The Role of Fluorescence Bacterial Scanning in the Identification and Treatment of Intertriginous Bacteria in Diabetic Feet

Introduction: Intertriginous (between toes) bacteria in diabetic patients can be a significant source of infection. Previously we were able to identify, only through fluorescence scans of bacteria, an intertriginous micro-fissure as the entry point for bacteria in a diabetic foot infection patient who did not have a wound.

This pilot study aimed to determine prevalence and management strategies for intertriginous bacteria in diabetic patients.

Methods: 10 consecutive diabetic patients being seen for lower extremity wounds not involving the toes were scanned for intertriginous bacteria using fluorescence imaging*.

Results: Of the scanned patients, 50% had intertriginous bacteria. Of those that were found to have intertriginous bacteria, 2/5 had unexpected small fissures, a potential entry point for the bacteria that can lead to infection even without a wound in the region.

Treatment Algorithm:Based on these finding a treatment algorithm was created. All patients with diabetes and lower extremity wounds are scanned for intertriginous bacteria. If the scan is negative patients are educated on foot care including daily washing between their toes and not using lotion between the toes; lotion creates a moist environment where bacteria can thrive. If the scan is positive for intertriginous bacteria we first clean between the toes (flossing) with Dakins, which re-scanning typically demonstrates removal of the bacterial signal. If the bacterial signal remains on the scan patients are told to wash between toes daily and then use a silver alginate strip** between the toes to clear the remaining bacteria. Patients are then followed up in clinic to assure removal of the bacteria and healing of small fissures.

Conclusions:Diabetic education should include information on the importance of washing between the toes and not applying lotion between the toes. Fluorescence imaging provides objective information on the incidence of intertriginous bacteria and can be utilized to document clearance of bacteria with flossing and good foot care. This can potentially decrease the risk of diabetic foot infections originating from intertriginous bacteria. Fluorescence scans are a foundation for educating patients on the importance of at-home cleansing between the toes and provide point-of-care imaging that can potentially improve patient compliance.*MolecuLight **Aquacel Ag