Blanchette V, Brousseau-Foley M
Université du Québec à Trois-Rivières, programme de médecine podiatrique, département des sciences de l'activité physique, 3351, boulevard des Forges, CP 500, G9A 5H7 Trois-Rivières, Québec, Canada.
Université du Québec à Trois-Rivières, programme de médecine podiatrique, département des sciences de l'activité physique, 3351, boulevard des Forges, CP 500, G9A 5H7 Trois-Rivières, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec (CIUSSS-MCQ) affilié à l'Université de Montréal, Faculté de Médecine, Groupe de médecine familiale universitaire de Trois-Rivières, G9A 1X9 Trois-Rivières, Québec, Canada.
Rev Med Interne. 2021 Mar;42(3):193-201. doi: 10.1016/j.revmed.2020.09.004. Epub 2021 Jan 12.
Infection is one of the most common complications of diabetic foot ulceration resulting in lower extremity amputations and early mortality in this population. Several factors influence the course of diabetic foot ulceration infection and in that context, integrated multidisciplinary management is required as soon as possible. In fact, a holistic interdisciplinary approach should be the standard of care. Whether the infection is categorized as mild, moderate or severe, with or without bone infection, the overall individual's characteristics must be addressed, in addition to local wound care, offloading and antibiotic therapy. Some severe infections have potential indications for hospitalization and are considered as surgical emergencies. In some DFU cases, surgical revascularization of the limb is mandatory to treat the infection. However, surgical interventions and amputations, are sometimes inevitable, they are predictors of bad prognosis. Although some adjuvant therapies are effective to promote wound healing, their use is not recommended to treat diabetic foot ulcer infection. Infection management can be divided into three general interventions: proper clinical diagnosis, microbiological and imaging investigations, and treatment. This review is an update on the up-to-date evidences in scientific literature and includes the latest recommendations from the International Working Group on the Diabetic Foot (IWGDF).
感染是糖尿病足溃疡最常见的并发症之一,可导致该人群下肢截肢和早期死亡。多种因素影响糖尿病足溃疡感染的病程,在此背景下,需要尽快进行综合多学科管理。事实上,全面的跨学科方法应成为护理标准。无论感染被分类为轻度、中度还是重度,有无骨感染,除了局部伤口护理、减压和抗生素治疗外,还必须考虑个体的整体特征。一些严重感染有住院的潜在指征,被视为外科急症。在一些糖尿病足溃疡病例中,肢体的外科血管重建对于治疗感染是必不可少的。然而,手术干预和截肢有时是不可避免的,它们是预后不良的预测因素。尽管一些辅助治疗对促进伤口愈合有效,但不建议用于治疗糖尿病足溃疡感染。感染管理可分为三项一般干预措施:正确的临床诊断、微生物学和影像学检查以及治疗。本综述是对科学文献中最新证据的更新,并纳入了国际糖尿病足工作组(IWGDF)的最新建议。