Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy.
Department of Infectious Diseases, School of Medicine and Surgery, University of Salerno, Salerno, Italy.
Surgeon. 2020 Oct;18(5):311-320. doi: 10.1016/j.surge.2020.01.007. Epub 2020 Feb 17.
The diagnosis of diabetic food infection is usually clinical, and its severity is related to location and depth of the lesion, and the presence of necrosis or gangrene. Osteomyelitis of the foot and ankle can be extremely debilitating, and, in the preantibiotic era acute staphylococcal osteomyelitis carried a mortality rate of 50%. The microbiology of diabetic foot osteomyelitis (DFO) is usually polymicrobial. Indeed, gram-negative and gram-positive bacilli can be identified using molecular techniques applied to bone biopsies compared to conventional techniques. The aim of the present study is to report a complete overview regarding medical and surgical management of diabetic foot osteomyelitis (DFO) in combination or alone.
We performed a search in PubMed and Scopus electronic databases (up to January 2019) of articles assessing the epidemiology, diagnostic strategy and pharmacological treatment of diabetic foot infection. In the search strategy, we used various combinations of the following key terms: infection, orthopaedic, diabetic foot, management, DFO.
This article discusses the definition, epidemiology, microbiological assessment, clinical evaluation, pharmacological and surgical management and a comparison between them, of DFO. After the initial literature search and removal of duplicate records, a total of 756 potentially relevant citations were identified. After a further screening and according to the inclusion criteria, a total of 65 articles were included in the present review.
The association of antibiotic and surgical therapy seems to be more effective compared to each one alone. The lack of comparison studies and randomized controlled trials makes it difficult to give information about the efficacy of the different management therapies.
糖尿病性食物感染的诊断通常是临床诊断，其严重程度与病变的位置和深度以及是否存在坏死或坏疽有关。足踝骨髓炎可能会使人极其虚弱，在抗生素出现之前，急性葡萄球菌骨髓炎的死亡率为 50%。糖尿病足骨髓炎（DFO）的微生物学通常是多种微生物。事实上，与传统技术相比，应用于骨活检的分子技术可以识别革兰氏阴性和革兰氏阳性杆菌。本研究的目的是报告有关联合或单独使用医学和手术治疗糖尿病足骨髓炎（DFO）的完整概述。
我们在 PubMed 和 Scopus 电子数据库（截至 2019 年 1 月）中进行了搜索，以评估糖尿病足感染的流行病学、诊断策略和药物治疗的文章。在搜索策略中，我们使用了以下关键词的各种组合：感染、矫形、糖尿病足、管理、DFO。
本文讨论了 DFO 的定义、流行病学、微生物学评估、临床评估、药物和手术治疗以及它们之间的比较。经过最初的文献搜索和重复记录的删除，共确定了 756 篇潜在相关的引文。经过进一步筛选，并根据纳入标准，共有 65 篇文章被纳入本综述。
抗生素和手术治疗的联合似乎比单独使用更有效。缺乏比较研究和随机对照试验使得难以提供关于不同管理治疗方法疗效的信息。
