Long-Term Daily Chlorhexidine Foot Cleansing Reduces Staphylococcal Burden on the Feet of People with Prior Diabetic Foot Complications
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Background
Individuals with diabetes remain at high risk for diabetic foot ulcers (DFUs) even after ulcer healing. Dysbiosis of the skin microbiome has been associated with ulcer formation. 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.
Key Points
Long-term daily chlorhexidine foot cleansing in adults with diabetes reduces Staphylococcus abundance and overall bacterial burden more effectively than soap-and-water, with microbiota effects persisting for up to one month after treatment cessation, demonstrating durable pathogen suppression.
