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Abstract
Diabetic foot infections (DFI) are the most common problems which the diabetic
patients encounter, representing an expensive complication of cutaneous ulcers or of
traumatisms in these patients, a major cause of morbidity and mortality. These
infections include the cutaneous tissue, soft tissues and bony structures. DFI are
estimated to be the most common cause for hospital admission in diabetic patients and
one of the major causes of lower leg’s amputation. The risk factors for DFI are the
compromised microvascular circulation, peripheral neuropathy, local traumatisms,
and impaired immunity of the organism. The most frequent clinical forms of DFI are:
skin and soft tissues infections, cellulitis, acute and chronic osteomyelitis. DFI
diagnosis must include a thorough clinical assessment, along with laboratory and
imagistic investigations. The etiological agents most frequently isolated are Gram-
positive cocci, while Gram-negative bacilli are most frequently isolated in severe
infections, and the anaerobic germs are noticed in infections with a mixed etiology.
DFI treatment consists mainly in antibiotherapy (initially empirical, then based on
identifying the etiological agent and its susceptibility to antibiotics), surgical local
treatment, and assuring an optimal vascularization of the foot. DFI management must
be realised by a properly coordinated multidisciplinary team, in which the family
physician has an important role in the medical education and monitoring of the
diabetic patient, for preventing the complications and for a good evolution of the
disease.
Keywords
Rezumat
Infecţiile piciorului diabetic (IPD) reprezintă cele mai comune probleme pe care le
întâmpină pacientul diabetic, reprezentând o complicaţie costisitoare a ulcerelor cuta-
nate sau a traumatismelor la aceşti pacienţi, o cauză majoră de morbiditate şi
mortalitate. Aceste infecţii includ ţesutul cutanat, ţesuturile moi şi structurile osoase.
IPD sunt estimate ca fiind cea mai comună cauză de internare în spital a pacienţilor
diabetici şi una din cauzele majore de amputare a membrului inferior. Factorii de risc
ai IPD sunt circulaţia microvasculară compromisă, neuropatia periferică,
traumatismele locale şi imunitatea afectată a organismului. Formele clinice cele mai
frecvente ale IPD sunt: infecţiile pielii şi ale ţesuturilor moi, celulita, osteomielita acu-
tă şi cronică. Diagnosticarea IPD trebuie să includă o evaluare amănunţită clinică,
precum şi investigaţiile de laborator şi imagistice. Agenţii etiologici cel mai frecvent
izolaţi sunt cocii Gram-pozitivi, însă bacilii Gram-negativi sunt izolaţi cel mai des în
infecţii severe, iar germenii anaerobi se evidenţiază în special în infecţiile cu o etiolo-
gie mixtă. Tratamentul IPD constă, în principal, în antibioterapie (iniţial empirică,
apoi bazată pe identificarea agentului etiologic şi a susceptibilităţii acestuia la
antibiotice), tratament chirurgical local şi asigurarea unei vascularizaţii optime la
nivelul piciorului. Managementul IPD trebuie realizat de o echipă bine coordonată,
multidisciplinară, în care medicul de familie are un rol important în educaţia medicală
şi supravegherea atentă a pacientului diabetic pentru prevenirea complicaţiilor şi buna
evoluţie a acestei boli.
Cuvinte cheie
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