被忽视的糖尿病足感染致病因素：13 例真菌感染病因的回顾性评估。
A neglected causative agent in diabetic foot infection: a retrospective evaluation of 13 patients with fungal etiology.
出版信息
Turk J Med Sci. 2019 Feb 11;49(1):81-86. doi: 10.3906/sag-1809-74.
BACKGROUND/AIM: Clinicians often neglect fungal infections and do not routinely investigate deep tissue from the wound for fungal culture and sensitivity due to insufficient information in the literature. In this study, we aimed to evaluate fungal etiology of invasive fungal diabetic foot which is rarely reported in the literature.
MATERIALS AND METHODS
The patients who were unresponsive to antibiotic therapy and those with positive fungal in bone or deep tissue culture were enrolled in the study. Detailed hospital records were retrieved for demographics and clinical features.
RESULTS
A total of 13 patients who were diagnosed with invasive fungal diabetic foot (ten females, three males, mean age 59.8 ± 9 years) were included. All of the patients had type-2 diabetes mellitus. Eleven (84.6%) patients had mixed infection. The most common cause of fungal infections of diabetic foot ulcers was the Candida species. Ten (76.9%) patients underwent amputation, two (15.4%) patients refused amputation, and one patient died before surgery.
CONCLUSION
Invasive fungal infections may also be a causative pathogen in deep tissue infections. Therefore, fungal pathogens should be considered in patients unresponsive to long-term antibiotic therapy. Early detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation.
背景/目的：由于文献中信息不足，临床医生经常忽视真菌感染，并且通常不会对伤口深部组织进行真菌培养和药敏检查。本研究旨在评估侵袭性真菌性糖尿病足的真菌病因，这在文献中很少报道。
材料和方法
本研究纳入了对抗生素治疗无反应且骨或深部组织培养阳性的真菌感染患者。详细检索了患者的住院记录以获取人口统计学和临床特征。
结果
共纳入 13 例诊断为侵袭性真菌性糖尿病足的患者（10 名女性，3 名男性，平均年龄 59.8 ± 9 岁）。所有患者均患有 2 型糖尿病。11 例（84.6%）患者存在混合感染。糖尿病足溃疡真菌感染的最常见原因是念珠菌属。10 例（76.9%）患者接受了截肢手术，2 例（15.4%）患者拒绝截肢，1 例患者在手术前死亡。
结论
侵袭性真菌感染也可能是深部组织感染的致病病原体。因此，对于长期抗生素治疗无反应的患者，应考虑真菌病原体。早期发现高危人群的真菌感染对于预防严重后果（如截肢）至关重要。
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