采用优化抗感染治疗模式改善糖尿病足感染预后的临床观察  

Clinical observation of optimized anti-infective treatment model to improve the prognosis of diabetic foot infection

作　　者：姜珊[1] 李湘燕[2] 田硕涵[3] 温冰[1] 何睿[1] 齐心[1] Jiang Shan;Li Xiangyan;Tian Shuohan;Wen Bing;He Rui;Qi Xin(Department of Plastic Surgery and Burns,Peking University First Hospital,Beijing 100034,China;Department of Infectious Disease,the Institute of Clinical Pharmacology,Peking University First Hospital,Beijing 100034,China;Department of Pharmacy,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院整形烧伤科,100034 [2]北京大学第一医院感染疾病科临床药理研究所,100034 [3]北京大学第一医院药剂科,100034

出　　处：《中华损伤与修复杂志（电子版）》2024年第5期396-401,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：中央高水平医院临床科研业务费资助(2022CR94)。

摘　　要：目的针对糖尿病足感染,建立一种新的多学科抗感染治疗模式并评估其效果。方法采用历史性对照研究设计。回顾性分析北京大学第一医院整形烧伤科2016年10月1日至2018年3月31日期间收治的糖尿病足感染患者的临床资料,将其纳入常规管理组(对照组,48例)。将2018年4月1日至2019年9月30日期间收治的糖尿病足感染患者前瞻性纳入优化管理组,由整形烧伤科、感染疾病科及药剂科医师组成团队,早期、全程参与患者抗感染治疗(优化组,52例)。比较2组患者的一般情况、糖尿病足感染情况、治疗及预后指标。结果一般情况方面,与对照组相比,优化组患者糖尿病足溃疡病程更长(120 d vs 30 d,P<0.05)、周围神经病变比例更高(80.8%vs 54.2%,P<0.05);入组时糖尿病足感染情况方面,与对照组相比,优化组患者的骨髓炎部位更多(P<0.05)、多重细菌感染的比例更高(48.1%vs 10.0%,P<0.05);但在治疗及预后方面,与对照组相比,优化组接受初始经验性抗感染治疗的正确率更高(86.5%vs 31.3%,P<0.05),发热持续时间更短(1.5 d vs 8.0 d,P<0.05)。随访1年,两组患者的治愈率和复发率相近。结论整形烧伤科、感染疾病科及药剂科医师早期、全程参与的优化多学科抗感染治疗模式,有利于糖尿病足感染的治疗,改善患者预后。Objective To establish a new multidisciplinary anti-infective treatment model for diabetic foot infections(DFI)and evaluate its effect.Methods A before-after study was conducted.The medical charts of inpatients with DFI admitted between October 1,2016 and March 31,2018(control group,n=48)were reviewed retrospectively.Inpatients diagnosed with DFI between April 1,2018 and September 30,2019 were prospectively enrolled as the optimization group,in which a team of physicians from plastic and burn department,anti-infective department and pharmacist participated in the anti-infective treatment of patients in the early stage and throughout the whole process(optimization group,n=52).The general condition,characteristics of DFI,treatment and prognostic indicators of the two groups were compared.Results As to general condition,compared with the control group,the patients in the optimization group had a longer course of diabetes foot ulcer(120 d vs 30 d,P<0.05)and a higher proportion of peripheral neuropathy(80.8%vs 54.2%,P<0.05);As to characteristics of DFI,compared with the control group,the patients in the optimization group had more sites of osteomyelitis(P<0.05)and a higher proportion of polymicrobial infections(48.1%vs 10.0%,P<0.05);However,as to treatment and prognostic indicators,compared with the control group,the patients in the optimization group received adequate initial empirical treatment more frequently(86.5%vs 31.3%,P<0.05),and had a shorter median duration of fever(1.5 d vs 8.0 d,P<0.05).Rates of healing and relapse within one year were similar between the groups.Conclusion The optimized multidisciplinary anti-infective treatment model with early and full participation of physicians from plastic and burn department,anti-infective department and pharmacist is conducive to the treatment of diabetic foot infection and improves the prognosis of patients.

关 键 词：糖尿病足感染 感染性疾病 抗生素应用 

分 类 号：R587.1[医药卫生—内分泌]