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Wound fluid lactate concentration: a helpful marker for diagnosing soft‐tissue infection in diabetic foot ulcers? Preliminary findings

Published on Feb 1, 2011in Diabetic Medicine 3.13
· DOI :10.1111/j.1464-5491.2010.03123.x
Markus Loeffler77
Estimated H-index: 77
Derek Zieker19
Estimated H-index: 19
+ 7 AuthorsStefan Beckert17
Estimated H-index: 17
Diabet. Med. 28, 175–178 (2011) Abstract Aims  To investigate the impact of wound fluid lactate concentration on diagnosing soft-tissue infection in diabetic foot ulcers. Methods  Lactate concentration in wound fluid obtained from diabetic foot ulcers was determined using a lactate analyser and compared with clinical examination findings. Results  Overall median wound fluid lactate concentration was 21.03 mm (5.58–80.40 mm). Wound lactate levels were significantly higher in infected compared with non-infected diabetic foot ulcers (P = 0.001). Non-infected diabetic foot ulcers that healed within 6 months of treatment showed a significantly lower wound fluid lactate concentration at baseline as opposed to those that did not heal (P = 0.007). Conclusions  Non-healing diabetic foot ulcers are characterized by high wound fluid lactate levels. Assessment of wound fluid lactate concentration might be helpful for confirming the suspicion of soft tissue infection, particularly when clinical signs are atypical.
  • References (14)
  • Citations (19)
Published on Jan 1, 2009in Diabetes Care 13.40
Yu Liu3
Estimated H-index: 3
Danqing Min9
Estimated H-index: 9
+ 4 AuthorsSusan V. McLennan30
Estimated H-index: 30
OBJECTIVE—We studied the relationships of diabetic ulcer wound fluid matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and transforming growth factor-s1 (TGF-s1) with wound healing rate. RESEARCH DESIGN AND METHODS—The ulcers were cleansed to remove exudates, and wound fluids were collected for analysis of MMP-2 and -9, TIMP-1, and TGF-s1. RESULTS—At presentation, MMP-9 and the MMP-9–to–TIMP-1 ratio correlated inversely with the wound healing rate at 28 days (P 4...
183 Citations Source Cite
Published on Aug 1, 2007in Antioxidants & Redox Signaling 6.53
Thomas K. Hunt69
Estimated H-index: 69
(University of California, San Francisco),
Rummana Aslam10
Estimated H-index: 10
+ 5 AuthorsChandan K. Sen75
Estimated H-index: 75
Hypoxia serves as a physiological cue to drive angiogenic response via HIF-dependent mechanisms. Interestingly, minor elevation of lactate levels in the tissue produces the same effect under aerobic conditions. Aerobic glycolysis contributes to lactate accumulation in the presence of oxygen especially under inflammatory conditions. We have previously postulated that aerobic lactate accumulation, already known to stimulate collagen deposition, will also stimulate angiogenesis. If substantiated, t...
124 Citations Source Cite
Published on Jun 1, 2007in Journal of Bacteriology 3.22
Stephan Fuchs16
Estimated H-index: 16
Jan Pané-Farré18
Estimated H-index: 18
+ 2 AuthorsSusanne Engelmann44
Estimated H-index: 44
An investigation of gene expression in Staphylococcus aureus after a switch from aerobic to anaerobic growth was initiated by using the proteomic and transcriptomic approaches. In the absence of external electron acceptors like oxygen or nitrate, an induction of glycolytic enzymes was observed. At the same time the amount of tricarboxylic acid cycle enzymes was very low. NAD is regenerated by mixed acid and butanediol fermentation, as indicated by an elevated synthesis level of fermentation enzy...
184 Citations Source Cite
Published on Mar 1, 2007in Journal of Investigative Dermatology 6.45
Sabine A. Eming36
Estimated H-index: 36
(University of Cologne),
Th. Krieg62
Estimated H-index: 62
(University of Cologne),
Jeffrey M. Davidson57
Estimated H-index: 57
(Vanderbilt University)
In post-natal life the inflammatory response is an inevitable consequence of tissue injury. Experimental studies established the dogma that inflammation is essential to the establishment of cutaneous homeostasis following injury, and in recent years information about specific subsets of inflammatory cell lineages and the cytokine network orchestrating inflammation associated with tissue repair has increased. Recently, this dogma has been challenged, and reports have raised questions on the valid...
1,086 Citations Source Cite
Published on May 1, 2006in Diabetes Care 13.40
Stefan Beckert17
Estimated H-index: 17
Maria B. Witte13
Estimated H-index: 13
+ 2 AuthorsS. Coerper17
Estimated H-index: 17
OBJECTIVE —Several well-accepted classification systems are available for diabetic foot ulcers. However, there are only a few and scientifically not validated severity scores. The aim of this study was to establish a new wound-based clinical scoring system for diabetic foot ulcers suitable for daily clinical practice anticipating chances for healing and risk of amputation. RESEARCH DESIGN AND METHODS —Four clinically defined parameters, namely palpable pedal pulses, probing to bone, ulcer locati...
89 Citations Source Cite
Published on Apr 1, 2006in Diabetic Medicine 3.13
S. O'Meara23
Estimated H-index: 23
(University of York),
E. A. Nelson14
Estimated H-index: 14
(University of York)
+ 3 AuthorsCynthia P Iglesias30
Estimated H-index: 30
(University of York)
Aim To undertake a systematic review of the diagnostic performance of clinical examination, sample acquisition and sample analysis in infected foot ulcers in diabetes. Methods Nineteen electronic databases plus other sources were searched. To be included, studies had to fulfil the following criteria: (i) compare a method of clinical assessment, sample collection or sample analysis with a reference standard; (ii) recruit diabetic individuals with foot ulcers; (ii) present 2 × 2 diagnostic data. S...
41 Citations Source Cite
Published on Dec 5, 2005in International Journal of Medical Microbiology 3.30
Christian Kohler16
Estimated H-index: 16
Susanne Wolff6
Estimated H-index: 6
+ 5 AuthorsMichael Hecker84
Estimated H-index: 84
Abstract Staphylococcus aureus is a versatile human pathogen causing a wide variety of diseases ranging from wound infection to endocarditis, osteomyelitis, and sepsis. In order to investigate this pathogen, we sought to analyze the cytoplasmic proteome of S. aureus COL by using two different approaches: two-dimensional (2D) gel analyses combined with matrix-assisted laser ionization-time of flight mass spectrometry and a gel-free system using multidimensional liquid chromatography followed by m...
72 Citations Source Cite
Published on Nov 1, 2005in The Lancet 53.25
Andrew J.M. Boulton87
Estimated H-index: 87
(University of Manchester),
Loretta Vileikyte25
Estimated H-index: 25
(University of Manchester)
+ 1 AuthorsJan Apelqvist53
Estimated H-index: 53
(Lund University)
Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes in the next 20 years. People at greatest risk of ulceration can easily be identified by careful clinical examination of the feet: education and frequent follow-...
1,182 Citations Source Cite
Published on Nov 1, 2005in The Lancet 53.25
Peter R. Cavanagh66
Estimated H-index: 66
(Cleveland Clinic Lerner College of Medicine),
Benjamin A. Lipsky69
Estimated H-index: 69
(University of Washington)
+ 1 AuthorsGeorgeanne Botek9
Estimated H-index: 9
(Cleveland Clinic)
People with diabetes develop foot ulcers because of neuropathy (sensory, motor, and autonomic deficits), ischaemia, or both. The initiating injury may be from acute mechanical or thermal trauma or from repetitively or continuously applied mechanical stress. Patients with clinically significant limb ischaemia should be assessed by a vascular surgeon to determine the need for angioplasty, stenting, or femorodistal bypass. When infection complicates a foot ulcer, the combination can be limb or life...
281 Citations Source Cite
Published on Apr 1, 2001in Clinical Microbiology Reviews 20.64
P. G. Bowler1
Estimated H-index: 1
(Center for Global Development),
B. I. Duerden1
Estimated H-index: 1
(University of Wales),
David Armstrong89
Estimated H-index: 89
(Manchester Royal Infirmary)
The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as micro...
940 Citations Source Cite
Cited By19
Published on Dec 18, 2018in Frontiers in Immunology 5.51
Heather L. Caslin4
Estimated H-index: 4
Marcela Taruselli6
Estimated H-index: 6
+ 4 AuthorsJohn J. Ryan27
Estimated H-index: 27
Source Cite
Published on Feb 1, 2018in Diabetic Medicine 3.13
John R. Ingram15
Estimated H-index: 15
(Cardiff University),
S. Cawley1
Estimated H-index: 1
(Cardiff and Vale University Health Board)
+ 8 AuthorsKerenza Hood46
Estimated H-index: 46
(Cardiff University)
Aims Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Four inflammatory biomarkers were investigated to develop a composite algorithm for mildly infected diabetic foot ulcers: venous white cell count, C-reactive protein (CRP) and procalcitonin, and a novel wound exudate calprotectin assay. Calprotectin is a marker of neutrophilic inflammation. Methods In a prospective study, people with uninfected or mildly infected diabet...
1 Citations Source Cite
Published on Sep 20, 2017
Elizabeth Stenhouse13
Estimated H-index: 13
(Plymouth State University)
Source Cite
Published on Apr 1, 2017in Wound Repair and Regeneration 2.95
Carla Kruse5
Estimated H-index: 5
(Brigham and Women's Hospital),
Mansher Singh7
Estimated H-index: 7
(Brigham and Women's Hospital)
+ 4 AuthorsKristo Nuutila9
Estimated H-index: 9
(Brigham and Women's Hospital)
Wound microenvironment plays a major role in the process of wound healing. It contains various external and internal factors that participate in wound pathophysiology. The pH is an important factor that influences wound healing by changing throughout the healing process. Several previous studies have investigated the role of pH in relation to pathogens but studies concentrating on the effects of pH on wound healing itself are inconclusive. The purpose of this study was to comprehensively and in ...
14 Citations Source Cite
Published on Nov 1, 2015in Diabetes Research and Clinical Practice 2.55
Emer Van Ryswyk4
Estimated H-index: 4
(University of Adelaide),
Philippa Middleton45
Estimated H-index: 45
(University of Adelaide)
+ 2 AuthorsCaroline A Crowther60
Estimated H-index: 60
(University of Adelaide)
Abstract Aim To identify factors influencing postpartum healthcare seeking, from the perspective of women who have experienced gestational diabetes mellitus (GDM). Methods Systematic review that searched PubMed, Web of Science, EMBASE and CINAHL on 27th February 2013. Qualitative studies and surveys, with women as participants, which reported pre-specified outcomes, including barriers and facilitators to healthcare seeking for GDM after birth, were included. Two authors independently extracted d...
15 Citations Source Cite
Published on Sep 1, 2015in Seminars in Vascular Surgery 1.29
Alessandro Scalise11
Estimated H-index: 11
(Marche Polytechnic University),
A. Bianchi1
Estimated H-index: 1
(Marche Polytechnic University)
+ 5 AuthorsG. Di Benedetto6
Estimated H-index: 6
(Marche Polytechnic University)
Abstract Wound healing is a systemic response to injury that impacts the entire body and not just the site of tissue damage; it represents one of the most complex biological processes. Our knowledge of wound healing continues to evolve and it is now clear that the wound microenvironment plays a crucial role. The interactions between cells and the surface microenvironment, referred to as the "biofilm," contributes to skin homeostasis and healing. Understanding the functional complexity of the wou...
13 Citations Source Cite
Published on Jul 1, 2015in Wound Repair and Regeneration 2.95
Carla Kruse5
Estimated H-index: 5
(Brigham and Women's Hospital),
Kristo Nuutila9
Estimated H-index: 9
(Harvard University)
+ 5 AuthorsJens Ahm Sørensen24
Estimated H-index: 24
(Odense University Hospital)
The skin wound microenvironment can be divided into two main components that influence healing: the external wound microenvironment, which is outside the wound surface; and the internal wound microenvironment, underneath the surface, to which the cells within the wound are exposed. Treatment methods that directly alter the features of the external wound microenvironment indirectly affect the internal wound microenvironment due to the exchange between the two compartments. In this review, we focu...
17 Citations Source Cite
Published on Jan 1, 2015in Advances in Experimental Medicine and Biology 1.76
Jaideep Banerjee10
Estimated H-index: 10
Chandan K. Sen16
Estimated H-index: 16
(The Ohio State University Wexner Medical Center)
microRNAs (miRNAs) are small noncoding RNA molecules which play pivotal roles in wound healing. The increased expression of certain genes and expression of some others represent a key component of the wound biology and are largely under the regulation of naturally occurring miRNAs. Understanding the dysregulated miRNAs in chronic wound biology will therefore enable the development of newer therapies. This chapter focuses on the miRNAs that can be potentially targeted for improving skin wound hea...
11 Citations Source Cite
Published on Sep 1, 2014in Wound Repair and Regeneration 2.95
Mette A. Sørensen3
Estimated H-index: 3
(University of Copenhagen),
Lars Jelstrup Petersen26
Estimated H-index: 26
(Aalborg University)
+ 2 AuthorsStine Jacobsen26
Estimated H-index: 26
(University of Copenhagen)
As in other fibroproliferative disorders, hypoxia has been suggested to play a key role in the pathogenesis of exuberant granulation tissue (EGT). The purpose of this study was to investigate metabolism and blood flow locally in full-thickness wounds healing with (limb wounds) and without (body wounds) formation of EGT. Microdialysis was used to recover endogenous metabolites from the wounds, and laser Doppler flowmetry was used to measure blood flow. Measurements were performed before wounding ...
14 Citations Source Cite
Aqsa Ali1
Estimated H-index: 1
(Frankston Hospital),
John Botha12
Estimated H-index: 12
(Frankston Hospital),
Ravindranath Tiruvoipati9
Estimated H-index: 9
(Frankston Hospital)
Abstract INTRODUCTION Acinetobacter baumannii is usually associated with respiratory tract, urinary tract and bloodstream infections. Recent reports suggest that it is increasingly causing skin and soft tissue infections. It is also evolving as a multidrug resistant organism that can be difficult to treat. We present a fatal case of multidrug resistant A. baumannii soft tissue infection and review of relevant literature. PRESENTATION OF CASE A 41 year old morbidly obese man, with history of alco...
9 Citations Source Cite