Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, D09 YD60 Dublin, Ireland.
School of Molecular and Cellular Biology, University of Illinois Urbana-Champaign, Champaign, IL 61801, USA.
Int J Mol Sci. 2023 Feb 15;24(4):3913. doi: 10.3390/ijms24043913.
Diabetic foot infection (DFI) management requires complex multidisciplinary care pathways with off-loading, debridement and targeted antibiotic treatment central to positive clinical outcomes. Local administration of topical treatments and advanced wound dressings are often used for more superficial infections, and in combination with systemic antibiotics for more advanced infections. In practice, the choice of such topical approaches, whether alone or as adjuncts, is rarely evidence-based, and there does not appear to be a single market leader. There are several reasons for this, including a lack of clear evidence-based guidelines on their efficacy and a paucity of robust clinical trials. Nonetheless, with a growing number of people living with diabetes, preventing the progression of chronic foot infections to amputation is critical. Topical agents may increasingly play a role, especially as they have potential to limit the use of systemic antibiotics in an environment of increasing antibiotic resistance. While a number of advanced dressings are currently marketed for DFI, here we review the literature describing promising future-focused approaches for topical treatment of DFI that may overcome some of the current hurdles. Specifically, we focus on antibiotic-impregnated biomaterials, novel antimicrobial peptides and photodynamic therapy.
糖尿病足感染（DFI）的管理需要复杂的多学科护理途径，其中包括减压、清创和靶向抗生素治疗，这是取得积极临床效果的关键。局部应用局部治疗和先进的伤口敷料通常用于治疗更浅表的感染，并与全身抗生素联合用于治疗更严重的感染。实际上，此类局部治疗方法的选择（单独使用或作为辅助治疗）很少基于证据，而且似乎没有单一的市场领导者。造成这种情况的原因有几个，包括缺乏关于其疗效的明确基于证据的指南，以及缺乏强有力的临床试验。尽管如此，随着越来越多的人患有糖尿病，预防慢性足部感染进展为截肢至关重要。局部药物可能会越来越多地发挥作用，尤其是因为它们有可能在抗生素耐药性日益增加的情况下限制全身抗生素的使用。虽然目前有许多先进的敷料用于 DFI，但在这里我们回顾了描述 DFI 局部治疗有前途的未来方法的文献，这些方法可能克服当前的一些障碍。具体来说，我们专注于抗生素浸渍生物材料、新型抗菌肽和光动力疗法。
