Rao Nalini
Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA.
Clin Orthop Relat Res. 2005 Oct;439:87-90. doi: 10.1097/01.blo.0000181497.42117.fa.
Foot infection is a huge economic and social burden for patients with diabetes. The etiology is multifactorial, necessitating a multidisciplinary team for successful treatment and prevention. Infection usually is a consequence rather than the cause of foot ulcers in patients with diabetes. Infection is a clinical diagnosis and can be categorized as mild cellulitis, moderate to severe cellulitis, and osteomyelitis. No single imaging technique is 100% sensitive or specific for the diagnosis of osteomyelitis. Infected foot ulcers require appropriate tissue and bone cultures to guide antibiotic therapy whereas uninfected ulcers, which may be colonized with bacteria, do not require antibiotics. Gram-positive organisms account for a substantial proportion of infections with increasing prevalence of methicillin-resistant Staphylococcus aureus in recent years. Osteomyelitis in patients with diabetes requires aggressive surgical intervention in addition to antibiotics. Duration of treatment varies from 2 to 6 weeks based on the severity of infection, along with surgical debridement. Prevention of foot ulcer and infection requires patient education, detection of neuropathy, glycemic control, and proper foot care with foot hygiene and appropriate footwear. The patient is an important member of the team and should be taught the importance of self examination and early reporting of foot problems.
足部感染对于糖尿病患者而言是一项巨大的经济和社会负担。其病因是多因素的，这就需要一个多学科团队来实现成功的治疗和预防。在糖尿病患者中，感染通常是足部溃疡的结果而非病因。感染是一种临床诊断，可分为轻度蜂窝织炎、中度至重度蜂窝织炎以及骨髓炎。没有单一的影像学技术对骨髓炎的诊断具有100%的敏感性或特异性。感染的足部溃疡需要进行适当的组织和骨培养以指导抗生素治疗，而未感染的溃疡（可能有细菌定植）则不需要使用抗生素。近年来，革兰氏阳性菌在感染中占相当大的比例，耐甲氧西林金黄色葡萄球菌的患病率不断上升。糖尿病患者的骨髓炎除了使用抗生素外，还需要积极的手术干预。根据感染的严重程度以及手术清创情况，治疗持续时间从2周至6周不等。预防足部溃疡和感染需要对患者进行教育、检测神经病变、控制血糖，并通过足部卫生和合适的鞋类进行适当的足部护理。患者是团队的重要成员，应了解自我检查和早期报告足部问题的重要性。
