Challenges in the treatment of skin infections in patients with high somatic burden as exemplified by diabetes mellitus

Recent years have witnessed a steady increase in the incidence of skin and soft tissue infections (SSTIs). Skin infections are notably common in children and the elderly. Skin infections are also common in people with systemic diseases, including diabetes mellitus. A large percentage of wounds in patients with diabetes contain a polymicrobial microflora. Infections are mainly caused by aerobic gram-positive cocci, gram-negative rods, and group B streptococci. In patients with diabetes, ulcerous defects are frequently found on the lower extremities, especially the feet (approximately 15%). At the same time, congestive heart failure, chronic lung diseases and renal failure are more common in patients with other wound localizations in the anamnesis. Diabetes mellitus negatively affects the healing of wound surfaces. Hyperglycemia causes delayed epithelialization, chronic inflammation, dysregulation of angiogenesis and other disturbances in the wound microenvironment. Chronic skin infections are often observed in patients with diabetes mellitus, which may result from excessive growth of bacterial flora. Topical treatments for SSTIs may be low-efficient in patients with systemic diseases. Chronic infections can spread and be caught quite rapidly, which requires the prescription of systemic therapy. Moreover, elderly patients or patients with a number of systemic diseases may experience dysphagia, which can affect patients' ability to take antibiotics in solid oral dosage forms. In cases like that, dispersible forms of antibiotics, such as a combination of amoxicillin and clavulanic acid, are of interest. This combination is effective against a wide range of gram-positive and gram-negative bacteria, including causative agents of skin infections.

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