抗生素英文课件精品ANTIBIOTICS WITHIN THE MANAGEMENT of Diabetic .pptVIP

ANTIBIOTICS WITHIN THE MANAGEMENT of Diabetic foot Nice 28-29avril2005 ABDULMASSIH Bassam MD Endocrinologist Definition of a Diabetic Foot Infection(1) No generally-accepted definition Foot infections in diabetics can be ulcer- or non-ulcer related Anatomic location of primary site Depth of infection (skin/soft tissue vs. bone/joint) Isolation of pathogenic bacteria from an appropriate culture specimen entrance ,growth ,metabolic activity and ensuing pathophysiologic effects of microorganisms in the tissues of a patient Purulent discharge from the ulcer Signs of inflammation around the ulcer Systemic signs (fever-leukocytosis) The manifestation of the inflammatory signs depends on intact nervous and vascular system Epidemiology life time risk of DM patient : 15% 14-20% will need amputation 1 leg is lost every 30 sec. More than 80% are potentially preventable Site of foot ulcers: toes: 51%plantar metatarsal head: 28%dorsum of foot: 14%multiple ulcers: 7% Pathogenesis of diabetic foot infection triangle of devil Classification Systems for Diabetic Foot Infections Classification systems Severity of Infection Foot Ulcer (Wound) Classification Systems for Severity of Diabetic Foot Infections Limb-threatening vs. non-limb threatening Mild, moderate, severe Classification Systems for Diabetic Foot Ulcers Wagner Univ. of Texas Depth-ischemia class. Wagner Classification 0- Intact skin (may have bony deformities. 1- Localized superficial ulcer. 2- Deep ulcer to tendon, bone, ligament or joint. 3- Deep abscess or osteomyelitis. 4- Gangrene of toes or forefoot. 5- Gangrene of whole foot. Wagner FW: The diabetic foot and amputations of the foot. In Surgery of the Foot. 5th ed. Mann, R editor. St Louis, Mo. The C.V. Mosby Company. Small ulcer with big problem Depth- ischemia classification Management based classificationstructure damage Skin Subcutaneous tissues Muscle and tendon Bone Articulation Multidisciplinary team 1-Diabetologist 2