Lipsky Benjamin A
University of Washington, USA.
Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S66-71. doi: 10.1002/dmrr.828.
Foot infections are common in persons with diabetes and are often the proximate cause of lower extremity amputation. There have been many publications in the past few years dealing with the appropriate ways to diagnose and treat diabetic foot infections. This review presents information gathered from a comprehensive, ongoing surveillance of the literature (published and abstracts) over the past 4 years. Prospective studies have now defined the epidemiology of diabetic foot infections, as well as methods to score and classify the wounds. Several recently published guidelines can assist clinicians in managing these infections. The etiologic agents of infection have been well-defined, and the prevalence of multi-drug-resistance pathogens is growing. Molecular methods offer great promise for quicker and more sensitive diagnosis of infection. New antimicrobial agents, both systemic and topical, as well as novel local treatments, have been shown to be effective in various studies. Improved methods of deploying older agents have added to the variety of treatment approaches now available. Several adjunctive treatments may benefit some patients but their role is as yet unclear. While there is much yet to learn about the most cost-effective ways to diagnose and treat diabetic foot infections the main effort is now to disseminate the available information and facilitate employing the evidence-based guideline recommendations.
足部感染在糖尿病患者中很常见，且常常是下肢截肢的直接原因。在过去几年里，有许多关于诊断和治疗糖尿病足部感染的适当方法的出版物。本综述呈现了过去4年从对文献（已发表的和摘要）进行的全面、持续监测中收集到的信息。前瞻性研究现已明确了糖尿病足部感染的流行病学，以及对伤口进行评分和分类的方法。最近发布的几项指南可帮助临床医生管理这些感染。感染的病原体已得到明确界定，多重耐药病原体的患病率正在上升。分子方法为更快、更灵敏地诊断感染带来了很大希望。在各项研究中，新型全身性和局部用抗菌药物以及新颖的局部治疗方法已显示出有效性。改进使用传统药物的方法增加了目前可用的治疗方法的种类。几种辅助治疗可能使一些患者受益，但其作用尚不清楚。虽然在诊断和治疗糖尿病足部感染的最具成本效益的方法方面仍有许多有待了解之处，但目前的主要工作是传播现有信息，并促进采用基于证据的指南建议。
