Table 5 - uploaded by Afsaneh Alavi
Content may be subject to copyright.
Source publication
Abstract: Diabetic foot infections (DFIs), which present with a variety of clinical manifestations,
are commonly encountered by clinicians. They are associated with a high morbidity, a high amputation
rate, a high mortality, and increased health care costs. An effective management of DFIs
requires a multidisciplinary approach with a strong collabor...
Citations
... Після отримання результатів чутливості верифікованих збудників переходять на цілеспрямовану вузьку АБТ. Залишається невирішеною проблемою MRSA-інфекція [12,13,16,17]. На жаль, лише деяким центрам доступні експрес-методи на основі ланцюгової полімеразної реакції виявлення зазначених збудників у біологічних рідинах і тканинах, що значно зменшує необхідність застосування емпіричної АБТ стосовно MRSA-інфекції. ...
Неадекватна стартова терапія інфекції дібетичної стопи (ДС) здатна призвести до негативних наслідків у лікуванні, а також до зростання резистентних штамів бактерій. Стратифікація ступеня тяжкості інфекції ДС – важлива складова
у виборі адекватної антибіотикотерапії (АБТ). Лікування хірургічної інфекції ДС має бути спрямоване на хірургічний контроль джерела інфекції та антимікробну терапію з урахуванням індивідуальних чинників ризику пацієнта і мультирезистентних штамів бактерій. У ході численних досліджень, присвячених порівнянню новітніх препаратів і стандартних антибіотиків (АБ), не було виявлено переконливо кращої ефективності останніх із майже однаковою кількістю побічних ефектів. Хоча слід зауважити, що стосовно лінезоліду існує достатня доказова база щодо його
переваги над ванкоміцином для застосування у деяких пацієнтів із підтвердженою інфекцією MRSA.
... The mechanisms are not fully understood, but hyperglycaemia has been shown to impair multiple immune pathways including neutrophil activation and antibody function [2,3]. In addition to these systemic factors, local factors such as foot ulceration can contribute to higher infection rates [4]. Specific infections in diabetes, including foot and urinary tract infections [5,6], have been studied in detail. ...
Aim:
To investigate the impact of glycaemic control on infection incidence in people with Type 2 diabetes.
Methods:
We compared infection rates during 2014 in people with Type 2 diabetes and people without diabetes in a large primary care cohort in the UK (the Royal College of General Practitioners Research and Surveillance Centre database). We performed multilevel logistic regression to investigate the impact of Type 2 diabetes on presentation with infection, and the effect of glycaemic control on presentation with upper respiratory tract infections, bronchitis, influenza-like illness, pneumonia, intestinal infectious diseases, herpes simplex, skin and soft tissue infections, urinary tract infections, and genital and perineal infections. People with Type 2 diabetes were stratified by good [HbA1c <53 mmol/mol (<7%)], moderate [HbA1c 53-69 mmol/mol (7-8.5%)] and poor [HbA1c >69 mmol/mol (>8.5%)] glycaemic control using their most recent HbA1c concentration. Infection incidence was adjusted for important sociodemographic factors and patient comorbidities.
Results:
We identified 34 278 people with Type 2 diabetes and 613 052 people without diabetes for comparison. The incidence of infections was higher in people with Type 2 diabetes for all infections except herpes simplex. Worsening glycaemic control was associated with increased incidence of bronchitis, pneumonia, skin and soft tissue infections, urinary tract infections, and genital and perineal infections, but not with upper respiratory tract infections, influenza-like illness, intestinal infectious diseases or herpes simplex.
Conclusions:
Almost all infections analysed were more common in people with Type 2 diabetes. Infections that are most commonly of bacterial, fungal or yeast origin were more frequent in people with worse glycaemic control. This article is protected by copyright. All rights reserved.
... Empiric antibiotic is antibiotics given before susceptibility test result were known. Definitive antibiotic is antibiotics given after susceptibility test result were known [9]- [11]. ...
This chapter discusses the acute wound healing process and impaired chronic wound healing. It addresses different types of chronic wounds, the prevalence of mixed infections in chronic wounds, and the host response to mixed infections. Mixed/polymicrobial infections demonstrate the pathological and clinical manifestations induced by multiple infectious pathogens and are referred to as complex, complicated, dual, mixed, synergistic, or antagonistic. The molecular mechanisms of interaction between the microorganisms need to be clarified to help understand their importance to human disease. Most bacterial‐fungal interactions lead to biofilm formation, which is a very common complication in diabetic foot ulcers, burns, pressure ulcers, and surgical site infections. The chapter reviews different wound management strategies. The delivery of antimicrobials through dressings directly to wound sites may be preferred to systemic administration because dressings require a lower dose of antimicrobials; therefore, antimicrobial dressings have the advantages of avoiding systemic side effects, interference with wound healing, and induction of drug resistance.
Hand hygiene in wound care by health care providers (HCPs) is a key principle in treating hospitalized patients with diabetic foot infections. This study aimed to estimate the extent to which patients with type-2-diabetes (T2D) intend to speak up for HCPs' hand hygiene during inpatient foot treatment, test whether this motivation increases given the hospital would invite patients to speak up, and identify associations with socio-demographics, knowledge of hand hygiene requirements, and diabetes-related factors. A questionnaire-survey was conducted in eight diabetes outpatient centres in Lower Saxony/Germany. Intentions to speak up (without and with institutional encouragement) and knowledge about hand hygiene during foot-care were assessed. Analyses of variance were conducted, partly as repeated measures-models with intention-items as within-subject factor. N = 473 patients participated (response = 77.4%). N = 177 (41%) strongly intended to speak up. Institutional encouragement was associated with an increased rate of strong (54% vs. 41%; p < .001) and higher mean intention (M = 3.9 vs. 3.4 with vs. without encouragement [5-point-scales]; F(1, 434) = 41.5, p < .001). In patients without diabetic foot syndrome, this effect was limited to those with at least medium school education (F(2, 292) = 4.4, p = .013) and knowledge on HCPs' hand hygiene (F(2, 294) = 3.1, p = .047). In conclusion, a majority of T2D-patients in diabetes outpatient centres intend to speak for HCPs' hand hygiene in inpatient foot treatment, and are receptive to institutional encouragement. However, this presupposes at least medium education and knowledge about hand hygiene, emphasizing that patient empowerment begins with knowledge.
