Abstract：
The optimal approaches to managing diabetic foot infections remain a challenge for clinicians. Despite an exponential rise in publications investigating different treatment strategies, the various agents studied generally produce comparable results, and high-quality data are scarce. In this systematic review, we searched the medical literature using the PubMed and Embase databases for published studies on the treatment of diabetic foot infections from 30 June 2018 to 30 June 2022. We combined this search with our previous literature search of a systematic review performed in 2020, in which the infection committee of the International Working Group on the Diabetic Foot searched the literature until June 2018. We defined the context of the literature by formulating clinical questions of interest, then developing structured clinical questions (Patients-Intervention-Control-Outcomes) to address these. We only included data from controlled studies of an intervention to prevent or cure a diabetic foot infection. Two independent reviewers selected articles for inclusion and then assessed their relevant outcomes and methodological quality. Our literature search identified a total of 5,418 articles, of which we selected 32 for full-text review. Overall, the newly available studies we identified since 2018 do not significantly modify the body of the 2020 statements for the interventions in the management of diabetes-related foot infections. The recent data confirm that outcomes in patients treated with the different antibiotic regimens for both skin and soft tissue infection and osteomyelitis of the diabetes-related foot are broadly equivalent across studies, with a few exceptions (tigecycline not non-inferior to ertapenem [±vancomycin]). The newly available data suggest that antibiotic therapy following surgical debridement for moderate or severe infections could be reduced to 10 days and to 3 weeks for osteomyelitis following surgical debridement of bone. Similar outcomes were reported in studies comparing primarily surgical and predominantly antibiotic treatment strategies in selected patients with diabetic foot osteomyelitis. There is insufficient high-quality evidence to assess the effect of various recent adjunctive therapies, such as cold plasma for infected foot ulcers and bioactive glass for osteomyelitis. Our updated systematic review confirms a trend to a better quality of the most recent trials and the need for further well-designed trials to produce higher quality evidence to underpin our recommendations.
摘要：
管理糖尿病足感染的最佳方法仍然是临床医生的挑战。尽管研究不同治疗策略的出版物呈指数级增长，研究的各种药物通常会产生可比的结果，高质量的数据是稀缺的。在这次系统审查中，我们使用PubMed和Embase数据库检索了2018年6月30日至2022年6月30日期间已发表的糖尿病足感染治疗研究的医学文献.我们将此搜索与我们以前在2020年进行的系统评价的文献检索相结合，其中糖尿病足国际工作组感染委员会检索了文献，直到2018年6月。我们通过提出感兴趣的临床问题来定义文献的背景，然后制定结构化的临床问题（患者-干预-控制-结果）来解决这些问题。我们仅纳入了预防或治愈糖尿病足感染的干预措施的对照研究数据。两名独立审稿人选择文章进行收录，然后评估其相关结果和方法学质量。我们的文献检索共识别了5,418篇文章，其中我们选择了32个进行全文审查。总的来说,自2018年以来我们发现的新研究并未显著改变2020年糖尿病相关足部感染管理干预措施声明的正文.最近的数据证实，使用不同抗生素治疗糖尿病相关足部皮肤和软组织感染和骨髓炎的患者的结果在研究中大致相等。除少数例外（替加环素不劣于厄他培南[±万古霉素]）。新获得的数据表明，手术清创术后对中度或重度感染的抗生素治疗可减少至10天，而对骨清创术后的骨髓炎则可减少至3周。在比较选定的糖尿病足骨髓炎患者的主要手术和主要抗生素治疗策略的研究中，也报道了类似的结果。没有足够的高质量证据来评估最近各种辅助疗法的效果，如感染足部溃疡的冷血浆和骨髓炎的生物活性玻璃。我们更新的系统评价证实了最近试验质量更好的趋势，以及需要进一步精心设计的试验来产生更高质量的证据来支持我们的建议。
