Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors
Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors
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DOI：
10.1111/dom.13507
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发表时间：
2019-02-01
影响因子：
5.8
通讯作者：
Uckay, Ilker
中科院分区：
文献类型：
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作者：
Gariani, Karim;Lebowitz, Dan;Uckay, Ilker
目的确定糖尿病足感染(DFIs)抗生素治疗的最佳疗程。方法采用成人DFIS患者的临床路径(回溯性队列分析)，建立集群控制的COX回归模型，评估感染缓解的相关因素，强调抗生素相关变量。我们排除了DFI和DFI导致的全部截肢，并对结果进行了随访。在482名患者的1018次DFI中，我们发现了392例骨髓炎，626例软组织感染，246例大脓肿，322例蜂窝组织炎和335例坏死；313例涉及血管重建。824例(81%)患者接受了外科清创，其中596例(59%)需要截肢。抗生素治疗的中位总持续时间为20天。中位数随访3年后，251例(24.7%)发作后又有1例增加发作(S)。与有和没有额外发作的患者相比，接受截肢、患有1型糖尿病或接受血管重建的患者复发风险较低。在包括整个研究人群的多变量分析中，缓解风险与1型糖尿病呈负相关(风险比[HR]0.3，95%可信区间[CI]0.2-0.6)。抗生素治疗和肠外治疗的持续时间均不影响复发风险(HR为1.0，95%CI均为0.99~1.01)。同样，仅骨髓炎病例的3周和1周与3周和0.6(95%可信区间0.2-1.3)均无统计学意义。规划抗生素治疗的持续时间未能确定防止复发的任何最佳阈值。结论我们的分析没有发现预防DFI复发的抗生素治疗最佳持续时间或给药途径的阈值。这些有限的数据可能支持DFI患者更短的治疗时间。
Aim To determine the most appropriate duration of antibiotic therapy for diabetic foot infections (DFIs). Methods Using a clinical pathway for adult patients with DFIs (retrospective cohort analysis), we created a cluster-controlled Cox regression model to assess factors related to remission of infection, emphasizing antibiotic-related variables. We excluded total amputations as a result of DFI and DFI episodes with a follow-up time of Results Among 1018 DFI episodes in 482 patients, we identified 392 episodes of osteomyelitis, 626 soft tissue infections, 246 large abscesses, 322 episodes of cellulitis and 335 episodes of necrosis; 313 cases involved revascularization. Patients underwent surgical debridement for 824 episodes (81%), of which 596 (59%) required amputation. The median total duration of antibiotic therapy was 20 days. After a median follow-up of 3 years, 251 of the episodes (24.7%) were followed by >= 1 additional episode(s). Comparing patients with and without additional episodes, risk of recurrence was lower in those who underwent amputation, had type 1 diabetes, or underwent revascularization. On multivariate analysis including the entire study population, risk of remission was inversely associated with type 1 diabetes (hazard ratio [HR] 0.3, 95% confidence interval [CI] 0.2-0.6). Neither duration of antibiotic therapy nor parenteral treatment affected risk of recurrence (HR 1.0, 95% CI 0.99-1.01 for both). Similarly, neither >3 weeks versus 1 week versus 3 weeks overall and 0.6 (95% CI 0.2-1.3) for osteomyelitis cases only. Plotting of duration of antibiotic therapy failed to identify any optimal threshold for preventing recurrences. Conclusions Our analysis found no threshold for the optimal duration or route of administration of antibiotic therapy to prevent recurrences of DFI. These limited data might support possibly shorter treatment duration for patients with DFI.