Wright Angela, Wood Stephen, De Silva Janath, Bell J Simon
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia.
Pharmacy Department, Mackay Base Hospital, Mackay, QLD 4740, Australia.
Antibiotics (Basel). 2023 Jun 12;12(6):1041. doi: 10.3390/antibiotics12061041.
Diabetic foot infections (DFIs) are a common complication of diabetes; however, there is clinical uncertainty regarding the optimal antimicrobial selection. The aim of this review was to critically evaluate the recent systematic reviews on the efficacy and safety of systemic (parenteral or oral) antimicrobials for DFI. Medline, Embase, CENTRAL, and CINAHL databases and the PROSPERO register were searched from January 2015 to January 2023. Systematic reviews with or without meta-analyses on systemic antimicrobials for DFI, with outcomes of clinical infection resolution or complications, were included. Of the 413 records identified, 6 systematic reviews of 29 individual studies were included. Heterogeneity of individual studies precluded meta-analysis, except for ertapenem versus piperacillin-tazobactam (RR 1.07, 95% CI [0.96-1.19]) and fluoroquinolones versus piperacillin-tazobactam (RR 1.03, 95% CI [0.89-1.20]) in one review. The application of the AMSTAR-2 tool determined two reviews to be of high quality. There was no statistical difference in the clinical resolution of infections for 24 different antimicrobial regimens (penicillins, cephalosporins, carbapenems, fluoroquinolones, vancomycin, metronidazole, clindamycin, linezolid, daptomycin, and tigecycline). However, tigecycline did not meet non-inferiority against ertapenem ± vancomycin (absolute difference -5.5%, 95% CI [-11.0-0.1]) and was associated with a higher incidence of adverse drug events. There is minimal systematic review evidence to suggest one regimen is superior to another for DFI.
糖尿病足感染（DFIs）是糖尿病常见的并发症；然而，在最佳抗菌药物选择方面存在临床不确定性。本综述的目的是严格评估近期关于全身性（肠外或口服）抗菌药物治疗DFIs的疗效和安全性的系统评价。检索了2015年1月至2023年1月的Medline、Embase、CENTRAL和CINAHL数据库以及PROSPERO注册库。纳入了对治疗DFIs的全身性抗菌药物进行的有或没有荟萃分析的系统评价，其结果为临床感染消退或并发症。在识别出的413条记录中，纳入了对29项个体研究的6项系统评价。除了一项综述中厄他培南与哌拉西林 - 他唑巴坦（RR 1.07，95% CI [0.96 - 1.19]）以及氟喹诺酮类与哌拉西林 - 他唑巴坦（RR 1.03，95% CI [0.89 - 1.20]）的比较外，个体研究的异质性使得无法进行荟萃分析。AMSTAR - 2工具的应用确定两项综述质量高。24种不同抗菌治疗方案（青霉素类、头孢菌素类、碳青霉烯类、氟喹诺酮类、万古霉素、甲硝唑、克林霉素、利奈唑胺、达托霉素和替加环素）在感染的临床消退方面没有统计学差异。然而，替加环素在与厄他培南±万古霉素比较时未达到非劣效性（绝对差异 -5.5%，95% CI [-11.0 - 0.1]），并且与药物不良事件的发生率较高相关。几乎没有系统评价证据表明一种治疗方案在治疗DFIs方面优于另一种方案。
