Larval Therapy: A Novel Treatment in Eliminating Methicillin-Resistant Staphylococcus aureus From Diabetic Foot Ulcers

  1. Frank L. Bowling, BS, DPM1,
  2. Eleanna V. Salgami, MD, PHD1 and
  3. Andrew J.M. Boulton, MD, FRCP12
  1. 1University Department of Medicine and Diabetes, Manchester Royal Infirmary, Manchester, U.K.
  2. 2Division of Endocrinology, Metabolism, and Diabetes, University of Miami School of Medicine, Miami, Florida
  1. Address correspondence and reprint requests to Frank L. Bowling, BS, DPM, c/o Prof. A.J.M. Boulton, University Department of Medicine and Diabetes, Manchester Royal Infirmary, Oxford Road, M13 9WL, Manchester, U.K. E-mail: frank.bowling{at}

Overuse of antibiotics and the selection of broad- rather than narrow-spectrum agents have contributed to the high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in diabetic foot wounds. Consequently, MRSA is now an endemic in both the community and hospital environments (1,2). We previously highlighted the problem (3) of MRSA colonization in our diabetic foot clinic (40% of S. aureus isolates were MRSA). A follow-up study (4) demonstrated that the number of foot wounds from which MRSA was isolated doubled in a 3-year period. Although terms such as critical colonization are not clearly defined, the risk of MRSA infection and bacteremia in patients with colonized ulcers is recognized (5,6). Furthermore, there is evidence (4) that MRSA colonization of chronic ulcers is associated with delayed healing times. Strategies to eliminate MRSA from colonized wounds are therefore essential and should include the use of simple, low-cost, effective treatments.

Larval therapy is suggested (7) to successfully remove sloughy necrotic tissue from ulcers and to facilitate healing. We hypothesized that larval therapy would eradicate MRSA colonization from diabetic foot ulcers. Here, we report the results of our preliminary …

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