AI Insight
A randomized controlled trial of 87 diabetic patients with prior foot complications found that daily chlorhexidine gluconate (CHG) foot cleansing over 12 months significantly reduced bacterial bioburden, increased microbial diversity, and decreased Staphylococcus abundance on foot skin compared to soap-and-water treatment. These microbiota changes were durable, persisting more than four weeks after treatment ended. Despite these measurable microbial effects, the intervention did not produce a statistically significant reduction in new diabetic foot ulcers, suggesting that microbiota modification alone is insufficient to prevent recurrence.
Why it matters
Diabetic foot ulcers are a leading cause of non-traumatic lower limb amputations and carry substantial morbidity, so identifying effective preventive strategies is clinically important. These findings suggest that while CHG may play a supportive role in reducing staphylococcal burden in high-risk patients, it must be combined with additional interventions to meaningfully lower ulcer recurrence rates.
⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Microbiota dysbiosis of the skin has been implicated in ulcer formation. Individuals with diabetes remain at high risk for diabetic foot ulcers (DFUs) even after ulcer healing. Topical chlorhexidine gluconate (CHG) is a broad-spectrum antiseptic commonly used to reduce microbial burden. In a prior randomized clinical trial comparing daily CHG foot treatment with soap-and-water treatment, no statistically significant reduction in new DFUs was observed, prompting evaluation of whether CHG produced durable changes in the skin microbiota. Objective: To compare changes in foot skin microbiota (including bacterial bioburden, diversity, and community composition) associated with daily CHG versus soap-and-water use over one year in people with diabetes and prior foot complications. Methods: In a single-center, double-blind, placebo-controlled randomized trial, 87 participants were randomized to daily CHG wipes or soap-and-water wipes for 12 months. Foot swabs were collected at baseline, 3 and 12 months, and 4 weeks post-treatment. Bacterial bioburden was quantified. Microbiota composition was assessed using 16S rRNA and ITS amplicon sequencing. Key Results: CHG treatment significantly reduced bacterial bioburden, increased microbial diversity, and altered community composition, including sustained reductions in Staphylococcus abundance. Several microbiota changes persisted more than 4 weeks after treatment cessation. Soap-and-water treatment showed similar but smaller and largely nonsignificant trends. Conclusions: Daily CHG use durably modifies foot skin microbiota in high-risk individuals with diabetes. However, this alone may be insufficient to prevent new foot complications, highlighting the need for additional interventions. These findings have implications for long-term CHG use in populations at risk for staphylococcal infections.