{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:01:07Z","timestamp":1792195267704,"version":"4.4.0"},"reference-count":123,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>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)\u2014it 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.<\/jats:p>","DOI":"10.3390\/microorganisms8101580","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T21:24:39Z","timestamp":1602710679000},"page":"1580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":233,"title":["Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6815-7819","authenticated-orcid":false,"given":"Cassandra","family":"Pouget","sequence":"first","affiliation":[{"name":"Virulence Bact\u00e9rienne et Maladies Infectieuses, INSERM U1047, Universit\u00e9 de Montpellier, 30908 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Dunyach-Remy","sequence":"additional","affiliation":[{"name":"Virulence Bact\u00e9rienne et Maladies Infectieuses, INSERM U1047, Universit\u00e9 de Montpellier, Service de Microbiologie et Hygi\u00e8ne Hospitali\u00e8re, Clinique du Pied Gard Occitanie, CHU N\u00eemes, 30029 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alix","family":"Pantel","sequence":"additional","affiliation":[{"name":"Virulence Bact\u00e9rienne et Maladies Infectieuses, INSERM U1047, Universit\u00e9 de Montpellier, Service de Microbiologie et Hygi\u00e8ne Hospitali\u00e8re, Clinique du Pied Gard Occitanie, CHU N\u00eemes, 30029 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Schuldiner","sequence":"additional","affiliation":[{"name":"Virulence Bact\u00e9rienne et Maladies Infectieuses, INSERM U1047, Universit\u00e9 de Montpellier, Service des Maladies M\u00e9taboliques et Endocriniennes, Clinique du Pied Gard Occitanie, CHU N\u00eemes, 30240 Le Grau du Roi, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6463-9386","authenticated-orcid":false,"given":"Albert","family":"Sotto","sequence":"additional","affiliation":[{"name":"Virulence Bact\u00e9rienne et Maladies Infectieuses, INSERM, Universit\u00e9 de Montpellier, Service des Maladies Infectieuses et Tropicales, Clinique du Pied Gard Occitanie, CHU N\u00eemes, 30029 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9484-0304","authenticated-orcid":false,"given":"Jean-Philippe","family":"Lavigne","sequence":"additional","affiliation":[{"name":"Virulence Bact\u00e9rienne et Maladies Infectieuses, INSERM U1047, Universit\u00e9 de Montpellier, Service de Microbiologie et Hygi\u00e8ne Hospitali\u00e8re, Clinique du Pied Gard Occitanie, CHU N\u00eemes, 30029 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N. 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