Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Abbas Medical Center, Dar es Salaam, Tanzania.
Endocrinol Diabetes Metab. 2024 Jul;7(4):e00503. doi: 10.1002/edm2.503.
Diabetic foot ulcers in developing countries often become infected. The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI).
We evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource-poor settings such as in Africa.
The management of DFI very often is adapted to the financial and practical realities of the resource-poor regions. The application of the point-of-care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi-quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs.
In the practical and resource-saving management of DFI, the 'therapeutic' use of Gram stains is not common in resource-rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.
发展中国家的糖尿病足溃疡常发生感染。医疗保健系统通常没有能力进行培养和药敏试验，无法为糖尿病足感染（DFI）开具针对性的抗生素治疗方案。
我们评估了各级医疗保健机构的抗生素管理计划，重点关注资源匮乏的地区，如非洲。
DFI 的管理通常会根据资源匮乏地区的财务和实际情况进行调整。即时检测深层组织样本的革兰氏染色在经济上具有高效、快速、低成本和广泛可用性的优势。根据革兰氏染色中主要病原体的鉴定，可以根据世界卫生组织的预警、观察和限制基本药物清单，开始进行半定量的先发制人抗生素治疗。该清单适用于每个国家，是一个强大的工具。然而，为了选择最合适的药物，需要了解当地微生物流行病学的一些基本知识。我们报告了使用快速获得的革兰氏染色来缩小上市抗生素药物先发制人的选择范围的经验，这是在 DFI 中进行抗生素管理的经济工具。
在 DFI 的实际和节约资源的管理中，革兰氏染色的“治疗”用途在资源丰富的国家并不常见，但应作为抗生素管理的一般努力的一部分加入。
