The analysis, published January 20, 2026, examined the DNA of E. coli bacteria taken from infected diabetic foot ulcers across various continents. Researchers discovered a surprising level of genetic diversity, with numerous strains carrying genes associated with both antibiotic resistance and increased virulence. This finding challenges previous assumptions that a single, highly aggressive strain was primarily responsible for the infections.

"We found that diabetic foot infections are not caused by one 'superbug,' but by a complex community of E. coli strains, many of which are equipped with the tools to resist antibiotics and cause significant tissue damage," said Dr. Anya Sharma, lead researcher on the study at King's College London. "This helps explain why these infections can be so persistent and difficult to eradicate, often leading to amputation."

Diabetic foot ulcers are a major complication of diabetes, a condition that affects an estimated 537 million adults worldwide, according to the International Diabetes Federation. The prevalence of diabetes is rapidly increasing in many parts of the world, particularly in South Asia and sub-Saharan Africa, where access to proper diabetes management and foot care is often limited. This lack of access contributes to higher rates of diabetic foot infections and subsequent amputations in these regions.

The study's findings have significant implications for the development of more effective treatment strategies. Current approaches often rely on broad-spectrum antibiotics, which can contribute to the rise of antibiotic-resistant bacteria. The identification of specific genes associated with virulence and resistance in the various E. coli strains could pave the way for targeted therapies that are less likely to promote resistance.

"Understanding the genetic makeup of these E. coli strains is crucial for developing new diagnostic tools and treatments," explained Dr. Kenji Tanaka, a collaborator on the study from the University of Tokyo. "We need to move away from a one-size-fits-all approach and tailor treatments to the specific strains present in each infection."

The research team is now working on developing rapid diagnostic tests that can identify the specific E. coli strains present in a diabetic foot ulcer, as well as their antibiotic resistance profiles. They are also exploring the potential of phage therapy, which uses viruses to target and kill specific bacteria, as a possible alternative to antibiotics. The global collaboration hopes these advancements will lead to improved outcomes for patients with diabetic foot infections worldwide, particularly in resource-limited settings where the burden of this condition is greatest.