Photodynamic therapy for infected foot ulcers in people with diabetes mellitus: a systematic review

BACKGROUND: Ulceration of the feet in patients with diabetes is a frequent complication that increases morbidity, mortality, hospitalization, treatment costs, and non-traumatic amputations. OBJECTIVE: To present a systematic review of the treatment of patients with diabetes mellitus and infect-ed foot ulcers using photodynamic therapy.DESIGN AND SETTING: A systematic review was performed in the postgraduate program in nursing at the Universidade da Integracao Internacional da Lusofonia Afro-Brasileira, Ceara, Brazil. METHODS: PubMed, CINAHL, Web of Science, EMBASE, Cochrane Library, Scopus, and LILACS databases were screened. The methodological quality, risk of bias, and quality of evidence of each study were as-sessed. Review Manager was used for the meta-analysis.RESULTS: Four studies were included. They highlighted significantly better outcomes in patient groups treated with photodynamic therapy than those in the control groups that were treated with topical col-lagenase and chloramphenicol (P = 0.036), absorbent (P < 0.001), or dry covers (P = 0.002). Significant improvements were noted in terms of the microbial load in the ulcers and tissue repair, with a reported reduction in the need for amputation by up to 35 times. Photodynamic therapy resulted in significantly better outcomes between the experimental and control groups (P = 0.04). CONCLUSION: Photodynamic therapy is significantly more effective in treating infected foot ulcers than standard therapies. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROS-PERO) -CRD42020214187, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214187.