Infectiology, Balgrist University Hospital, University of Zurich, Switzerland.
Diabetic Foot Unit, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Switzerland.
J Diabetes Res. 2022 Aug 5;2022:9546144. doi: 10.1155/2022/9546144. eCollection 2022.
While a patient's nutritional status is known to generally have a role in postoperative wound healing, there is little information on its role as therapy in the multifaceted problem of diabetic foot infections (DFIs).
We assessed this issue by conducting a retrospective case-control cohort study using a multivariate Cox regression model. The nutrition status of the DFI patients was assessed by professional nutritionists, who also orchestrated the nutritional intervention (counselling, composition of the intrahospital food) during hospitalization.
Among 1,013 DFI episodes in 586 patients (median age 67 years; 882 with osteomyelitis), 191 (19%) received a professional assessment of their nutrition accompanied by between 1 and 6 nutritional interventions. DFI cases who had professional nutritionists' interventions had a significantly shorter hospital stay, had shorter antibiotic therapies, and tended to fewer surgical debridements. By multivariate analysis, episodes with low Nutritional Risk Status- (NRS-) Scores 1-3 were associated with significantly lower failure rates after therapy for DFI (Cox regression analysis; hazard ratio 0.2, 95% confidence interval 0.1-0.7).
In this retrospective cohort study, DFI episodes with low NRS-Score were associated with lower rates of clinical failure after DFI treatment, while nutritional interventions improved the outcome of DFI. We need prospective interventional trials for this treatment, and these are underway.
虽然患者的营养状况通常对术后伤口愈合有一定作用，但关于其在糖尿病足感染（DFI）这一复杂问题中的治疗作用的信息却很少。
我们通过使用多变量 Cox 回归模型进行回顾性病例对照队列研究来评估这个问题。DFI 患者的营养状况由专业营养师进行评估，营养师还在住院期间协调营养干预（咨询、院内食物的组成）。
在 586 名患者的 1013 例 DFI 发作（中位年龄 67 岁；882 例伴有骨髓炎）中，有 191 例（19%）接受了专业的营养评估，并进行了 1 至 6 次营养干预。接受专业营养师干预的 DFI 病例住院时间明显更短，抗生素治疗时间更短，手术清创次数也更少。多变量分析显示，NRS 评分 1-3 低的 DFI 发作在治疗后临床失败率显著降低（Cox 回归分析；危险比 0.2，95%置信区间 0.1-0.7）。
在这项回顾性队列研究中，NRS 评分低的 DFI 发作与 DFI 治疗后临床失败率降低相关，而营养干预改善了 DFI 的结局。我们需要针对这种治疗进行前瞻性干预试验，这些试验正在进行中。
