Muri Thaddaeus, Schöni Madlaina, Waibel Felix W A, Altmann Dominique, Sydler Christina, Furrer Pascal R, Napoli Francesca, Uçkay İlker
Technical Orthopedics and Neuro-Orthopedics Team, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
Infectiology, Balgrist University Hospital, 8008 Zurich, Switzerland.
Antibiotics (Basel). 2024 Nov 26;13(12):1136. doi: 10.3390/antibiotics13121136.
Many patients with community-acquired diabetic foot infections (DFI) receive systemic (empirical) antibiotic treatments before surgical interventions, often by the general practitioner. Sometimes, hospital clinicians prescribe them before surgery to reduce the infection inoculum and preserve soft tissue for immediate wound closure in case of residual infection after surgery. In contrast, the international guidelines (IWGDF) advocate against presurgical antibiotic use in routine situations without severe progredient soft tissue infections and/or sepsis. We run several retrospective and prospective cohorts of DFI and retrospectively analyze the influence of presurgical antibiotic therapy (as binary (yes/no) or continuous (in days) variables) on failures after a combined surgical and medical treatment. In our large database, the presence, choice, administration routes, or duration of preoperative antibiotic therapy did not improve the postoperative outcomes of operated diabetic foot infections or prevent their failures. In turn, this lack of influence leaves space for enhanced antibiotic stewardship in the management of DFI.
许多社区获得性糖尿病足感染（DFI）患者在手术干预前接受全身性（经验性）抗生素治疗，通常由全科医生进行。有时，医院临床医生在手术前开具抗生素，以减少感染菌量，并在术后残留感染时保留软组织以便立即闭合伤口。相比之下，国际指南（IWGDF）主张在无严重进行性软组织感染和/或脓毒症的常规情况下，反对术前使用抗生素。我们对多个DFI回顾性和前瞻性队列进行研究，并回顾性分析术前抗生素治疗（作为二元（是/否）或连续（天数）变量）对手术和药物联合治疗后失败情况的影响。在我们的大型数据库中，术前抗生素治疗的存在、选择、给药途径或持续时间并未改善手术治疗的糖尿病足感染的术后结局，也未能预防其治疗失败。相应地，这种缺乏影响为DFI管理中加强抗生素管理留出了空间。
