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糖尿病足感染的新型抗菌策略:应对挑战与耐药性

Novel antimicrobial strategies for diabetic foot infections: addressing challenges and resistance.

作者信息

Alenazi Fahaad, Khan Mohd Shahid

机构信息

Department of Pharmacology, College of Medicine, University of Ha'il, Ha'il City, Saudi Arabia.

Department of Microbiology, Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, Uttar Pradesh, India.

出版信息

Acta Diabetol. 2025 Mar;62(3):303-321. doi: 10.1007/s00592-024-02438-3. Epub 2025 Jan 6.

Abstract

AIMS

This review examines the challenges posed by Diabetic Foot Infections (DFIs), focusing on the impact of neuropathy, peripheral arterial disease, immunopathy, and the polymicrobial nature of these infections. The aim is to explore the factors contributing to antimicrobial resistance and assess the potential of novel antimicrobial treatments and drug delivery systems in improving patient outcomes.

METHOD

A comprehensive analysis of existing literature on DFIs was conducted, highlighting the multifactorial pathogenesis and polymicrobial composition of these infections. The review delves into the rise of antimicrobial resistance due to the overuse of antimicrobials, biofilm formation, and microbial genetic adaptability. Additionally, it considers glycemic control, patient adherence, and recurrence rates as contributing factors to treatment failure. Emerging therapies, including new antimicrobial classes and innovative drug delivery systems, were evaluated for their potential efficacy.

RESULTS

DFIs present unique treatment challenges, with high rates of antimicrobial resistance and poor response to standard therapies. Biofilm formation and the genetic adaptability of pathogens worsen resistance, complicating treatment. Current antimicrobial therapies are further hindered by poor glycemic control and patient adherence, leading to recurrent infections. Novel antimicrobial classes and innovative delivery systems show promise in addressing these challenges by offering more targeted, effective treatments. These new approaches aim to reduce resistance and improve treatment outcomes.

CONCLUSION

DFIs remain a clinical challenge due to their multifactorial nature and antimicrobial resistance. The development of novel antimicrobials and drug delivery systems is crucial to improving patient outcomes and combating resistance. Future research should focus on enhancing treatment efficacy, reducing resistance, and addressing patient adherence to reduce the burden of DFIs.

摘要

目的

本综述探讨糖尿病足感染(DFIs)带来的挑战,重点关注神经病变、外周动脉疾病、免疫病变以及这些感染的多微生物性质的影响。目的是探究促成抗菌药物耐药性的因素,并评估新型抗菌治疗方法和药物递送系统在改善患者预后方面的潜力。

方法

对关于DFIs的现有文献进行全面分析,突出这些感染的多因素发病机制和多微生物组成。该综述深入研究了由于抗菌药物过度使用、生物膜形成和微生物遗传适应性导致的抗菌药物耐药性的上升。此外,还将血糖控制、患者依从性和复发率视为治疗失败的促成因素。对新兴疗法,包括新的抗菌类别和创新的药物递送系统的潜在疗效进行了评估。

结果

DFIs带来了独特的治疗挑战,抗菌药物耐药率高,对标准疗法反应不佳。生物膜形成和病原体的遗传适应性加剧了耐药性,使治疗复杂化。目前的抗菌治疗因血糖控制不佳和患者依从性差而受到进一步阻碍,导致感染复发。新型抗菌类别和创新的递送系统通过提供更有针对性、更有效的治疗方法,在应对这些挑战方面显示出希望。这些新方法旨在降低耐药性并改善治疗结果。

结论

由于其多因素性质和抗菌药物耐药性,DFIs仍然是一个临床挑战。新型抗菌药物和药物递送系统的开发对于改善患者预后和对抗耐药性至关重要。未来的研究应侧重于提高治疗效果、降低耐药性以及解决患者依从性问题,以减轻DFIs的负担。

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