Barwell Nicholas D, Devers Marion C, Kennon Brian, Hopkinson Helen E, McDougall Claire, Young Matthew J, Robertson Hannah M A, Stang Duncan, Dancer Stephanie J, Seaton Andrew, Leese Graham P
Forth Valley Royal Hospital, Larbert, UK.
Monklands Hospital, Airdrie, UK.
Int J Clin Pract. 2017 Oct;71(10). doi: 10.1111/ijcp.13006. Epub 2017 Sep 11.
Healthcare events related to diabetic foot disease carry a burden of morbidity, mortality and economic cost. Prompt identification of clinical infection with appropriate tissue sampling limits use of broad spectrum empirical antibiotics and improves antibiotic stewardship. Staphylococcus aureus remains the commonest infecting organism and high-dose flucloxacillin remains the empirical antibiotic of choice for antibiotic naïve patients. Barriers to microbe-specific treatment include: adequate tissue sampling, delays in culture results, drug allergies and the emergence of multidrug-resistant organisms which can complicate the choice of targeted antibiotics. Even appropriate antibiotic treatment carries a risk of adverse events including the selection of resistant organisms.
Multidisciplinary clinical assessment of a diabetic foot infection is supported by the use of appropriate imaging modalities and deep tissue sampling, both of which are encouraged to enhance sampling accuracy. Narrow-spectrum, high dose, short duration antimicrobial therapy is ideal. Further clarity in these areas would be of benefit to clinicians involved in management of diabetic foot infections.
A combination of literature review with expert discussion was used to generate consensus on management of diabetic foot infection, with a specific focus on empirical antimicrobial therapy.
Gram positive organisms represent the commonest pathogens in diabetic foot infection. However there are developing challenges in antimicrobial resistance and antibiotic availability.
Recommendations for empirical therapy, including the choice of alternative oral agents and use of outpatient antibiotics would be of benefit to those involved in diabetic foot care.
This paper provides advice on empirical antibiotic therapy that may be used as a framework for local guideline development to support clinicians in the management of diabetic foot infection.
与糖尿病足病相关的医疗事件会带来发病、死亡负担以及经济成本。通过适当的组织采样迅速识别临床感染，可限制广谱经验性抗生素的使用，并改善抗生素管理。金黄色葡萄球菌仍然是最常见的感染病原体，高剂量氟氯西林仍然是未使用过抗生素患者的经验性首选抗生素。针对特定微生物治疗的障碍包括：足够的组织采样、培养结果延迟、药物过敏以及多重耐药菌的出现，这些都会使靶向抗生素的选择变得复杂。即使是适当的抗生素治疗也存在不良事件风险，包括耐药菌的产生。
使用适当的成像方式和深部组织采样来支持对糖尿病足感染进行多学科临床评估，鼓励二者结合以提高采样准确性。窄谱、高剂量、短疗程抗菌治疗是理想的。在这些领域进一步明确将有助于参与糖尿病足感染管理的临床医生。
结合文献综述与专家讨论，就糖尿病足感染的管理达成共识，特别关注经验性抗菌治疗。
革兰氏阳性菌是糖尿病足感染中最常见的病原体。然而，在抗菌药物耐药性和抗生素可用性方面正出现挑战。
关于经验性治疗的建议，包括替代口服药物的选择和门诊抗生素的使用，将对参与糖尿病足护理的人员有益。
本文提供了关于经验性抗生素治疗的建议，可作为制定当地指南的框架，以支持临床医生管理糖尿病足感染。
