# Development and Control of Biofilms in Diabetic Foot Infections: A Narrative Review
## 17 Conclusions  
Diabetic foot ulcers (DFUs) necessitate careful management due to the complexities associated with their treatment. Microorganisms such as _Staphylococcus aureus_ and _Pseudomonas aeruginosa_ are significant biofilm formers, creating protective biofilms that obstruct the penetration of antibiotics and leukocytes into the wound. The extracellular polymeric substance (EPS) produced by these biofilms diminishes the phagocytic activity of leukocytes. Additionally, these organisms engage in horizontal gene transfer, which increases antimicrobial resistance by facilitating the transfer of resistance genes among them. This biofilm formation represents a major challenge in the treatment of DFUs.  
Adherence to prescribed antibiotic regimens is crucial, as any deviation must be avoided. This review has detailed the significance of biofilms in DFUs, methods for detecting biofilms, and various treatment options. Recent advancements, such as the use of placental-derived materials and human umbilical cord allografts, offer promising treatments with little to no side effects.  
It is critical to note that if a low-grade ulcer progresses to a high-grade ulcer, amputation may be necessary [18]. While lower-grade ulcers can often be treated conservatively, there remains a 25-50% chance of amputation for patients with DFUs [25], alongside a 50-60% infection rate [13]. Therefore, optimal care is essential, including routine hospital visits and debridement of necrotic tissue [128].  
Proper wound care, including the use of iodine solutions, can effectively reduce polymicrobial biofilm formation [130; 131]. Maintaining an oxygenated environment is vital to prevent the growth of anaerobic bacteria. A clean, hygienic setting, combined with appropriate treatments, will facilitate faster recovery. The primary goal of DFU treatment is to eradicate polymicrobial biofilms, as their presence significantly delays wound healing [58]. Consequently, direct approaches to eliminate biofilms in diabetic foot ulcers are essential for effective treatment and improved patient outcomes.  
Effective management of diabetic foot infections, particularly those complicated by biofilm formation, necessitates a multidisciplinary approach. Coordination between endocrinology, infectious disease, and surgical departments is critical to address the multifaceted nature of these infections. Endocrinologists play a pivotal role in optimizing glycemic control, which is essential for wound healing and infection resolution, while infectious disease specialists guide the use of targeted antimicrobial therapy to disrupt biofilms. Surgeons contribute by performing debridement or other necessary procedures to remove infected and necrotic tissues. This collaborative strategy ensures a comprehensive and individualized treatment plan, improving patient outcomes in even the most complex cases.  
This research received no external funding.  
**Institutional Review Board Statement:** Not applicable.  
**Informed Consent Statement:** Not applicable.  
**Data Availability Statement:** Data is contained within the article.  
**Conflicts of Interest:** The authors declare no conflict of interest exists.