Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review

被引:15
|
作者
Soldevila-Boixader, Laura [1 ,2 ]
Fernandez, Alberto Perez [3 ,4 ]
Laguna, Javier Munoz [5 ,6 ]
Uckay, Ilker [1 ]
机构
[1] Balgrist Univ Hosp, Unit Appl & Clin Res, Infectiol, CH-8008 Zurich, Switzerland
[2] Bellvitge Univ Hosp, Infect Dis Dept, Barcelona 08907, Spain
[3] Bellvitge Univ Hosp, Orthoped Dept, Foot & Ankle Unit, Barcelona 08907, Spain
[4] Bellvitge Univ Hosp, Diabet Foot Unit, Barcelona 08907, Spain
[5] Univ Zurich, Balgrist Univ Hosp, EBPI UZWH Musculoskeletal Epidemiol Res Grp, CH-8008 Zurich, Switzerland
[6] Univ Zurich, Univ Spine Ctr Zurich UWZH, Balgrist Univ Hosp, CH-8008 Zurich, Switzerland
来源
ANTIBIOTICS-BASEL | 2023年 / 12卷 / 01期
关键词
diabetic foot infection; osteomyelitis; local antibiotics; topical antibiotics; local delivery antibiotic systems; IMPREGNATED CALCIUM-SULFATE; GENTAMICIN-COLLAGEN SPONGE; ANTIMICROBIAL THERAPY; CEMENT; OSTEOMYELITIS; MANAGEMENT; ULCERS; SPACER; PEXIGANAN; MODERATE;
D O I
10.3390/antibiotics12010124
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Along with the increasing global burden of diabetes, diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO) remain major challenges for patients and society. Despite progress in the development of prominent international guidelines, the optimal medical treatment for DFI and DFO remains unclear as to whether local antibiotics, that is, topical agents and local delivery systems, should be used alone or concomitant to conventional systemic antibiotics. To better inform clinicians in this evolving field, we performed a narrative review and summarized key relevant observational studies and clinical trials of non-prophylactic local antibiotics for the treatment of DFI and DFO, both alone and in combination with systemic antibiotics. We searched PubMed for studies published between January 2000 and October 2022, identified 388 potentially eligible records, and included 19 studies. Our findings highlight that evidence for adding local antibiotic delivery systems to standard DFO treatment remains limited. Furthermore, we found that so far, local antibiotic interventions have mainly targeted forefoot DFO, although there is marked variation in the design of the included studies. Suggestive evidence emerging from observational studies underscores that the addition of local agents to conventional systemic antibiotics might help to shorten the clinical healing time and overall recovery rates in infected diabetic foot ulcers, although the effectiveness of local antibiotics as a standalone approach remains overlooked. In conclusion, despite the heterogeneous body of evidence, the possibility that the addition of local antibiotics to conventional systemic treatment may improve outcomes in DFI and DFO cannot be ruled out. Antibiotic stewardship principles call for further research to elucidate the potential benefits of local antibiotics alone and in combination with conventional systemic antibiotics for the treatment of DFI and DFO.
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页数:15
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