Rao Nalini, Lipsky Benjamin A
Division of Infectious Disease, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232-1381, USA.
Drugs. 2007;67(2):195-214. doi: 10.2165/00003495-200767020-00003.
Foot infections are common and the most serious lower extremity complication contributing to amputations, particularly in patients with diabetes mellitus. Infection is most often a consequence of foot ulcerations, which typically follows trauma to a neuropathic foot. Foot infections may be classified as mild, moderate and severe; this largely determines the approach to therapy. Gram-positive bacteria are the sole causative pathogens for most mild and moderate infections. These infections can usually be treated with culture-based narrow-spectrum antibacterials along with appropriate surgical debridement in an outpatient setting. In contrast, severe infections are often polymicrobial, requiring hospitalisation and treatment with broad-spectrum antibacterials along with appropriate medical and surgical interventions. The initial empirical antibacterial regimen may be tailored based on the results of culture and sensitivity tests from properly obtained specimens. Several antibacterial regimens have demonstrated effectiveness in randomised controlled trials, but no single regimen has shown superiority. Managing diabetic foot osteomyelitis is particularly controversial and requires reliable cultures to select an appropriate antibacterial regimen. Surgical resection of the infected and necrotic bone favours a good outcome in chronic osteomyelitis. The recommended duration of antibacterial therapy ranges from 1 to 4 weeks for soft tissue infection, to >6 weeks for unresected osteomyelitis. The incidence of meticillin-resistant Staphylococcus aureus infection is increasing in both the healthcare setting and the community. This should be considered when selecting an antibacterial, especially if the patient does not improve with initial antibacterial therapy. Certain other organisms, such as Pseudomonas aeruginosa and Enterococcus spp., while potentially pathogenic, are often colonisers that do not require targeted therapy.
足部感染很常见，是导致截肢的最严重的下肢并发症，在糖尿病患者中尤为如此。感染通常是足部溃疡的结果，而足部溃疡通常继发于神经病变足部的创伤。足部感染可分为轻度、中度和重度；这在很大程度上决定了治疗方法。革兰氏阳性菌是大多数轻度和中度感染的唯一致病病原体。这些感染通常可以在门诊环境中使用基于培养的窄谱抗菌药物以及适当的手术清创来治疗。相比之下，严重感染往往是多微生物感染，需要住院治疗，并使用广谱抗菌药物以及适当的医学和手术干预措施。初始经验性抗菌治疗方案可根据从适当获取的标本中进行的培养和药敏试验结果进行调整。几种抗菌治疗方案在随机对照试验中已证明有效，但没有一种方案显示出优越性。治疗糖尿病足骨髓炎尤其具有争议性，需要可靠的培养结果来选择合适的抗菌治疗方案。对感染和坏死骨进行手术切除有利于慢性骨髓炎取得良好预后。软组织感染的抗菌治疗推荐疗程为1至4周，未切除的骨髓炎则>6周。耐甲氧西林金黄色葡萄球菌感染在医疗机构和社区中的发生率都在上升。在选择抗菌药物时应考虑到这一点，尤其是如果患者在初始抗菌治疗后没有改善。某些其他微生物，如铜绿假单胞菌和肠球菌属，虽然可能具有致病性，但通常是定植菌，不需要针对性治疗。
