Omar Nesrene S, El-Nahas Mamdouh R, Gray Jim
Medical Microbiology & Immunology Department, Faculty of Medicine, Mansoura University, Egypt.
Int J Antimicrob Agents. 2008 May;31(5):411-9. doi: 10.1016/j.ijantimicag.2007.10.016. Epub 2007 Dec 26.
Foot infections are a major cause of morbidity in diabetic patients. Staphylococcus aureus is the most important pathogen in mild infections; moderate to severe infections are frequently polymicrobial. Multidrug resistance is an increasing problem in isolates from diabetic feet. Worldwide, up to 30% of patients with diabetic foot infection (DFI) are colonised with methicillin-resistant S. aureus (MRSA), whilst extended-spectrum beta-lactamase-producing Gram-negative bacteria are also common in some countries. This emergence of drug resistance has coincided with the launch or imminent availability of many new antibiotics. Most of these were developed to target multidrug-resistant Gram-positive bacteria, although some have a spectrum of activity that includes Gram-negative bacteria and anaerobes. There is a variable amount of experience with these agents in treating skin and skin-structure infections (SSSIs), especially for DFI. However, at least some have a spectrum of activity and/or pharmacological properties that suggest that they may be of value in managing DFIs. The aim of this paper is to review evidence for the efficacy of new antibiotics in the management of SSSIs, including any data relating specifically to the diabetic foot, and to consider where they might fit into the therapeutic armory against DFI.
足部感染是糖尿病患者发病的主要原因。金黄色葡萄球菌是轻度感染中最重要的病原体；中度至重度感染通常是多微生物感染。多重耐药性在糖尿病足分离株中是一个日益严重的问题。在全球范围内，高达30%的糖尿病足感染（DFI）患者感染了耐甲氧西林金黄色葡萄球菌（MRSA），而产超广谱β-内酰胺酶的革兰氏阴性菌在一些国家也很常见。耐药性的出现与许多新抗生素的推出或即将上市同时发生。这些新抗生素大多是针对多重耐药革兰氏阳性菌开发的，不过有些抗生素的活性谱包括革兰氏阴性菌和厌氧菌。在治疗皮肤及皮肤结构感染（SSSI），尤其是糖尿病足感染方面，使用这些药物的经验各不相同。然而，至少有些抗生素的活性谱和/或药理特性表明它们在治疗糖尿病足感染方面可能具有价值。本文的目的是综述新抗生素治疗皮肤及皮肤结构感染有效性的证据，包括任何与糖尿病足相关的具体数据，并考虑它们在对抗糖尿病足感染的治疗手段中可能处于什么位置。
