Mansilha A, Brandão D
Unit of Angiology and Vascular Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
J Cardiovasc Surg (Torino). 2013 Feb;54(1 Suppl 1):193-200.
Diabetic foot ulcers and their consequences do not only represent a major tragedy for the patient and his/her family, but also place a significant burden on the healthcare systems and society in general. Diabetic patients may develop foot ulcers due to neuropathy (autonomic, sensory, and motor deficits), angiopathy or both. As a result of the additional immunopathy associated with diabetes, the probability of these wounds to become infected is extremely high. Diabetic foot infections can be classified in mild, moderate and severe according to local and systemic signs. Their identification should lead to a prompt and systematic evaluation and treatment, ideally performed by a multidisciplinary team. Decisions concerning empirical initial antibiotic agent(s), desirable route of administration, duration and need of hospitalization should be based on the more likely involved pathogen(s), the severity of the infection, the ulcer chronicity and the presence of significant ischemia. Wound cultures, ideally from ulcer tissue, are strongly advisable and can help guiding and narrowing the antibiotic spectrum. Appropriate wound care and off-loading should not be neglected. When revascularization is required, the correct timing can be crucial for limb salvage. Since the recurrence of ulcer and infection is high, the implementation of appropriate preventive measures can be critical. Ultimately, the definitive goal in the treatment of diabetic foot infections is to prevent the amputation catastrophe.
糖尿病足溃疡及其后果不仅给患者及其家庭带来巨大悲剧，也给医疗系统乃至整个社会造成沉重负担。糖尿病患者可能因神经病变（自主神经、感觉和运动功能障碍）、血管病变或两者兼而有之而发生足部溃疡。由于糖尿病相关的额外免疫病变，这些伤口感染的可能性极高。糖尿病足感染可根据局部和全身症状分为轻度、中度和重度。对其识别应促使进行迅速且系统的评估和治疗，理想情况下由多学科团队开展。关于经验性初始抗生素药物、理想给药途径、疗程及住院需求的决策应基于最可能涉及的病原体、感染严重程度、溃疡慢性化情况以及是否存在严重缺血。强烈建议进行伤口培养，最好取自溃疡组织，这有助于指导并缩小抗生素使用范围。不应忽视适当的伤口护理和减压。当需要进行血管重建时，正确的时机对于挽救肢体可能至关重要。由于溃疡和感染的复发率很高，实施适当的预防措施可能至关重要。最终，治疗糖尿病足感染的最终目标是防止截肢悲剧的发生。
