国际糖尿病足工作组(IWGDF)自1999年以来发布了有关糖尿病相关足部疾病的管理和预防的循证指南。本指南是关于糖尿病患者足部感染诊断和管理的2019年IWGDF指南的更新。建议的分级,评估,发展,和评估(等级)框架用于制定本指南。这是围绕以P(A)ICO格式识别临床相关问题而构建的,确定患者重要的结果,系统地审查证据,评估证据的确定性,最后从证据转向建议。本指南是为参与糖尿病相关足部护理的医疗保健专业人员制定的,旨在为患者重要结局的临床护理提供信息。更新了2019年的两次系统综述,以告知本指南,从更新的检索中确定了符合纳入标准的149项研究(62项新研究),并将其纳入本指南.更新的建议来自这些系统审查,以及在没有证据的情况下做出的最佳实践声明。根据益处和危害权衡证据,以得出建议。在此更新中修改了某些建议的证据的确定性,并以患者重要结局为中心更精细地应用了GRADE框架。此更新的基本原理部分重点介绍了这一点。还注意到新确定的证据没有改变先前建议的证据的强度或确定性。这里提出的建议继续涵盖诊断软组织和骨感染的各个方面,包括诊断感染及其严重程度的分类方案。关于如何收集微生物样本的指南,以及如何处理它们以识别致病病原体,也概述了。最后,我们提出了治疗糖尿病患者足部感染的方法,包括为软组织和骨骼感染选择适当的经验性和确定性抗菌治疗;何时以及如何进行手术治疗;以及哪些辅助治疗可能会或可能不会影响糖尿病相关足部问题的感染结局。我们相信,遵循这些建议将有助于医疗保健专业人员为糖尿病和足部感染患者提供更好的护理,防止截肢和截肢的次数,并减少与糖尿病相关的足部疾病的患者和医疗负担。
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based
guidelines on the management and prevention of diabetes-related foot diseases since 1999. The present
guideline is an update of the 2019 IWGDF
guideline on the diagnosis and management of foot infections in persons with diabetes mellitus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline. This was structured around identifying clinically relevant questions in the P(A)ICO format, determining patient-important outcomes, systematically reviewing the evidence, assessing the certainty of the evidence, and finally moving from evidence to the recommendation. This
guideline was developed for healthcare professionals involved in diabetes-related foot care to inform clinical care around patient-important outcomes. Two systematic reviews from 2019 were updated to inform this
guideline, and a total of 149 studies (62 new) meeting inclusion criteria were identified from the updated search and incorporated in this
guideline. Updated recommendations are derived from these systematic reviews, and best practice statements made where evidence was not available. Evidence was weighed in light of benefits and harms to arrive at a recommendation. The certainty of the evidence for some recommendations was modified in this update with a more refined application of the GRADE framework centred around patient important outcomes. This is highlighted in the rationale section of this update. A note is also made where the newly identified evidence did not alter the strength or certainty of evidence for previous recommendations. The recommendations presented here continue to cover various aspects of diagnosing soft tissue and bone infections, including the classification scheme for diagnosing infection and its severity. Guidance on how to collect microbiological samples, and how to process them to identify causative pathogens, is also outlined. Finally, we present the approach to treating foot infections in persons with diabetes, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and bone infections; when and how to approach surgical treatment; and which adjunctive treatments may or may not affect the infectious outcomes of diabetes-related foot problems. We believe that following these recommendations will help healthcare professionals provide better care for persons with diabetes and foot infections, prevent the number of foot and limb amputations, and reduce the patient and healthcare burden of diabetes-related foot disease.