Esposito Silvano, Russo Enrico, Noviello Silvana, Leone Sebastiano
UOD Medicina Infettivologica, Universita di Salerno, Italy.
Infez Med. 2012;20 Suppl 1:28-34.
All infected diabetic foot wounds require antibiotic treatment. Antibiotic treatment is influenced by the patient's features as the vascular status, the leukocyte function and the kidney activity. The initial antibiotic regimen is usually chosen empirically and it can be modified on the basis of the microbiological information obtained subsequently. The initial empiric therapy should be based, on one hand, on the grade of infected lesion and, secondly, on the epidemiological data. Almost all of the mild/moderate infected wounds can be treated with antibiotics with a spectrum of activity limited to Gram-positive cocci. Treatment with oral antibiotics is sufficient in most cases in patients with mild/moderate infections. With severe infections is more appropriate to use a broad-spectrum antibiotic therapy. Furthermore it is safer to start a parenteral therapy, possibly modifying it into an oral administration if the patient has stabilized. The most frequently pathogen observed in diabetic foot infections is Staphylococcus aureus. It is important to understand whether there are elements that may lead to the suspicion of MRSA infection in order to establish an appropriate antimicrobial therapy.
所有感染的糖尿病足伤口都需要抗生素治疗。抗生素治疗会受到患者自身状况的影响，如血管状态、白细胞功能和肾脏功能。初始抗生素治疗方案通常是经验性选择的，可根据随后获得的微生物学信息进行调整。初始经验性治疗一方面应基于感染病变的分级，另一方面应基于流行病学数据。几乎所有轻度/中度感染伤口都可用抗菌谱限于革兰氏阳性球菌的抗生素治疗。对于轻度/中度感染患者，大多数情况下口服抗生素治疗就足够了。对于严重感染，使用广谱抗生素治疗更为合适。此外，开始肠外治疗更安全，如果患者病情稳定，可改为口服给药。糖尿病足感染中最常见的病原体是金黄色葡萄球菌。了解是否存在可能导致怀疑耐甲氧西林金黄色葡萄球菌（MRSA）感染的因素对于制定适当的抗菌治疗方案很重要。
