Naslov
Infekcija i odabir antibiotika - Mikrobiologija dijabetičkog stopala i osobitosti, uzročnici i vrste infekcija
(Infections and appropriate antibiotic therapy - Microbiological features of diabetic foot, causes and types of infections)

Autori
Škrlin, Jasenka

Izvornik
Acta medica Croatica (1330-0164) 64 (2010), Suppl 1; 83-88

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, stručni

Ključne riječi
dijabetičko stopalo ; klasifikacija ; izolat ; antimikrobna terapija
(diabetic foot infection ; classification ; isolate ; antimicrobial therapy)

Sažetak
Foot infections are the most common problems in persons with diabetes. These individuals are predisposed to foot infections because of a compromised vascular supply secondary to diabetes. In addition to microvascular disease, local trauma and/or pressure may result in various diabetic foot infections. The spectrum of foot infections in diabetes ranges from simple superficial cellulitis to chronic osteomyelitis. Infections in patients with diabetes are difficult to treat because these patients have impaired microvascular circulation, which limits the access of phagocytic cells to the infected area and results in poor concentration of antibiotics in the infected tissues. For this reason, cellulitis is the most easily treatable and reversible form of foot infections in patients with diabetes. Deep skin and soft tissue infections are also usually curable, but they can be life threatening and result in substantial long-term morbidity. In terms of infective microorganisms and the likelihood of successful treatment with antimicrobial therapy, except for chronic osteomyelitis, infections in patients with diabetes are caused by the same microorganisms that can infect the extremities of those without diabetes. Superficial skin infections such as cellulitis are caused by the same organisms as those in healthy hosts, i.e. group A streptococci and Staphylococcus aureus. Deep soft tissue infections can be associated with gas-producing gram-negative bacilli. Clinically, these infections appear as necrotizing fasciitis, compartment syndrome, or myositis. Gas gangrene is uncommon in persons with diabetes. Acute osteomyelitis usually occurs as the result of foot trauma in an individual with diabetes and the distribution of organisms is the same as in the individual without diabetes who has acute osteomyelitis. In chronic osteomyelitis, the pathogens are group A and group B streptococci, aerobic gram-negative bacilli, and Bacteroidesfragilis, among others, while Pseudomonas aeruginosa is generally not a pathogen in this type of infections. Fetid foot represents a combined deep skin and soft tissue infection caused by pathogens involved in chronic osteomyelitis. Microbiologic diagnosis is important because diabetic patients may need antimicrobial therapy. Surface swabs of diabetic ulcers yield a plethora of organisms but often do not correlate with the pathogens isolated from deeper infections, such as osteomyelitis. After debridement, deep wound cultures and aspirates will have a 50%-70% concordance with bone biopsy cultures. Currently, some investigators advocate bone biopsy to establish accurate cultural data on diabetic foot infections and osteomyelitis in diabetics. Management requires differentiation of colonization from infection. Classification of the severity of an infection is commonly important to interpret the effectiveness of care. Foot infections in diabetics should be recognized and treated promptly. When a superficial infection is encountered, the physician should aggressively treat it to prevent progression to deeper tissues. Appropriate monotherapy for cellulitis includes cefazolin, amoxicillin/clavulanic acid or clindamycin. Although gram-negative bacteria are unusual causes of cellulitis, if they are suspected, a fluoroquinolone (avoid as a single agent) may be used in conjunction with clindamycin. When deep infection (deep skin and severe soft tissue and chronic osteomyelitis) is suspected, surgical intervention and antibiotic treatment should be timely and aggressive. These infections may be treated with monotherapy involving carbapenems or piperacillin/tazobactam or clindamycin in combination with gram-negative agents. Prompt surgical debridement and even local amputation, together with antimicrobial therapy, will reduce limb loss and the length of hospital stay.

Izvorni jezik
Hrvatski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA