The pH of Wound Fluid in Diabetic Foot Ulcers- the Way Forward in Detecting Clinical Infection?

Carla McArdle, Katie Lagan, D A McDowell

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Infections within diabetic foot ulcers are often hard to detect and extremely difficult to treat. The normal signs and symptoms of infection including purulence, erythema, pain, tenderness, warmth and induration are frequently absent in such wounds necessitating exploration of other ways of rapidly and accurately detecting infection. This study considers diabetic wound fluid pH as a possible alternative means of monitoring infection status. CINAHL, Ovid SP and MEDLINE were searched for papers in English published between January 2004 to May 2014. Key search terms included wound fluid, exudate, wound, ulcer, diabetes, pH, healing, infection, bacteria. This paper considers the potential benefits of augmenting and supporting current clinical practice in the early determination of wound healing trajectory and infection status, by monitoring wound fluid pH. The evidence collected highlights the need for further research and suggests the potential of wound fluid analysis as a possible surrogate marker for detecting infection in diabetic foot ulcers.
Original languageEnglish
Pages (from-to)177-181
Number of pages5
JournalCurrent Diabetes Reviews
Issue number3
Publication statusPublished - Jun 2014

Bibliographical note

Reference text: Caravaggi C, Sganzaroli A, Galenda P, Bassetti M, Ferraresi R, Gabrielli L. The management of the infected diabetic foot. Cur Diab Rev 2013; 9: 7-24.
Diabetes UK. The British Diabetic association. 2011. Available from:
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293: 217-228.
Sibbald GR, Woo KY. The biology of chronic foot ulcers in persons with diabetes. Diabetes Metab Res Rev 2008; 24: S25-S30.
International working group on the diabetic foot. International consenus on the diabetic foot. 2011. In: International Diabetes Federation; Brussels. http: //
Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendell CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006; 29: 1288-1293.
Leveen HH, Falk G, Blanche DC, et al. Chemical acidification of wounds: an adjuvant to healing and the unfavourable action of alkalinity and ammonia. Ann Surg 1973; 178(6): 745-753.
Schneider LA, Korber A, Grabbe S, Dissemond J. 2007. Influence of pH on wound-healing: a new perspective for wound-therapy? Arch Dermatol Res 2007; 29(9): 413-420.
Percival SL, McCarty S, Hunt JA, Woods EJ. The effects of pH on wound healing, biofilms and antimicrobial efficacy. Wound Repair Regen 2014; 22: 174-186.
Richard J, Lavigne J, Sotto A. Diabetes and foot infection: More than double trouble. Diabetes Metab Res Rev 2012; 28: S46-53.
Cooper RA, Ameen H, Price P, McCullough H. Harding KG. A clinical investigation into the microbiological status of ‘locally infected’ leg ulcers. Int Wound J 2009; 6(6): 453-462.
Pastuer L. De I’attenuation virus du cholera des poules. C R Acad d Sci 1880; 91: 673-680.
Slater RA, Lazarovitch T, Boldur I, et al. Swab cultures accurately identify bacterial pathogens in diabetic foot wounds not involving bone. Diabet Med 2004; 21(7): 705-709.
Kessler L, Piemont Y, Ortega F, Lesens O, Boeri C, Averous C, et al. Comparison of microbiological results of needle puncture vs. superficial swab in infected diabetic foot ulcer with osteomyelitis. Diabet Med 2006; 23: 99-102.
Angel DE, Lloyd P, Carville K, Santamaria N. The clinical efficacy of two semi-quantitative wound-swabbing techniques in identifying the causative organism(s) in infected cutaneous wounds. Int Wound J 2011; 8(2): 176-185.
Gardner SE, Frantz RA. Wound Bioburden and Infection-Related Complications in Diabetic Foot Ulcers. Biol Res Nurs 2008; 10: 44-53.
Prompers L, Huijberts M, Schaper N, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study. Diabetologia 2008; 51: 1826-34.
Jeffcoate WL, Harding KG. Diabetic foot ulcers. Lancet 2003; 361: 1545-1551.
Jeffcoate W, Lipsky BA, Berendt AR, et al. Unresolved issues in the management of ulcers of the foot in diabetes. Diabet Med 2008; 25: 1380-1389.
Apelqvist J, Bakker K, Van Houtum WH, et al. Practical guidelines on the management and prevention of the diabetic foot: Based upon the international consensus on the diabetic foot (2007) prepared by the international working group on the diabetic foot. Diabetes Metab Res Rev 2008; 24: S181-7.
Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approached to wound management. Clin Microbiol Rev 2001; 14: 244-269.
Bowler PG. The 105 bacterial growth guideline: Reassessing its clinical relevance in wound healing. Ostomy Wound Manage 2003; 49: 44-53.
Santy J. Recognising infection in wounds. Nurs Stand 2008; 23(7): 53-60.
McIntosh C. Managing diabetic foot ulceration. Review of best clinical practice. Wound Essentials 2009; 4(1): 102-111.
O'Meara S, Nelson E, Golder S, et al. Systematic review of methods to diagnose infection in foot ulcers in diabetes. Diabet Med 2006; 23(4): 341-347.
Loffler MW, Schuster H, Buhler S, Beckert S, Wound Fluid in Diabetic Foot Ulceration: More Than Just an undefined Soup. Int J Low Extrem Wounds 2013; 12(2): 113-129.
Widgerow AD. Chronic wound fluid--thinking outside the box. Wound Repair Regen 2011; 19(3): 287-291.
Yager DR, Kulma RA, Gilman LA. Wound fluids: a window into the wound environment? Int J Low Extrem Wounds 2007; 6: 262-272.
Loffler M, Zieker D, Weinreich J, et al. Wound fluid lactate concentration: a helpful marker for diagnosing soft-tissue infection in diabetic foot ulcers? Preliminary findings. Diabet Med 2011; 28(2): 175-178.
White, R. and Cutting, K.F. 2006. Modern exudate management: a review of wound treatments. Available from: http://www.worldwidewounds. com/2006 /september/White/Modern-Exudate-Mgt. html.
Trengrove NJ, Langton SR, Stacey MC. Biochemical analysis of wound fluid from non-healing and healing chronic leg ulcers. Wound Repair Regen 1996; 4(2): 234-239.
Cooper RA, Morwood JM, Burton N. Histamine production by bacteria isolated from wounds. J Infect 2004; 49: 39-43.
Liu Y, Min D, Bolton T, et al. Increased matrix metalloproteinase- 9 predicts poor wound healing in diabetic foot ulcers. Diabetes Care 2009; 32(1): 117-119.
Gethin G. The significance of surface pH in chronic wounds. Wounds UK 2007; 3(3): 52-56.
Rushton I. Understanding the role of proteases and pH in wound healing. Nurs Stand 2007; 21(32): 68-74.
Greener B, Hughes AA, Bannister, NP. Douglas J. Proteases and pH in chronic wounds. J Wound Care 2005; 14(2): 59-61.
Shukla VK, Shukla D, Tiwary SK, et al. Evaluation of pH measurement as a method of wound assessment. J Wound Care 2007; 16(7): 291-294.
Kurabayashi H, Tamura K, Machida I, Kubota K. Initiating bacteria and skin pH in hemiplegia. Am J Phys Med Rehabil 2001; 81: 40-46.
Shi L, Ramsay S, Ermis R, Carson D. pH in the Bacteria-Contaminated Wound and Its Impact on Clostridium histolyticum Collagenase Activity: Implications for the Use of Collagenase
Wound Debridement Agents. J Wound Ostomy Continence Nurs 2011; 38(5): 514-521.
Thomas J, Linton S, Corum L, Slone W, Okel T, Percival SL. The effect of pH and bacterial phenotypic state on antibiotic efficacy. Int Wound J 2012; 9(4): 428-435.
James TJ, Hughes MA, Cherry GW, Taylor RP. Evidence of oxidative stress in chronic venous ulcers. Wound Repair Regen 2003; 11(3): 172-176.


  • Diabetes
  • ulcer
  • wound fluid
  • pH
  • infection
  • bacteria.


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