{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:41:19Z","timestamp":1790494879952,"version":"4.1.0"},"reference-count":60,"publisher":"MDPI AG","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>This study investigated the resistance of bacteria isolated from diabetic foot ulcers (DFUs) to antibiotics frequently used in the management of the diabetic foot infections, at a range of pH values (pH 6.5, 7.5, and 8.5) known to exist in DFU wound fluid. This study aimed to determine whether changes (or atypical stasis) in wound fluid pH modulate the antibiotic resistance of DFU isolates, with potential implications in relation to the suppression\/eradication of bacterial infections in DFUs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Thirty bacterial isolates were recovered from DFU wound fluid, including Staphylococcus spp, Staphylococcus aureus, Escherichia coli, Streptococcus spp, Pseudomonas spp, and Pseudomonas aeruginosa. The resistances of these isolates to a panel of antibiotics currently used in the treatment of infected or potentially infected DFUs, ie, ciprofloxacin, amoxicillin-clavulanate, doxycycline, and piperacillin-tazobactam, at the previously mentioned pH values were determined by a modification of the Kirby-Bauer assay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The resistance of DFU isolates to clinically relevant antibiotics was significantly affected by the pH levels in DFU wound fluid.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These findings highlight the importance of a more comprehensive understanding of the conditions in DFUs to inform clinical decision making in the selection and application of antibiotics in treating these difficult-to-heal wounds. The scale of the differences in the efficacies of antibiotics at the different pH values examined is likely to be sufficient to suggest reconsideration of the antibiotics of choice in the treatment of DFU infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/16-033","type":"journal-article","created":{"date-parts":[[2018,3,16]],"date-time":"2018-03-16T10:55:17Z","timestamp":1521197717000},"page":"6-11","source":"Crossref","is-referenced-by-count":19,"title":["Effects of pH on the Antibiotic Resistance of Bacteria Recovered from Diabetic Foot Ulcer Fluid"],"prefix":"10.3390","volume":"108","author":[{"given":"Carla D.","family":"McArdle","sequence":"first","affiliation":[{"name":"Queen Margaret University, Health Sciences, Musselburgh, Edinburgh, Scotland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie M.","family":"Lagan","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Health Sciences, Ulster University, Newtownabbey, County Antrim, Ireland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"McDowell","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Health Sciences, Ulster University, Newtownabbey, County Antrim, Ireland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"ref251","first-page":"65","article-title":"Foot ulcers in the diabetic patient, prevention and treatment","volume":"3","author":"Wu","year":"2007","journal-title":"Vasc Health Risk Manag"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"S104","DOI":"10.1086\/383271","article-title":"Medical treatment of diabetic foot diseases","volume":"39","author":"Lipsky","year":"2004","journal-title":"Clin Infect Dis"},{"key":"ref211","doi-asserted-by":"crossref","first-page":"2530","DOI":"10.1093\/jac\/dkq375","article-title":"Antibacterial activity of flinafloxacin under different pH conditions against isogenic strains of Escherichia coli expressing combinations of defined mechanisms of fluoroquinolone resistance","volume":"65","author":"Emrich","year":"2010","journal-title":"J Antimicrob Chemother"},{"key":"ref401","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1093\/jac\/dkh513","article-title":"A review on the microbiology, antibiotic usage and resistance in chronic skin wounds","volume":"55","author":"Howell-Jones","year":"2005","journal-title":"J Antimicrob Chemother"},{"key":"ref261","doi-asserted-by":"crossref","first-page":"53","DOI":"10.7748\/ns.23.7.53.s55","article-title":"Recognising infection in wounds","volume":"23","author":"Santy","year":"2008","journal-title":"Nurs Stand"},{"key":"ref631","doi-asserted-by":"crossref","first-page":"59","DOI":"10.12968\/jowc.2005.14.2.26739","article-title":"Proteases and pH in chronic wounds","volume":"14","author":"Greener","year":"2005","journal-title":"J Wound Care"},{"key":"ref521","doi-asserted-by":"crossref","first-page":"A8","DOI":"10.1186\/1757-1146-8-S1-A8","article-title":"Diabetic foot ulcer wound fluid: the effects of pH on bacteria and infection","volume":"8","author":"McArdle","year":"2015","journal-title":"J Foot Ankle Res"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/j.1742-481X.2011.00902.x","article-title":"The effect of pH and bacterial phenotypic state on antibiotic efficacy","volume":"9","author":"Thomas","year":"2012","journal-title":"Int Wound J"},{"key":"ref381","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/1099800408319056","article-title":"Wound bioburden and infection-related complications in diabetic foot ulcers","volume":"10","author":"Gardner","year":"2008","journal-title":"Biol Res Nurs"},{"key":"ref501","first-page":"62","article-title":"Use of antibiotics in people with diabetic foot disease: a consensus statement","volume":"12","author":"Leese","year":"2009","journal-title":"Diabet Foot J"},{"key":"ref591","doi-asserted-by":"crossref","first-page":"53","DOI":"10.7748\/ns.23.7.53.s55","article-title":"Recognising infection in wounds","volume":"23","author":"Santy","year":"2008","journal-title":"Nurs Stand"},{"key":"ref431","doi-asserted-by":"crossref","first-page":"291","DOI":"10.12968\/jowc.2007.16.7.27062","article-title":"Evaluation of pH measurement as a method of wound assessment","volume":"16","author":"Shukla","year":"2007","journal-title":"J Wound Care"},{"key":"ref301","doi-asserted-by":"crossref","first-page":"59","DOI":"10.12968\/jowc.2005.14.2.26739","article-title":"Proteases and pH in chronic wounds","volume":"14","author":"Greener","year":"2005","journal-title":"J Wound Care"},{"key":"ref561","doi-asserted-by":"crossref","DOI":"10.1016\/j.urology.2014.04.048","article-title":"The influence of urinary pH on antibiotic efficacy against bacterial uropathogens","volume":"84:","author":"Yang","year":"2014","journal-title":"Urology"},{"key":"ref611","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1464-5491.2004.1424-8.x","article-title":"MRSA and osteomyelitis of the foot in diabetes","volume":"21","author":"Game","year":"2004","journal-title":"Diabet Med"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"A8","DOI":"10.1186\/1757-1146-8-S1-A8","article-title":"Diabetic foot ulcer wound fluid: the effects of pH on bacteria and infection","volume":"8","author":"McArdle","year":"2015","journal-title":"J Foot Ankle Res"},{"key":"ref281","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1464-5491.2004.1424-8.x","article-title":"MRSA and osteomyelitis of the foot in diabetes","volume":"21","author":"Game","year":"2004","journal-title":"Diabet Med"},{"key":"ref341","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/wrr.12125","article-title":"The effects of pH on wound healing, biofilms and antimicrobial efficacy","volume":"22","author":"Percival","year":"2014","journal-title":"Wound Repair Regen"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1742-481X.2009.00640.x","article-title":"A clinical investigation into the microbiological status of \u2018locally infected' leg ulcers","volume":"6","author":"Cooper","year":"2009","journal-title":"Int Wound J"},{"key":"ref391","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1742-481X.2009.00640.x","article-title":"A clinical investigation into the microbiological status of \u2018locally infected' leg ulcers","volume":"6","author":"Cooper","year":"2009","journal-title":"Int Wound J"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1046\/j.1464-5491.2001.00584.x","article-title":"Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb-threatening diabetic foot infection","volume":"18","author":"Pellizzer","year":"2001","journal-title":"Diabet Med"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s12020-012-9619-x","article-title":"Diagnosis and treatment of the diabetic foot","volume":"41","author":"Apelqvist","year":"2012","journal-title":"Endocrine"},{"key":"ref551","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1128\/AAC.41.9.2047","article-title":"Effect of pH on in vitro antimicrobial susceptibility of Bacteroides fragilis group","volume":"41","author":"Falagas","year":"1997","journal-title":"Antimicrob Agents Chemother"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1128\/MMBR.00016-10","article-title":"Origins and evolution of antibiotic resistance","volume":"74","author":"Davies","year":"2010","journal-title":"Microbiol Mol Biol Rev"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s12020-012-9619-x","article-title":"Diagnosis and treatment of the diabetic foot","volume":"41","author":"Apelqvist","year":"2012","journal-title":"Endocrine"},{"key":"ref491","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/dmrr.2706","article-title":"Interventions in the management of infection in the foot in diabetes: a systematic review","volume":"32","author":"Peters","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"ref571","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/j.1742-481X.2012.00991.x","article-title":"Multi-resistant organisms, wounds and topical antimicrobial protection","volume":"9","author":"Bowler","year":"2012","journal-title":"Int Wound J"},{"key":"ref471","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1046\/j.1464-5491.2001.00584.x","article-title":"Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb-threatening diabetic foot infection","volume":"18","author":"Pellizzer","year":"2001","journal-title":"Diabet Med"},{"key":"ref201","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1093\/ajcp\/45.4_ts.493","article-title":"Antibiotic susceptibility by standardized single dink method","volume":"45","author":"Bauer","year":"1966","journal-title":"Am J Clin Pathol"},{"key":"ref331","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1128\/MMBR.00016-10","article-title":"Origins and evolution of antibiotic resistance","volume":"74","author":"Davies","year":"2010","journal-title":"Microbiol Mol Biol Rev"},{"key":"ref641","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/j.1742-481X.2007.00424.x","article-title":"The impact of Manuka honey dressings on the surface pH of chronic wounds","volume":"5","author":"Gethin","year":"2008","journal-title":"Int Wound J"},{"key":"ref511","doi-asserted-by":"crossref","first-page":"177","DOI":"10.2174\/1573399810666140609143217","article-title":"The pH of wound fluid in diabetic foot ulcers: the way forward in detecting clinical infection?","volume":"10","author":"McArdle","year":"2014","journal-title":"Curr Diabetes Rev"},{"key":"ref531","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1093\/ajcp\/45.4_ts.493","article-title":"Antibiotic susceptibility by standardized single dink method","volume":"45","author":"Bauer","year":"1966","journal-title":"Am J Clin Pathol"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"291","DOI":"10.12968\/jowc.2007.16.7.27062","article-title":"Evaluation of pH measurement as a method of wound assessment","volume":"16","author":"Shukla","year":"2007","journal-title":"J Wound Care"},{"key":"ref651","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/WON.0b013e31822ad034","article-title":"pH in the bacteria-contaminated wound and its impact on Clostridium histolyticum collagenase activity: implications for the use of collagenase wound debridement agents","volume":"38","author":"Shi","year":"2011","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1111\/j.1742-481X.2011.00903.x","article-title":"The antimicrobial efficacy of silver on antibiotic-resistance bacteria isolated from burn wounds","volume":"9","author":"Percival","year":"2011","journal-title":"Int Wound J"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1128\/CMR.00040-09","article-title":"Antibacterial-resistant Pseudomonas aeruginosa: complex regulation of chromosomally encoded resistance mechanisms","volume":"22","author":"Lister","year":"2009","journal-title":"Clin Microbiol Rev"},{"key":"ref291","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3389\/fmicb.2013.00004","article-title":"Evolutionary consequences of antibiotic use for the resistome, mobilome and microbial pangenome","volume":"4","author":"Gillings","year":"2013","journal-title":"Front Microbiol"},{"key":"ref321","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/WON.0b013e31822ad034","article-title":"pH in the bacteria-contaminated wound and its impact on Clostridium histolyticum collagenase activity: implications for the use of collagenase wound debridement agents","volume":"38","author":"Shi","year":"2011","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref371","doi-asserted-by":"crossref","first-page":"S104","DOI":"10.1086\/383271","article-title":"Medical treatment of diabetic foot diseases","volume":"39","author":"Lipsky","year":"2004","journal-title":"Clin Infect Dis"},{"key":"ref181","doi-asserted-by":"crossref","first-page":"177","DOI":"10.2174\/1573399810666140609143217","article-title":"The pH of wound fluid in diabetic foot ulcers: the way forward in detecting clinical infection?","volume":"10","author":"McArdle","year":"2014","journal-title":"Curr Diabetes Rev"},{"key":"ref441","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1111\/j.1742-481X.2011.00903.x","article-title":"The antimicrobial efficacy of silver on antibiotic-resistance bacteria isolated from burn wounds","volume":"9","author":"Percival","year":"2011","journal-title":"Int Wound J"},{"key":"ref171","first-page":"62","article-title":"Use of antibiotics in people with diabetic foot disease: a consensus statement","volume":"12","author":"Leese","year":"2009","journal-title":"Diabet Foot J"},{"key":"ref541","doi-asserted-by":"crossref","first-page":"2530","DOI":"10.1093\/jac\/dkq375","article-title":"Antibacterial activity of flinafloxacin under different pH conditions against isogenic strains of Escherichia coli expressing combinations of defined mechanisms of fluoroquinolone resistance","volume":"65","author":"Emrich","year":"2010","journal-title":"J Antimicrob Chemother"},{"key":"ref621","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3389\/fmicb.2013.00004","article-title":"Evolutionary consequences of antibiotic use for the resistome, mobilome and microbial pangenome","volume":"4","author":"Gillings","year":"2013","journal-title":"Front Microbiol"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00403-006-0713-x","article-title":"Influence of pH on wound-healing: a new perspective for wound-therapy?","volume":"298","author":"Schneider","year":"2007","journal-title":"Arch Dermatol Res"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1128\/AAC.41.9.2047","article-title":"Effect of pH on in vitro antimicrobial susceptibility of Bacteroides fragilis group","volume":"41","author":"Falagas","year":"1997","journal-title":"Antimicrob Agents Chemother"},{"key":"ref311","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/j.1742-481X.2007.00424.x","article-title":"The impact of Manuka honey dressings on the surface pH of chronic wounds","volume":"5","author":"Gethin","year":"2008","journal-title":"Int Wound J"},{"key":"ref601","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/cis346","article-title":"2102 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin Infect Dis"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/dmrr.2706","article-title":"Interventions in the management of infection in the foot in diabetes: a systematic review","volume":"32","author":"Peters","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"ref481","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1128\/CMR.00040-09","article-title":"Antibacterial-resistant Pseudomonas aeruginosa: complex regulation of chromosomally encoded resistance mechanisms","volume":"22","author":"Lister","year":"2009","journal-title":"Clin Microbiol Rev"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/cis346","article-title":"2102 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin Infect Dis"},{"key":"ref411","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/j.1742-481X.2011.00902.x","article-title":"The effect of pH and bacterial phenotypic state on antibiotic efficacy","volume":"9","author":"Thomas","year":"2012","journal-title":"Int Wound J"},{"key":"ref461","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00403-006-0713-x","article-title":"Influence of pH on wound-healing: a new perspective for wound-therapy?","volume":"298","author":"Schneider","year":"2007","journal-title":"Arch Dermatol Res"},{"key":"ref241","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/j.1742-481X.2012.00991.x","article-title":"Multi-resistant organisms, wounds and topical antimicrobial protection","volume":"9","author":"Bowler","year":"2012","journal-title":"Int Wound J"},{"key":"ref581","first-page":"65","article-title":"Foot ulcers in the diabetic patient, prevention and treatment","volume":"3","author":"Wu","year":"2007","journal-title":"Vasc Health Risk Manag"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1093\/jac\/dkh513","article-title":"A review on the microbiology, antibiotic usage and resistance in chronic skin wounds","volume":"55","author":"Howell-Jones","year":"2005","journal-title":"J Antimicrob Chemother"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/1099800408319056","article-title":"Wound bioburden and infection-related complications in diabetic foot ulcers","volume":"10","author":"Gardner","year":"2008","journal-title":"Biol Res Nurs"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/wrr.12125","article-title":"The effects of pH on wound healing, biofilms and antimicrobial efficacy","volume":"22","author":"Percival","year":"2014","journal-title":"Wound Repair Regen"},{"key":"ref231","doi-asserted-by":"crossref","DOI":"10.1016\/j.urology.2014.04.048","article-title":"The influence of urinary pH on antibiotic efficacy against bacterial uropathogens","volume":"84:","author":"Yang","year":"2014","journal-title":"Urology"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/108\/1\/6\/1404532\/16-033.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/108\/1\/6\/1404532\/16-033.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:17:21Z","timestamp":1783505841000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/108\/1\/6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,1]]},"references-count":60,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1,1]]}},"URL":"https:\/\/doi.org\/10.7547\/16-033","relation":{},"ISSN":["8750-7315","1930-8264"],"issn-type":[{"value":"8750-7315","type":"print"},{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,1]]}}}