Gustave Dron Hospital, Tourcoing, France.
Lille University, France.
Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3281. doi: 10.1002/dmrr.3281.
Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potentially mortality and present formidable challenges in surgical and antimicrobial treatment.
In June 2018, we searched the literature using PuEbMed and EMBASE for published studies on the diagnosis of diabetic foot infection. On the basis of predetermined criteria, we reviewed prospective controlled, as well as noncontrolled, studies in any language, seeking translations for those not in English. We then developed evidence statements on the basis of the included papers.
From the 4242 records screened, we selected 35 papers that met our inclusion criteria. The quality of all but one of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot scheme correlates with the patient's likelihood of ulcer healing, of lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers are supportive, but not diagnostic, of soft tissue or bone infection. In patients with suspected diabetic foot osteomyelitis, both a positive probe-to-bone test and an elevated erythrocyte sedimentation rate are strongly associated with its presence. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Plain X-ray remains the first-line imaging examination when there is suspicion of diabetic foot osteomyelitis, but advanced imaging methods help in cases when either the diagnosis or the localization of infection is uncertain.
The results of this first reported systematic review on the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is a need for more prospective controlled studies of high quality.
尽早准确诊断糖尿病足感染并评估其严重程度至关重要，因为这些感染可能导致严重的发病率和潜在的死亡率，并在手术和抗菌治疗方面带来巨大挑战。
我们于 2018 年 6 月使用 PubMed 和 EMBASE 搜索关于糖尿病足感染诊断的文献。根据预定的标准，我们回顾了前瞻性对照和非对照研究，语言不限，并为非英语文献寻求翻译。然后，我们根据纳入的论文制定证据陈述。
在筛选出的 4242 条记录中，我们选择了 35 篇符合纳入标准的论文。由于几乎所有研究的方法学都很薄弱，除了一篇论文外，所有证据陈述的质量都很低。现有数据表明，根据临床体征和症状并按照国际糖尿病足工作组方案进行分类来诊断糖尿病足感染，与患者溃疡愈合、下肢截肢和死亡风险相关。选择的血清炎症标志物水平升高支持，但不能诊断软组织或骨感染。在疑似糖尿病足骨髓炎的患者中，探针到骨试验阳性和红细胞沉降率升高均与该病的存在密切相关。当小心避免污染时，对软组织或骨的组织样本进行培养可提供比浅层（拭子）样本培养更准确的微生物学信息。当怀疑有糖尿病足骨髓炎时，普通 X 射线仍然是一线影像学检查，但当诊断或感染定位不确定时，高级影像学方法会有所帮助。
这是首次对糖尿病足感染诊断进行的系统评价，结果为临床医生提供了一些指导，但仍需要更多高质量的前瞻性对照研究。
