Diabetic Foot Infections: A Need for Innovative Assessments
Diabetic Foot Infections: A Need for Innovative Assessments
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DOI：
10.1177/1534734610363459
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发表时间：
2010-03-01
影响因子：
1.7
通讯作者：
Armstrong, David G.
中科院分区：
文献类型：
--
作者：
Fisher, Timothy K.;Wolcott, Randall;Armstrong, David G.
足部伤口是糖尿病相关住院的最常见原因，经常导致截肢。虽然通常根据炎症的体征和症状进行临床诊断，但经验性抗生素治疗应基于组织培养，直到感染消退。在过去十年中，分子检测的进步，包括快速显色琼脂和实时聚合酶链反应，提高了诊断能力。然而，慢性伤口可能存在生物膜细菌，目前的微生物检测无法充分检测到。需要增强的DNA测试来识别这些病原体以及不断发展和以前诊断不足的细菌。两种选择，核酸荧光原位杂交和rDNA测序，是在地平线上的临床应用。伤口生物膜还需要更复杂的临床管理，包括清创、增强宿主防御、抑制生物膜和伤口闭合。采用这些诊断和治疗方面的进展可能有助于整体预后并降低医疗费用。
Foot wounds are the most common diabetes-related cause of hospitalization and frequently result in amputation. Although generally diagnosed clinically based on signs and symptoms of inflammation, empirical antibiotic treatment should be based on tissue cultures until resolution of infection. Advances in molecular detection over the past decade, including rapid chromogenic agar and real-time polymerase chain reaction, have improved diagnostic capabilities. However, chronic wounds may host biofilm bacteria not adequately detected by current microbiological testing. Enhanced DNA testing is required to identify these pathogens as well as evolving and previously underdiagnosed bacteria. Two options, nucleic acid fluorescent in situ hybridization and rDNA sequencing, are on the horizon for clinical use. Wound biofilms also necessitate more complex clinical management including debridement, augmenting host defenses, suppression of biofilms, and wound closure. Adopting these advances in diagnosis and treatment may help with overall prognosis and reduce health care costs.