Executive Summary: Evaluation and Management of Diabetes-related Foot Infections.
Executive Summary: Evaluation and Management of Diabetes-related Foot Infections.
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执行摘要：糖尿病相关足部感染的评估和管理。
DOI：
10.1093/cid/ciad429
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Schechter,MarcosC
中科院分区：
文献类型：
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作者：
Cortes-Penfield,NicolasW;Armstrong,DavidG;Brennan,MeghanB;Fayfman,Maya;Ryder,JonathanH;Tan,Tze-Woei;Schechter,MarcosC
糖尿病相关足溃疡（DFU）的全球患病率为 6.3%，在北美达到 13%[1]。 DFU 的预后很差，5 年和 10 年生存率分别约为 50% 和 25% [2, 3]。感染使超过 40% 的糖尿病足溃疡 (DFU) 复杂化，这往往是致命一击；近一半因糖尿病相关足部感染 (DFI) 住院的患者在 1 年内接受截肢 [4, 5]。这些风险对黑人、西班牙裔、原住民、农村和低收入社区的影响尤为严重 [6, 7]。 DFU 导致的下肢截肢是第三大昂贵的糖尿病并发症，许多患者对它的恐惧甚至超过了死亡 [8]。 2012 年，美国传染病学会 (IDSA) DFI 指南的作者宣称，“目前的主要问题不是我们对这个问题缺乏充分的了解，因为我们未能应用我们所知道的有效方法。”[9] 这一说法在十年后仍然准确。多学科 DFI 团队可以减少重大截肢，类似的团队也大大降低了感染性心内膜炎的死亡率 [10, 11]。尽管如此，专家之间不一致且无组织的协作导致共同决策失败的情况仍然很常见。在这篇叙述性评论中，我们汇集了传染病、内分泌学、足病学和血管外科方面的专家，讨论 DFI 护理中的共同决策。我们重点概述了这些患者的综合管理，重点介绍了由我们的外科同事带头的现代研究和国际糖尿病足工作组 (IWGDF) 的当代指导，可以说是 DFI 专家的通用语言 [12]。最后，我们为临床医生与临床医生以及患者与临床医生共同决策提供最佳实践。
Diabetes-related foot ulcers (DFUs) have a global prevalence of 6.3%, reaching 13% in North America [1]. DFUs have a dismal prognosis, with 5-and 10-year survival rates of approximately 50% and 25%, respectively [2, 3]. Infection, complicating> 40% of DFUs, is often the coup-de-grace; nearly half of patients hospitalized with a diabetes-related foot infection (DFI) undergo amputation within 1 year [4, 5]. These risks disproportionately affect Black, Hispanic, Native, rural, and low-income communities [6, 7]. Lower extremity amputations due to DFUs are the third most costly diabetes complication and are feared by many patients more than death [8].In 2012, the authors of the Infectious Diseases Society of America (IDSA) DFI guidelines declared that “The main problem currently is less our lack of full understanding of the problem as our failure to apply what we know works.”[9] This statement remains accurate a decade later. Multidisciplinary DFI teams can reduce major amputations, and similar teams have dramatically reduced attributable mortality for infective endocarditis [10, 11]. Despite this, inconsistent and unstructured collaboration between specialists that lead to breakdowns in shared decision-making remains common. In this narrative review, we bring together experts in infectious diseases, endocrinology, podiatry, and vascular surgery to discuss shared decision-making in DFI care. We provide a focused overview of the comprehensive management of these patients, highlighting modern research spearheaded by our surgical colleagues and contemporary guidance from the International Working Group for the Diabetic Foot (IWGDF), arguably the lingua franca of DFI specialists [12]. Finally, we offer best practices for clinician–clinician and patient–clinician shared decision-making.