Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Infection and Immunity Institute, De Boelelaan 1117, Amsterdam, The Netherlands.
Department of Medicine, University of Washington, Seattle, Washington.
Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3282. doi: 10.1002/dmrr.3282.
The optimal approaches to managing diabetic foot infections remain a challenge for clinicians. Despite an exponential rise in publications investigating different treatment strategies, the various agents studied generally produce comparable results, and high-quality data are scarce. In this systematic review, we searched the medical literature using the PubMed and Embase databases for published studies on the treatment of diabetic foot infections as of June 2018. This systematic review is an update of previous reviews, the first of which was undertaken in 2010 and the most recent in 2014, by the infection committee of the International Working Group of the Diabetic Foot. We defined the context of literature by formulating clinical questions of interest, then developing structured clinical questions (PICOs) to address these. We only included data from controlled studies of an intervention to prevent or cure a diabetic foot infection. Two independent reviewers selected articles for inclusion and then assessed their relevant outcomes and the methodological quality. Our literature search identified a total of 15 327 articles, of which we selected 48 for full-text review; we added five more studies discovered by means other than the systematic literature search. Among these selected articles were 11 high-quality studies published in the last 4 years and two Cochrane systematic reviews. Overall, the outcomes in patients treated with the different antibiotic regimens for both skin and soft tissue infection and osteomyelitis of the diabetic foot were broadly equivalent across studies, except that treatment with tigecycline was inferior to ertapenem (±vancomycin). Similar outcomes were also reported in studies comparing primarily surgical and predominantly antibiotic treatment strategies in selected patients with diabetic foot osteomyelitis. There is insufficient high-quality evidence to assess the effect of various adjunctive therapies, such as negative pressure wound therapy, topical ointments or hyperbaric oxygen, on infection related outcomes of the diabetic foot. In general, the quality of more recent trial designs are better in past years, but there is still a great need for further well-designed trials to produce higher quality evidence to underpin our recommendations.
对于临床医生来说，管理糖尿病足感染的最佳方法仍然是一个挑战。尽管发表了大量研究不同治疗策略的文献，但所研究的各种药物通常产生相当的结果，并且高质量的数据很少。在这项系统评价中，我们检索了截至 2018 年 6 月在 PubMed 和 Embase 数据库中发表的关于糖尿病足感染治疗的文献。这项系统评价是对以前综述的更新，最早的综述于 2010 年进行，最近的一次于 2014 年由糖尿病足国际工作组感染委员会进行。我们通过提出感兴趣的临床问题来定义文献的背景，然后制定结构化的临床问题（PICOS）来解决这些问题。我们仅纳入了预防或治疗糖尿病足感染的干预措施的对照研究的数据。两名独立的审稿人选择纳入的文章，然后评估其相关结局和方法学质量。我们的文献检索共确定了 15327 篇文章，其中我们选择了 48 篇进行全文审查；我们通过系统文献检索以外的其他方式发现了另外 5 项研究。在这些入选的文章中，有 11 项高质量的研究是在过去 4 年发表的，还有两项 Cochrane 系统评价。总的来说，除了替加环素不如厄他培南（±万古霉素）外，接受不同抗生素方案治疗的患者在皮肤和软组织感染以及糖尿病足骨髓炎的结局在不同研究中基本相当。在对选择的糖尿病足骨髓炎患者主要采用手术和主要采用抗生素治疗策略的研究中，也报告了类似的结局。目前尚无足够的高质量证据来评估各种辅助治疗（如负压伤口治疗、局部软膏或高压氧）对糖尿病足感染相关结局的影响。总的来说，过去几年中，较新试验设计的质量有所提高，但仍需要进一步精心设计的试验来产生更高质量的证据，以支持我们的建议。
