糖尿病足感染的系统评价：发病机制、诊断及管理策略
A systematic review of diabetic foot infections: pathogenesis, diagnosis, and management strategies.
作者信息
Maity Sabyasachi, Leton Noah, Nayak Narendra, Jha Ameet, Anand Nikhilesh, Thompson Kamala, Boothe Danielle, Cromer Alexandra, Garcia Yaliana, Al-Islam Aliyah, Nauhria Samal
机构信息
Department of Physiology, Neuroscience, and Behavioral Sciences, St. George's University School of Medicine, St. George's, Grenada.
Department of Microbiology, St. Matthews University School of Medicine, Grand Cayman, Cayman Islands.
出版信息
Front Clin Diabetes Healthc. 2024 Aug 6;5:1393309. doi: 10.3389/fcdhc.2024.1393309. eCollection 2024.
BACKGROUND
Diabetic foot infection represents a significant complication of diabetes mellitus, contributing substantially to morbidity, mortality, and healthcare expenditure worldwide. Accurate diagnosis relies on a comprehensive assessment integrating clinical evaluation, imaging studies, and microbiological analysis. Management necessitates a multidisciplinary approach, encompassing surgical intervention, antimicrobial therapy, and advanced wound care strategies. Preventive measures are paramount in reducing the incidence and severity, emphasizing patient education, regular foot screenings, and early intervention.
METHODS
The researchers performed a systematic review of literature using PUBMED MESH keywords. Additionally, the study was registered in the International Prospective Register of Systematic Reviews at the Center for Reviews and Dissemination, University of York (CRD42021277788). This review provides a comprehensive overview of the microbial spectrum and antibiotic susceptibility patterns observed in diabetic foot infections.
RESULTS
The search through the databases finally identified 13 articles with 2545 patients from 2021 to 2023. Overall, the predominant Gram-positive microbial species isolated were Staphylococcus aureus, Enterococcus fecalis, Streptococcus pyogenes, Streptococcus agalactiae, and Staphylococcus epidermidis. Whereas the predominant Gram-negative included Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa.
CONCLUSION
Diabetic foot infections represent a complex and multifaceted clinical entity, necessitating a holistic approach to diagnosis, management, and prevention. Limited high-quality research data on outcomes and the effectiveness of guideline recommendations pose challenges in updating and refining existing DFI management guidelines.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021277788, identifier CRD42021277788.
背景
糖尿病足感染是糖尿病的一种严重并发症，在全球范围内对发病率、死亡率和医疗保健支出有重大影响。准确诊断依赖于综合评估，包括临床评估、影像学检查和微生物学分析。治疗需要多学科方法，包括手术干预、抗菌治疗和先进的伤口护理策略。预防措施对于降低发病率和严重程度至关重要，强调患者教育、定期足部筛查和早期干预。
方法
研究人员使用PUBMED医学主题词对文献进行了系统评价。此外，该研究已在约克大学评审与传播中心的国际系统评价前瞻性注册库（CRD42021277788）注册。本综述全面概述了糖尿病足感染中观察到的微生物谱和抗生素敏感性模式。
结果
通过数据库检索最终确定了2021年至2023年的13篇文章，涉及2545例患者。总体而言，分离出的主要革兰氏阳性微生物种类为金黄色葡萄球菌、粪肠球菌、化脓性链球菌、无乳链球菌和表皮葡萄球菌。而主要的革兰氏阴性菌包括大肠杆菌、肺炎克雷伯菌、奇异变形杆菌和铜绿假单胞菌。
结论
糖尿病足感染是一个复杂多面的临床实体，需要采用整体方法进行诊断、治疗和预防。关于结局和指南建议有效性的高质量研究数据有限，给更新和完善现有糖尿病足感染管理指南带来了挑战。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021277788，标识符CRD42021277788 。
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