Chen Yin, Ding Hui, Wu Hua, Chen Hong-Lin
1 School of Nursing, Nantong University, Nantong, Jiangsu, People's Republic of China.
Int J Low Extrem Wounds. 2017 Sep;16(3):183-190. doi: 10.1177/1534734617728642. Epub 2017 Sep 1.
In this study, we aimed to investigate the relationship between osteomyelitis complications and drug-resistant infection risk in diabetic foot ulcer. Searches of MEDLINE and ISI databases were performed for the studies. Odds ratios (ORs) for drug-resistant infection incidence were calculated for diabetic foot ulcer patients with or without osteomyelitis complications. Eleven studies (12 cohorts) with 1526 patients were included in this study. Meta-analysis showed that the summary OR was 3.343 (95% CI = 2.355-4.745; Z = 6.75, P < .00001) when compared with osteomyelitis group and without osteomyelitis group. Significant publication bias was found. Sensitivity analysis by only pooled the adjusted ORs showed that the result was robust (the summary OR = 4.081, 95% CI = 2.471-6.739). Subgroup analysis by drug-resistant type showed that the summary OR was 4.391 (95% CI = 2.287-8.394) for methicillin-resistant infection subgroup, and 2.693 (95% CI = 1.882-3.851) for multidrug-resistant infection subgroup. The meta-regression showed that drug-resistant incidence ( t = -0.90, P = .389) and published year ( t = -0.11, P = .913) were not related with the OR changes. In conclusion, our meta-analysis indicates that osteomyelitis complications are related with drug-resistant infection risk in diabetic foot ulcer. We suggest bone culture-based narrow-spectrum antibiotic therapy for osteomyelitis for prevention drug-resistant infection in diabetic foot ulcer.
在本研究中，我们旨在调查糖尿病足溃疡中骨髓炎并发症与耐药感染风险之间的关系。对MEDLINE和ISI数据库进行了检索以查找相关研究。计算了有或无骨髓炎并发症的糖尿病足溃疡患者耐药感染发生率的比值比（OR）。本研究纳入了11项研究（12个队列）中的1526例患者。荟萃分析显示，与骨髓炎组和无骨髓炎组相比，汇总OR为3.343（95%CI = 2.355 - 4.745；Z = 6.75，P <.00001）。发现存在显著的发表偏倚。仅通过汇总调整后的OR进行的敏感性分析表明结果是稳健的（汇总OR = 4.081，95%CI = 2.471 - 6.739）。按耐药类型进行的亚组分析显示，耐甲氧西林感染亚组的汇总OR为4.391（95%CI = 2.287 - 8.394），多重耐药感染亚组为2.693（95%CI = 1.882 - 3.851）。荟萃回归显示，耐药发生率（t = -0.90，P =.389）和发表年份（t = -0.11，P =.913）与OR变化无关。总之，我们的荟萃分析表明，骨髓炎并发症与糖尿病足溃疡中的耐药感染风险相关。我们建议对骨髓炎采用基于骨培养的窄谱抗生素治疗，以预防糖尿病足溃疡中的耐药感染。
