醫生 朋友

糖尿病腳傳染。

Bader女士

紐芬蘭醫學院紀念大學， St. 約翰的，紐芬蘭，加拿大。 msbader1@hotmail.com
腳傳染是共同的在有糖尿病的病人和同更低的肢截肢術聯繫在一起的高病態和風險。 糖尿病腳傳染被分類如溫和，適度或者嚴厲。 革蘭氏陽性的細菌，例如葡萄狀球菌-奧裡斯和beta溶血鏈球菌，是最共同的病原生物在早先未經治療的溫和和適度傳染。 嚴厲，慢性或者早先治療的傳染經常polymicrobial。

糖尿病腳傳染診斷根據地方炎症臨床標誌和症狀。 應該在debridement以後開化被傳染的創傷。 創傷或骨頭切片檢查法得到的通過刮潰瘍的基地用解剖刀或組織標本強烈更喜歡使拖把受傷。 想像研究為被懷疑的深軟的組織化膿收藏或骨髓炎被表明。

優選的管理需要進取的外科debridement和創傷管理、有效的抗藥性新陳代謝的反常性(高血糖症和主要動脈不足)的療法和更正。

治療與抗生素沒有為沒被感染的潰瘍需要。 溫和的軟的組織傳染可以有效地治療與口頭抗生素，包括dicloxacillin、cephalexin和氯林肯黴素。 嚴厲軟的組織傳染可以靜脈內最初治療與ciprofloxacin加上氯林肯黴素; piperacillin/tazobactam; 或imipenem/cilastatin。 2,6 -二甲氧基苯青黴素抗性S.的風險。 aureus傳染，當選擇抗生素時，應該考慮。

抗藥性治療應該持續從一個到四個星期為軟的組織傳染和六個到12個星期為骨髓炎，
Diabetic foot infection.

Bader MS.

Memorial University of Newfoundland School of Medicine, St. John's, Newfoundland, Canada. msbader1@hotmail.com

Foot infections are common in patients with diabetes and are associated with high morbidity and risk of lower extremity amputation. Diabetic foot infections are classified as mild, moderate, or severe. Gram-positive bacteria, such as Staphylococcus aureus and beta-hemolytic streptococci, are the most common pathogens in previously untreated mild and moderate infection. Severe, chronic, or previously treated infections are often polymicrobial. The diagnosis of diabetic foot infection is based on the clinical signs and symptoms of local inflammation. Infected wounds should be cultured after debridement. Tissue specimens obtained by scraping the base of the ulcer with a scalpel or by wound or bone biopsy are strongly preferred to wound swabs. Imaging studies are indicated for suspected deep soft tissue purulent collections or osteomyelitis. Optimal management requires aggressive surgical debridement and wound management, effective antibiotic therapy, and correction of metabolic abnormalities (mainly hyperglycemia and arterial insufficiency). Treatment with antibiotics is not required for noninfected ulcers. Mild soft tissue infection can be treated effectively with oral antibiotics, including dicloxacillin, cephalexin, and clindamycin. Severe soft tissue infection can be initially treated intravenously with ciprofloxacin plus clindamycin; piperacillin/tazobactam; or imipenem/cilastatin. The risk of methicillin-resistant S. aureus infection should be considered when choosing a regimen. Antibiotic treatment should last from one to four weeks for soft tissue infection and six to 12 weeks for osteomyelitis and should be followed by culture-guided definitive therapy.

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