[1]姚远,吴静,郑新莉,等.糖尿病足骨髓炎抗生素治疗时程及预后影响因素[J].医学研究与战创伤救治(原医学研究生学报),2025,38(01):63-68.[doi:10.16571/j.cnki.2097-2768.2025.01.010]
　YAO Yuan,WU Jing,ZHENG Xinli,et al.Study on the duration of antibiotic therapy and prognostic factors for osteomyelitis of diabetes foot[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2025,38(01):63-68.[doi:10.16571/j.cnki.2097-2768.2025.01.010]
点击复制

糖尿病足骨髓炎抗生素治疗时程及预后影响因素()

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第38卷
期数:
2025年01
页码:
63-68
栏目:
论著·临床研究
出版日期:
2025-04-30

文章信息/Info

Title:
Study on the duration of antibiotic therapy and prognostic factors for osteomyelitis of diabetes foot
文章编号:
2097-2768（2025）01-0063-04
作者:
姚远; 吴静; 郑新莉; 张姣; 郑伟
作者单位：239473 滁州，明光市人民医院内分泌科（姚远、吴静）；310013 杭州，解放军联勤保障部队第九〇三医院干部病房（郑新莉、郑伟）；210002 南京，东部战区总医院超声诊断科（张姣）
Author(s):
YAO Yuan; WU Jing; ZHENG Xinli; ZHANG Jiao; ZHENG Wei
（1.Department of Endocrinology，Mingguang People’s Hospital，Chuzhou 239473，Anhui，China;2.Cadre Ward，the903th Hospital of the Joint Logistics Support Force，PLA，Hangzhou 310013，Zhejiang，China;3.Department of Ultra?sound，General Hospital of Eastern Theater Command，PLA，Nanjing 210002，Jiangsu，China）
关键词:
糖尿病足骨髓炎; 抗生素; 风险因素
Keywords:
osteomyelitis of diabetic foot; antibiotics; riskfactor
分类号:
R587.1
DOI:
10.16571/j.cnki.2097-2768.2025.01.010
文献标志码:
A
摘要:
目的 探讨糖尿病足骨髓炎治疗过程中抗生素的使用时间对预后的影响。方法收集2022年6月至2024年5月明光市人民医院内分泌科因糖尿病足感染就诊的患者。将确诊糖尿病足的患者随机分成2组：短程组（抗生素治疗20 d，n=78）、长程组（抗生素治疗35 d，n=79）。比较两组中发生骨髓炎患者的临床结局，并通过Logistic回归分析影响骨髓炎愈合的风险因素。结果短程组36例患者发生糖尿病足骨髓炎，其中，24例骨髓炎完全缓解，22例糖尿病创面愈合；长程组40例发生糖尿病足骨髓炎，其中，26例骨髓炎完全缓解，24例糖尿病创面愈合。Logistic回归分析结果显示，DFI创面评分>16、红蓝光照射、下肢动脉介入或手术治疗及部分切除感染/坏死骨组织是影响糖尿病足骨髓炎临床预后的因素（P<0.05）。结论糖尿病足骨髓炎的治疗过程可适当控制抗生素的使用时间，有助于降低细菌耐药；患者的初始糖尿病创面评分与预后相关，治疗过程中，应积极开展红蓝光照射治疗、微创治疗扩张血管，改善血供，促进愈合，严格控制开展部分切除感染/坏死骨组织的手术。
Abstract:
Objective To compare the effects of the duration of antibiotic therapy on the prognosis of osteomyelitis of diabeticfoot. Methods We prospectively recruited the patients with diabetic foot infections from June 2022 to May 2024 in the Endocrinolo?gy Department of Mingguang People?s Hospital. These patients were randomly divided into two groups: one receiving short-term antibi?otic therapy（20 days，n=78）and the other receiveing long-term antibiotic treatment（35 days，n=79）. The clinical outcomes of thesepatients with osteomyelitis were compared. The risk factors affecting the osteomyelitis remission were analyzed by Logistic regression.Results In the short-term antibiotic treatment group，36 patients developed osteomyelitis of diabetes foot，with 24 patients achievingcomplete remission and 22 patients experiencing diabetic wound healing. In the long-term antibiotic group，40 patients developed osteo?myelitis of diabetic foot with 26 patients achieving complete remission of osteomyelitis and 24 patients experiencing diabetic woundhealing. Logistic regression analysis showed that diabetic foot infection（DFI）wound score>16，red and blue light therapy，lower limbartery intervention or surgical treatment，and partial amputation of infected and necrotic bones were significant factors affecting osteo?myelitis remission in diabetic foot（P<0.05）. Conclusion We should properly control the use time of antibiotics during the treat?ment of osteomyelitis of diabetic foot，which is helpful to reducebacterial resistance. The initial DFI wound score is a prognostic in?dicator，and Interventions such as Red and blue light therapy，mini?mally invasive treatments to improve blood and oxygen supply，andcautious partial amputation of infected and necrotic bones are rec?ommended to enhance outcomes.

参考文献/References:

［1］ Li Y，Teng D，Shi X，et al.Prevalence of diabetes recorded inmainland China using 2018 diagnostic criteria from the Ameri?can Diabetes Association: national cross sectional study［J］.BMJ，2020，369:m997.［2］ 谷涌泉. 中国糖尿病足诊治指南［J］. 中国临床医生杂志，2020，48（1）:19-27.［3］ 徐旭英《. 中国糖尿病足防治指南2019》解读［J］.中国临床医生杂志，2023，51（4）:394-397.［4］ 张效科，苏虹霞，段玉红《. 中国糖尿病足防治指南（2019版）》中医治疗部分解读［J］.现代中医药，2022，42（2）:17-19.［5］ Armstrong DG，Tan TW，Boulton A，et al.Diabetic Foot Ulcers: AReview［J］.JAMA，2023，330（1）:62-75.［6］ Senneville EM，Lipsky BA，van Asten S，et al.Diagnosing diabet?ic foot osteomyelitis［J］. Metab Res Rev，2020，36（Suppl 1）:e3250.［7］ Arias M，Hassan-Reshat S，Newsholme W.Retrospective analysisof diabetic foot osteomyelitis management and outcome at a ter?tiary care hospital in the UK［J］. PLoS One，2019，14（5）:e0216701.［8］ Embil JM，Rose G，Trepman E，et al.Oral antimicrobial therapyfor diabetic foot osteomyelitis［J］. Foot Ankle Int T，2006，27（10）:771-779.［9］ Gariani K，Pham TT，Kressmann B，et al.Three Weeks VersusSix Weeks of Antibiotic Therapy for Diabetic Foot Osteomyelitis:A Prospective，Randomized，Noninferiority Pilot Trial［J］. ClinInfect Dis，2021，73（7）:e1539-e1545.［10］ 中华医学会糖尿病学分会.中国2型糖尿病防治指南（2020年版）［J］.中华内分泌代谢杂志，2021，37（4）:311-398.［11］ 中华医学会糖尿病学分会，中国医师协会内分泌代谢科医师分会，中华医学会内分泌学分会，中华医学会儿科学分会.中国1型糖尿病诊治指南（2021版）［J］.中华糖尿病杂志，2022，14（11）:1143-1250.［12］ 徐俊，许樟荣.糖尿病足骨髓炎的诊断［J］.中华糖尿病杂志，2021，13（2）:133-135.［13］ Uckay I，Kressmann B，Malacarne S，et al.A randomized，con?trolled study to investigate the efficacy and safety of a topicalgentamicin-collagen sponge in combination with systemic antibi?otic therapy in diabetic patients with a moderate or severe footulcer infection［J］.BMC Infect Dis，2018，18（1）:361.［14］ 靳广.糖尿病足骨髓炎诊断新进展［J］.临床医药文献电子杂志，2019，6（58）:193-194.［15］ Mutluoglu M，Sivrioglu AK，Eroglu M，et al.The implications ofthe presence of osteomyelitis on outcomes of infected diabeticfoot wounds［J］.Scand J Infect Dis，2013，45（7）:497-503.［16］ Chang M，Nguyen TT.Strategy for Treatment of Infected DiabeticFoot Ulcers［J］.Acc Chem Res，2021，54（5）:1080-1093.［17］ Caravaggi C，Sganzaroli A，Galenda P，et al.The management ofthe infected diabetic foot［J］.Curr Diabetes Rev，2013，9（1）:7-24.［18］ 胡萍，邹梦晨，曹瑛，等.基于16s rRNA高通量测序分析糖尿病足骨髓炎感染骨组织中的病原微生物［J］.南方医科大学学报，2017，37（11）:1448-1455.［19］ Nijenhuis-Rosien L，Vriesendorp TM，Landman GW.Commenton Tone et al.Six-Week Versus Twelve-Week Antibiotic Therapyfor Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multi?center Open-Label Controlled Randomized Study［J］. DiabetesCare，2015，38（9）:e144.［20］ Tone A，Nguyen S，Devemy F，et al.Six-week versus twelve-weekantibiotic therapy for nonsurgically treated diabetic foot osteomy?elitis: a multicenter open-label controlled randomized study［J］.Diabetes Care，2015，38（2）:302-307.［21］ 殷贤坤，范露，铁璐，等.富血小板血浆用于创面修复的研究进展［J］. 医学研究与战创伤救治，2023，36（10）:1095-1099.［22］ 王诗琪，袁斯明.机器学习在糖尿病足预后应用的研究进展［J］.医学研究与战创伤救治，2023，36（10）:1111-1115.［23］ Gariani K，Lebowitz D，von Dach E，et al.Remission in diabeticfoot infections: Duration of antibiotic therapy and other possibleassociated factors［J］.Diabetes Obes Metab，2019，21（2）:244-251.

相似文献/References:

[1]叶 明,杨喜民,王 刚,等.耐碳青霉烯类铜绿假单胞菌的产酶及联合药敏试验[摘要][J].医学研究与战创伤救治(原医学研究生学报),2011,13(02):135.
　YE Ming,YANG Xi-min,WANG Gang,et al.The analysis of zymogenic state against Carbapenems-resistant Pseudomonas aeruginosa using a susceptibility test[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2011,13(01):135.
[2]杨 燕,孙长贵,陈 坚,等.用改良Hodge试验检测产碳青霉烯酶肠杆菌科细菌[J].医学研究与战创伤救治(原医学研究生学报),2011,13(03):223.
　YANG Yan,SUN Chang-gui,CHEN Jian,et al.Detection of carbapenemase in isolates of Enterobacteriaceae by the modified Hodge test[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2011,13(01):223.
[3]陶瑛瑛,马爱华,倪江洪.夫西地酸钠的配伍禁忌及处理方法[J].医学研究与战创伤救治(原医学研究生学报),2010,12(03):257.
[4]韩清萍,刘秀娟,余燕燕.头孢菌素致尿毒症患者神经毒性36例分析及护理[J].医学研究与战创伤救治(原医学研究生学报),2010,12(03):266.
[5]郎根强,章益峰,褚 健,等.[1]庄颜峰，吕 琦，陈学明，等. 严重骨盆骨折的初期救治体会[J]. 中华创伤骨科杂志，2004,6(5):582-583.[J].医学研究与战创伤救治(原医学研究生学报),2009,11(06):493.
　LANG Gen-qiang,ZHANG Yi-feng,CHU Jian,et al.Treatment of chronic prostatitis with ectoshortwave, antibiotics and prostant[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2009,11(01):493.
[6]潘雪飞,杜 斌,范 群,等.综合分析药物性肝损伤4 076例[J].医学研究与战创伤救治(原医学研究生学报),2009,11(06):505.
　PAN Xue-fei,DU Bin,FAN Qun,et al.The statistic analysis of the 4 076 patients with drug induced liver injury[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2009,11(01):505.
[7]杨辛怡综述,季国忠审校.幽门螺杆菌感染的治疗方案[J].医学研究与战创伤救治(原医学研究生学报),2017,19(03):280.[doi:10.3969/j.issn.1672-271X.2017.03.015]

备注/Memo

备注/Memo:
-
更新日期/Last Update: 2025-01-20