Controversies in diagnosing and managing osteomyelitis of the foot in diabetes
Controversies in diagnosing and managing osteomyelitis of the foot in diabetes
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DOI：
10.1086/383272
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发表时间：
2004-08-01
影响因子：
11.8
通讯作者：
Lipsky, BA
中科院分区：
文献类型：
--
作者：
Jeffcoate, WJ;Lipsky, BA
诊断和治疗糖尿病足骨髓炎的最佳方法尚不清楚。诊断基于临床体征，辅以各种影像学检查。骨活检是公认的诊断标准，但不被许多人使用。传统的治疗包括手术切除感染的骨，结合抗生素治疗。然而，最近的研究表明，在许多情况下，单独使用抗生素显然可以消除骨感染。也有证据表明，早期截肢感染的手指往往是不治愈的。需要就骨髓炎的诊断标准达成一致，迫切需要进行随机试验，以确定各种手术干预的相对益处和抗生素的最佳使用。我们回顾了糖尿病足骨髓炎的微生物学，各种诊断方法的优点和局限性，以及手术和非手术治疗有效性的证据。
The optimal approach to diagnosing and managing osteomyelitis of the foot in diabetes is unclear. Diagnosis is based on clinical signs, supplemented by a variety of imaging tests. Bone biopsy is the accepted criterion standard for diagnosis but is not used by many. Management traditionally involves surgical removal of infected bone, combined with antibiotic therapy. However, recent studies have shown that antibiotics alone may apparently eliminate bone infection in many cases. There is also evidence that early amputation of infected digits is frequently noncurative. Agreement on criteria for diagnosing osteomyelitis is required, and randomized trials are urgently needed, to determine the relative benefits of various surgical interventions and the optimal deployment of antibiotics. We review the microbiology of osteomyelitis of the foot in diabetes, the benefits and limitations of various diagnostic procedures, and the evidence for the effectiveness of both surgical and nonsurgical approaches to management.