikAAhmadJ. Glycosylated hemoglobin in diabetic foot and its correlation with clinical variables in a north Indian tertiary care hospital. J Diabetes Metab. 2015;06(07):1-6. doi:10.4172/2155-6156.1000571
31.
LiXHGuanLYLinHY, et al.Fibrinogen: a marker in predicting diabetic foot ulcer severity. J Diabetes Res. 2016;2016(January 2015):1–5. doi:10.1155/2016/2358321
32.
WeigeltCRoseBPoschenU, et al.Immune mediators in patients with acute diabetic foot syndrome. Diabetes Care. 2009;32(8):1491-1496. doi:10.2337/dc08-2318
33.
KafleDRShresthaP. Study of fibrinogen in patients with diabetes mellitus. Nepal Med Coll J. 2010;12(1):34-37. 20677607
34.
ParkJUOhBLeeJPChoiMHLeeMJKimBS. Influence of Microbiota on diabetic foot wound in comparison with adjacent normal skin based on the clinical features. Biomed Res Int. 2019;2019:1–10. doi:10.1155/2019/7459236
35.
WangCGuoMZhangNWangG. Effectiveness of honey dressing in the treatment of diabetic foot ulcers: a systematic review and meta-analysis. Complement Ther Clin Pract. 2019;34(May 2018):123-131. doi:10.1016/j.ctcp.2018.09.004
