الفهرس 
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Abstract
Diabetic foot ulceration (DFU) is one of the major complications associated with diabetes mellitus. Patients with DFU should have utmost care for the prevention of amputation. Patients are exposed to major limb loss due to healing slowlness and complication by poly-microbial infection and heavy exudates formation (Rathur and Bloulton, 2005). Finding more efficient solutions for DFU treatment can be enquired by better perception of the pathophysiology and molecular biology of these wounds. DFU therapies should be directed to actively correcting the expression of those biological factors which are important in the healing process (O’Loughlin and O’Brien, 2011).
Nearly 7.6 million Egyptians will have diabetes by 2025, making it one of the top 10 countries in the world in relation to the disease as predicted by International Diabetes Federation (IDF) (International Diabetes Federation, 2006). Diabetic foot problems might be aggravated by sociocultural factors in developing countries such as lack of patient knowledge, inappropriate footwear and the absence of specialized podiatric services. This can be easily attributed to several practices prevalent in Egypt, such as barefoot walking, inadequate facilities for diabetes care, low socioeconomic status, and illiteracy. Educating patients about proper foot care and periodic self-foot examinations has been found to be an effective method that can prevent foot ulceration. The alarming fact is that incidence of foot problems and amputations more than any other country, accounting for up to 25% of diabetes-related hospital admissions (Gunaid and Assabr, 2008).
Gram-positive (Staphylococcus aureus and Streptococcus spp) and Gram-negative bacteria (Pseudomonas aeruginosa and Proteus mirabilis) are the most common pathogen in moderate and severe diabetic foot infections. A general survey for the distribution and abundance of the organisms in wounds reveals that S. aureus and Streptococci are the main causative agent in chronic wounds, wound healing delayment and infection in both acute and chronic wounds. Therefore, the treatment of infection could be based on a better understanding of the microbiology of these wounds (Bowler et al., 2001).
Bacterial resistance to antibiotic treatment is a huge concern: introduction of any new antibiotic is shortly followed by the emergence of resistant bacterial isolates in the clinic. This issue is compounded by a severe lack of new antibiotics reaching the market. The significant rise in clinical resistance to antibiotics is especially problematic in nosocomial infections. Many believe that anti-virulence drugs would not be powerful enough to clear existing infections, restricting their potential application to prophylaxis (Ternent et al., 2015). Drug resistance enforces high dose administration of antibiotics giving rise to unbearable toxicity and severe side effects; development of new antibiotics requires significant economic and time investments (Huh and Kwon, 2011).
Development of resistant bacterial strains during monotherapy has become a grave problem. The synergistic effect of the combined drugs is considerably used for expanding the antimicrobial spectrum (Rahal, 2006).
All fields of human life are greatly influenced by the unique properties nan.