Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly.The development of foot ulcer in a diabetic pati...Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly.The development of foot ulcer in a diabetic patient has been estimated to be 19%-34%through their lifetime.The pathophysiology of diabetic foot ulcer consist of neuropathy,trauma and,in many patients,additional peripheral arterial disease.In particular,diabetic neuropathy leads to foot deformity,callus formation,and insensitivity to trauma or pressure.The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification,surgical debridement,dressing to facilitate wound healing,offloading,vascular assessment(status and presence of a chance for interventional vascular correction),and infection and glycemic control.Although especially surgical procedures are sometimes inevitable,they are poor predictive factors for the prognosis of diabetic foot ulcer.Different novel treatment modalities such as nonsurgical debridement agents,oxygen therapies,and negative pressure wound therapy,topical drugs,cellular bioproducts,human growth factors,energy-based therapies,and systematic therapies have been available for patients with diabetic foot ulcer.However,it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials.This review aims at evaluating diabetic foot ulcer with regard to all aspects.We will also focus on conventional and novel adjunctive therapy in diabetic foot management.展开更多
文摘Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly.The development of foot ulcer in a diabetic patient has been estimated to be 19%-34%through their lifetime.The pathophysiology of diabetic foot ulcer consist of neuropathy,trauma and,in many patients,additional peripheral arterial disease.In particular,diabetic neuropathy leads to foot deformity,callus formation,and insensitivity to trauma or pressure.The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification,surgical debridement,dressing to facilitate wound healing,offloading,vascular assessment(status and presence of a chance for interventional vascular correction),and infection and glycemic control.Although especially surgical procedures are sometimes inevitable,they are poor predictive factors for the prognosis of diabetic foot ulcer.Different novel treatment modalities such as nonsurgical debridement agents,oxygen therapies,and negative pressure wound therapy,topical drugs,cellular bioproducts,human growth factors,energy-based therapies,and systematic therapies have been available for patients with diabetic foot ulcer.However,it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials.This review aims at evaluating diabetic foot ulcer with regard to all aspects.We will also focus on conventional and novel adjunctive therapy in diabetic foot management.
文摘目的:调查基于Wagner分级糖尿病足感染(diabetic foot infection,DFI)的病原菌分布及药敏情况。方法:回顾性调查重庆医科大学附属第一医院2014年1月至2016年1月收治的216例DFI患者,统计分析不同Wagner分级的DFI患者病足溃疡标本中培养的病原菌分布、多重耐药(multiple drug resistance,MDR)菌构成及其药敏结果。结果:分离出病原菌263株:单菌感染占57.4%,混合菌感染占42.6%;革兰阳性(G+)菌、革兰阴性(G-)菌和真菌分别占43.5%、48.1%和8.4%。Wagner分级患足细菌培养结果显示:2级:G+菌45株,金黄色葡萄球菌占48.9%,G-菌43株,肠杆菌占69.8%;3级:G+菌36株,肠球菌占47.2%,金黄色葡萄球菌占27.8%,G-菌44株,肠杆菌占72.7%;4级:G+菌24株,肠球菌占33.3%,金黄色葡萄球菌占25.0%,链球菌占25.0%,G-菌23株,肠杆菌占73.9%;5级:G+菌9株,肠球菌占66.7%,G-菌16株,肠杆菌占81.3%。不同Wagner分级患者G+菌和G-菌分布情况无统计学差异(P=0.526)。G+菌对万古霉素、利奈唑胺、莫西沙星、替加环素敏感性达75%以上,G-菌对碳青霉烯类、阿米卡星、抗假单胞菌青霉素类复方制剂、四代头孢菌素类、头霉素类敏感性达64%以上。结论:DFI患者总体上单一菌略多于混合菌感染,G-菌较G+菌感染分布略占优势。G+菌及G-菌对常用的抗G+菌及G-菌药物有较好敏感性。
