Medical University of South Carolina, Charleston, SC, USA.
Am Fam Physician. 2021 Oct 1;104(4):386-394.
Diabetes-related foot infections occur in approximately 40% of diabetes-related foot ulcers and cause significant morbidity. Clinicians should consider patient risk factors (e.g., presence of foot ulcers greater than 2 cm, uncontrolled diabetes mellitus, poor vascular perfusion, comorbid illness) when evaluating for a foot infection or osteomyelitis. Indicators of infection include erythema, induration, tenderness, warmth, and drainage. Superficial wound cultures should be avoided because of the high rate of contaminants. Deep cultures obtained through aseptic procedures (e.g., incision and drainage, debridement, bone culture) help guide treatment. Plain radiography is used for initial imaging if osteomyelitis is suspected; however, magnetic resonance imaging or computed tomography may help if radiography is inconclusive, the extent of infection is unknown, or if the infection orientation needs to be determined to help in surgical planning. Staphylococcus aureus and Streptococcus agalactiae are the most commonly isolated pathogens, although polymicrobial infections are common. Antibiotic therapy should cover commonly isolated organisms and reflect local resistance patterns, patient preference, and the severity of the foot infection. Mild and some moderate infections may be treated with oral antibiotics. Severe infections require intravenous antibiotics. Treatment duration is typically one to two weeks and is longer for slowly resolving infections or osteomyelitis. Severe or persistent infections may require surgery and specialized team-based wound care. Although widely recommended, there is little evidence on the effectiveness of primary prevention strategies. Systematic assessment, counseling, and comorbidity management are hallmarks of effective secondary prevention for diabetes-related foot infections.
糖尿病相关的足部感染约占糖尿病相关足部溃疡的 40%，会导致严重的发病率。临床医生在评估足部感染或骨髓炎时，应考虑患者的风险因素（例如，存在大于 2 厘米的足部溃疡、未控制的糖尿病、血管灌注不良、合并症）。感染的指标包括红斑、硬结、压痛、发热和分泌物。由于污染率高，应避免进行浅层伤口培养。通过无菌程序（例如切开引流、清创、骨培养）获得的深层培养有助于指导治疗。如果怀疑骨髓炎，应进行初始影像学检查（例如 X 线平片）；但是，如果 X 线平片不确定、感染范围未知、或者需要确定感染方向以帮助手术规划，则可能需要进行磁共振成像或计算机断层扫描。金黄色葡萄球菌和无乳链球菌是最常分离的病原体，尽管多微生物感染很常见。抗生素治疗应覆盖常见的分离病原体，并反映当地的耐药模式、患者的偏好以及足部感染的严重程度。轻度和一些中度感染可以用口服抗生素治疗。严重感染需要静脉用抗生素。治疗时间通常为一到两周，对于缓慢消退的感染或骨髓炎则更长。严重或持续的感染可能需要手术和专门的团队式伤口护理。尽管广泛推荐，但针对初级预防策略的有效性的证据很少。系统评估、咨询和合并症管理是糖尿病相关足部感染有效二级预防的标志。
