1. Avalie a presença de infecção baseado nos sinais e sintomas de inflamação local em todo paciente diabético e com úlcera nos pés. |
Classe I/nível de evidência C158158 Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39(7):885-910. http://doi.org/10.1086/424846. PMid:15472838. http://doi.org/10.1086/424846...
159 Lipsky BA, Berendt AR, Embil J, de Lalla F. Diagnosing and treating diabetic foot infections. Diabetes Metab Res Rev. 2004;20(Suppl 1):S56-64. http://doi.org/10.1002/dmrr.441. PMid:15150816. http://doi.org/10.1002/dmrr.441...
160 Peters EJ, Lipsky BA. Diagnosis and management of infection in the diabetic foot. Med Clin North Am. 2013;97(5):911-46. http://doi.org/10.1016/j.mcna.2013.04.005. PMid:23992901. http://doi.org/10.1016/j.mcna.2013.04.00...
161 Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-93. http://doi.org/10.2337/dc05-2425. PMid:16732010. http://doi.org/10.2337/dc05-2425...
-162162 Senneville E, Lipsky BA, Abbas ZG, et al. Diagnosis of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2020;36(Suppl 1):e3281. http://doi.org/10.1002/dmrr.3281. PMid:32176440. http://doi.org/10.1002/dmrr.3281...
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2. Utilize a classificação da Infectious Diseases Society of America (IDSA) para estratificar a gravidade. |
Classe I/nível de evidência B9090 Ince P, Abbas ZG, Lutale JK, et al. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31(5):964-7. http://doi.org/10.2337/dc07-2367. PMid:18299441. http://doi.org/10.2337/dc07-2367...
,163163 Zhan LX, Branco BC, Armstrong DG, Mills JL Sr. The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing. J Vasc Surg. 2015;61(4):939-44. http://doi.org/10.1016/j.jvs.2014.11.045. PMid:25656592. http://doi.org/10.1016/j.jvs.2014.11.045...
,164164 Lavery LA, Peters EJ, Williams JR, Murdoch DP, Hudson A, Lavery DC. Reevaluating the way we classify the diabetic foot: restructuring the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care. 2008;31(1):154-6. http://doi.org/10.2337/dc07-1302. PMid:17934155. http://doi.org/10.2337/dc07-1302...
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3. Utilize a dosagem de PCR, VHS ou procalcitonina em casos de dúvida diagnóstica. |
Classe IIb/nível de evidência C165165 Uzun G, Solmazgul E, Curuksulu H, et al. Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med. 2007;213(4):305-12. http://doi.org/10.1620/tjem.213.305. PMid:18075234. http://doi.org/10.1620/tjem.213.305...
166 Park JH, Suh DH, Kim HJ, Lee YI, Kwak IH, Choi GW. Role of procalcitonin in infected diabetic foot ulcer. Diabetes Res Clin Pract. 2017;128:51-7. http://doi.org/10.1016/j.diabres.2017.04.008. PMid:28448892. http://doi.org/10.1016/j.diabres.2017.04...
167 Al-Shammaree SAW, Abu-ALkaseem BA, Salman IN. Procalcitonin levels and other biochemical parameters in patients with or without diabetic foot complications. J Res Med Sci. 2017;22(1):95. http://doi.org/10.4103/jrms.JRMS_906_16. PMid:28900451. http://doi.org/10.4103/jrms.JRMS_906_16...
168 Korkmaz P, Koçak H, Onbaşı K, et al. The role of serum procalcitonin, interleukin-6, and fibrinogen levels in differential diagnosis of diabetic foot ulcer infection. J Diabetes Res. 2018;2018:7104352. http://doi.org/10.1155/2018/7104352. PMid:29675434. http://doi.org/10.1155/2018/7104352...
169 Armstrong DG, Perales TA, Murff RT, Edelson GW, Welchon JG. Value of white blood cell count with differential in the acute diabetic foot infection. J Am Podiatr Med Assoc. 1996;86(5):224-7. http://doi.org/10.7547/87507315-86-5-224. PMid:8776158. http://doi.org/10.7547/87507315-86-5-224...
-170170 Umapathy D, Dornadula S, Rajagopalan A, et al. Potential of circulatory procalcitonin as a biomarker reflecting inflammation among South Indian diabetic foot ulcers. J Vasc Surg. 2018;67(4):1283-91.e2. http://doi.org/10.1016/j.jvs.2017.02.060. PMid:28736121. http://doi.org/10.1016/j.jvs.2017.02.060...
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4. Utilize a radiografia simples, teste de sondagem óssea e dosagem de velocidade de hemossedimentação para o diagnóstico de osteomielite. |
Classe I/nível de evidência B171171 Senneville E. Editorial commentary: probe-to-bone test for detecting diabetic foot osteomyelitis: rapid, safe, and accurate-but for which patients? Clin Infect Dis. 2016;63(7):949-50. http://doi.org/10.1093/cid/ciw450. PMid:27369318. http://doi.org/10.1093/cid/ciw450...
172 Álvaro-Afonso FJ, Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E, García-Álvarez Y, Molines-Barroso RJ. Inter-observer reproducibility of diagnosis of diabetic foot osteomyelitis based on a combination of probe-to-bone test and simple radiography. Diabetes Res Clin Pract. 2014;105(1):e3-5. http://doi.org/10.1016/j.diabres.2014.04.024. PMid:24857262. http://doi.org/10.1016/j.diabres.2014.04...
173 Lam K, van Asten SA, Nguyen T, La Fontaine J, Lavery LA. Diagnostic accuracy of probe to bone to detect osteomyelitis in the diabetic foot: a systematic review. Clin Infect Dis. 2016;63(7):944-8. http://doi.org/10.1093/cid/ciw445. PMid:27369321. http://doi.org/10.1093/cid/ciw445...
174 van Asten SA, Jupiter DC, Mithani M, La Fontaine J, Davis KE, Lavery LA. Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis. Int Wound J. 2017;14(1):142-8. http://doi.org/10.1111/iwj.12574. PMid:26953894. http://doi.org/10.1111/iwj.12574...
-175175 Ramanujam CL, Han D, Zgonis T. Medical imaging and laboratory analysis of diagnostic accuracy in 107 consecutive hospitalized patients with diabetic foot osteomyelitis and partial foot amputations. Foot Ankle Spec. 2018;11(5):433-43. http://doi.org/10.1177/1938640017750255. PMid:29291264. http://doi.org/10.1177/1938640017750255...
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5. Solicite RNM (preferencialmente) ou PET-TC /cintilografia com leucócitos marcados para diagnóstico da osteomielite apenas se houver dúvida diagnóstica após avaliação inicial. |
Classe I/nível de evidência B176176 Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008;47(4):519-27. http://doi.org/10.1086/590011. PMid:18611152. http://doi.org/10.1086/590011...
177 Cohen M, Cerniglia B, Gorbachova T, Horrow J. Added value of MRI to X-ray in guiding the extent of surgical resection in diabetic forefoot osteomyelitis: a review of pathologically proven, surgically treated cases. Skeletal Radiol. 2019;48(3):405-11. http://doi.org/10.1007/s00256-018-3045-y. PMid:30136224. http://doi.org/10.1007/s00256-018-3045-y...
178 Baker JC, Demertzis JL, Rhodes NG, Wessell DE, Rubin DA. Diabetic musculoskeletal complications and their imaging mimics. Radiographics. 2012;32(7):1959-74. http://doi.org/10.1148/rg.327125054. PMid:23150851. http://doi.org/10.1148/rg.327125054...
179 Chatha DS, Cunningham PM, Schweitzer ME. MR imaging of the diabetic foot: diagnostic challenges. Radiol Clin North Am. 2005;43(4):747-59, ix. http://doi.org/10.1016/j.rcl.2005.02.008. PMid:15893535. http://doi.org/10.1016/j.rcl.2005.02.008...
-180180 Weinstein D, Wang A, Chambers R, Stewart CA, Motz HA. Evaluation of magnetic resonance imaging in the diagnosis of osteomyelitis in diabetic foot infections. Foot Ankle. 1993;14(1):18-22. http://doi.org/10.1177/107110079301400104. PMid:8425726. http://doi.org/10.1177/10711007930140010...
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6. Colete de culturas, de forma asséptica, para definição do patógeno envolvido em todas as úlceras de pé diabético infectadas. |
Classe I/nível de evidência C145145 Senneville E, Morant H, Descamps D, et al. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin Infect Dis. 2009;48(7):888-93. http://doi.org/10.1086/597263. PMid:19228109. http://doi.org/10.1086/597263...
,181181 Senneville E, Melliez H, Beltrand E, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis. 2006;42(1):57-62. http://doi.org/10.1086/498112. PMid:16323092. http://doi.org/10.1086/498112...
182 Aslangul E, M’Bemba J, Caillat-Vigneron N, et al. Diagnosing diabetic foot osteomyelitis in patients without signs of soft tissue infection by coupling hybrid 67Ga SPECT/CT with bedside percutaneous bone puncture. Diabetes Care. 2013;36(8):2203-10. http://doi.org/10.2337/dc12-2108. PMid:23514729. http://doi.org/10.2337/dc12-2108...
-183183 Letertre-Gibert P, Desbiez F, Vidal M, et al. Blood cultures after bone biopsy in diabetic foot osteomyelitis. Diagn Microbiol Infect Dis. 2017;89(1):78-9. http://doi.org/10.1016/j.diagmicrobio.2017.02.011. PMid:28689896. http://doi.org/10.1016/j.diagmicrobio.20...
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7. Colete de culturas ósseas (cirúrgica ou percutânea) para identificação do patógeno em caso de osteomielite, principalmente quando houver falha do tratamento empírico ou alta probabilidade de osteomielite e dúvida diagnóstica após exames de imagem. |
Classe IIa/nível de evidência C145145 Senneville E, Morant H, Descamps D, et al. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin Infect Dis. 2009;48(7):888-93. http://doi.org/10.1086/597263. PMid:19228109. http://doi.org/10.1086/597263...
,181181 Senneville E, Melliez H, Beltrand E, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis. 2006;42(1):57-62. http://doi.org/10.1086/498112. PMid:16323092. http://doi.org/10.1086/498112...
182 Aslangul E, M’Bemba J, Caillat-Vigneron N, et al. Diagnosing diabetic foot osteomyelitis in patients without signs of soft tissue infection by coupling hybrid 67Ga SPECT/CT with bedside percutaneous bone puncture. Diabetes Care. 2013;36(8):2203-10. http://doi.org/10.2337/dc12-2108. PMid:23514729. http://doi.org/10.2337/dc12-2108...
-183183 Letertre-Gibert P, Desbiez F, Vidal M, et al. Blood cultures after bone biopsy in diabetic foot osteomyelitis. Diagn Microbiol Infect Dis. 2017;89(1):78-9. http://doi.org/10.1016/j.diagmicrobio.2017.02.011. PMid:28689896. http://doi.org/10.1016/j.diagmicrobio.20...
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8. Utilize antibioticoterapia para tratamento das úlceras de pé diabético infectadas de acordo com o perfil de sensibilidade dos prováveis patógenos envolvidos, a gravidade da infecção e uso prévio de antibióticos. |
Classe I/nível de evidência B184184 Selva Olid A, Sola I, Barajas-Nava LA, Gianneo OD, Bonfill Cosp X, Lipsky BA. Systemic antibiotics for treating diabetic foot infections. Cochrane Database Syst Rev. 2015;2015(9):CD009061. http://doi.org/10.1002/14651858.CD009061.pub2. PMid:26337865. http://doi.org/10.1002/14651858.CD009061...
185 Dumville JC, Lipsky BA, Hoey C, Cruciani M, Fiscon M, Xia J. Topical antimicrobial agents for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2017;6(6):CD011038. http://doi.org/10.1002/14651858.CD011038.pub2. PMid:28613416. http://doi.org/10.1002/14651858.CD011038...
186 Arda B, Uysal S, Tasbakan M, et al. Use of tigecycline for diabetic foot infections. Wounds. 2017;29(11):297-305. PMid:28976340.
187 Ingram PR, Rawlins MD, Murray RJ, Roberts JA, Manning L. Tigecycline use in the outpatient parenteral antibiotic therapy setting. Eur J Clin Microbiol Infect Dis. 2016;35(10):1673-7. http://doi.org/10.1007/s10096-016-2709-6. PMid:27325439. http://doi.org/10.1007/s10096-016-2709-6...
188 Hurlow JJ, Humphreys GJ, Bowling FL, McBain AJ. Diabetic foot infection: a critical complication. Int Wound J. 2018;15(5):814-21. http://doi.org/10.1111/iwj.12932. PMid:29808598. http://doi.org/10.1111/iwj.12932...
189 Lipsky BA, Dryden M, Gottrup F, Nathwani D, Seaton RA, Stryja J. Antimicrobial stewardship in wound care: a position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association. J Antimicrob Chemother. 2016;71(11):3026-35. http://doi.org/10.1093/jac/dkw287. PMid:27494918. http://doi.org/10.1093/jac/dkw287...
-190190 Uçkay I, Berli M, Sendi P, Lipsky BA. Principles and practice of antibiotic stewardship in the management of diabetic foot infections. Curr Opin Infect Dis. 2019;32(2):95-101. http://doi.org/10.1097/QCO.0000000000000530. PMid:30664029. http://doi.org/10.1097/QCO.0000000000000...
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9. Inicie antibioticoterapia parenteral em casos de infecção graves com possibilidade de modificação do tratamento para regime via oral quando melhora clínica e quando factível do ponto de vista de tolerância e biodisponibilidade. |
Classe IIa/nível de evidência C188188 Hurlow JJ, Humphreys GJ, Bowling FL, McBain AJ. Diabetic foot infection: a critical complication. Int Wound J. 2018;15(5):814-21. http://doi.org/10.1111/iwj.12932. PMid:29808598. http://doi.org/10.1111/iwj.12932...
189 Lipsky BA, Dryden M, Gottrup F, Nathwani D, Seaton RA, Stryja J. Antimicrobial stewardship in wound care: a position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association. J Antimicrob Chemother. 2016;71(11):3026-35. http://doi.org/10.1093/jac/dkw287. PMid:27494918. http://doi.org/10.1093/jac/dkw287...
-190190 Uçkay I, Berli M, Sendi P, Lipsky BA. Principles and practice of antibiotic stewardship in the management of diabetic foot infections. Curr Opin Infect Dis. 2019;32(2):95-101. http://doi.org/10.1097/QCO.0000000000000530. PMid:30664029. http://doi.org/10.1097/QCO.0000000000000...
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10. Não utilize antibióticos tópicos para o tratamento de infecção de ferida. |
Classe III/nível de evidência B191191 Uçkay I, Kressmann B, Malacarne S, et al. A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection. BMC Infect Dis. 2018;18(1):361. http://doi.org/10.1186/s12879-018-3253-z. PMid:30068306. http://doi.org/10.1186/s12879-018-3253-z...
,192192 Lauf L, Ozsvar Z, Mitha I, et al. Phase 3 study comparing tigecycline and ertapenem in patients with diabetic foot infections with and without osteomyelitis. Diagn Microbiol Infect Dis. 2014;78(4):469-80. http://doi.org/10.1016/j.diagmicrobio.2013.12.007. PMid:24439136. http://doi.org/10.1016/j.diagmicrobio.20...
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11. Administre antibióticos por 1-2 semanas para o tratamento de infecção de partes moles e 3-4 semanas em lesões extensas em melhora e/ou coexistência de DAP grave que possa prolongar o período de cicatrização. |
Classe IIa/nível de evidência C189189 Lipsky BA, Dryden M, Gottrup F, Nathwani D, Seaton RA, Stryja J. Antimicrobial stewardship in wound care: a position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association. J Antimicrob Chemother. 2016;71(11):3026-35. http://doi.org/10.1093/jac/dkw287. PMid:27494918. http://doi.org/10.1093/jac/dkw287...
,190190 Uçkay I, Berli M, Sendi P, Lipsky BA. Principles and practice of antibiotic stewardship in the management of diabetic foot infections. Curr Opin Infect Dis. 2019;32(2):95-101. http://doi.org/10.1097/QCO.0000000000000530. PMid:30664029. http://doi.org/10.1097/QCO.0000000000000...
,193193 Siami G, Christou N, Eiseman I, Tack KJ. Clinafloxacin versus piperacillin-tazobactam in treatment of patients with severe skin and soft tissue infections. Antimicrob Agents Chemother. 2001;45(2):525-31. http://doi.org/10.1128/AAC.45.2.525-531.2001. PMid:11158750. http://doi.org/10.1128/AAC.45.2.525-531....
194 Vick-Fragoso R, Hernández-Oliva G, Cruz-Alcázar J, et al. Efficacy and safety of sequential intravenous/oral moxifloxacin vs intravenous/oral amoxicillin/clavulanate for complicated skin and skin structure infections. Infection. 2009;37(5):407-17. http://doi.org/10.1007/s15010-009-8468-x. PMid:19768381. http://doi.org/10.1007/s15010-009-8468-x...
-195195 Abbas M, Uckay I, Lipsky BA. In diabetic foot infections antibiotics are to treat infection, not to heal wounds. Expert Opin Pharmacother. 2015;16(6):821-32. http://doi.org/10.1517/14656566.2015.1021780. PMid:25736920. http://doi.org/10.1517/14656566.2015.102...
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12. Administre antibióticos por até 6 semanas em casos de osteomielite, avaliando os resultados nas primeiras 2 a 4 semanas, considerando nova coleta ou adequação do tratamento de acordo com os resultados das culturas. |
Classe IIa/nível de eviência B196196 Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med. 2019;380(5):425-36. http://doi.org/10.1056/NEJMoa1710926. PMid:30699315. http://doi.org/10.1056/NEJMoa1710926...
197 Tone A, Nguyen S, Devemy F, et al. Six-week versus twelve-week antibiotic therapy for nonsurgically treated diabetic foot osteomyelitis: a multicenter open-label controlled randomized study. Diabetes Care. 2015;38(2):302-7. http://doi.org/10.2337/dc14-1514. PMid:25414157. http://doi.org/10.2337/dc14-1514...
-198198 Senneville E, Nguyen S. Current pharmacotherapy options for osteomyelitis: convergences, divergences and lessons to be drawn. Expert Opin Pharmacother. 2013;14(6):723-34. http://doi.org/10.1517/14656566.2013.780596. PMid:23496344. http://doi.org/10.1517/14656566.2013.780...
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13. Administre antibióticos com espectro para gram-positivos e gram-negativos mais prevalentes nas lesões em caso de DAP, uso prévio de antibiótico, ou lesõess moderadas-graves. Adicione cobertura a anaeróbios estritos para os casos moderados a graves e considerar a associação para cobertura para Pseudomonas aeruginosa.
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Classe IIa/nível de evidência C189189 Lipsky BA, Dryden M, Gottrup F, Nathwani D, Seaton RA, Stryja J. Antimicrobial stewardship in wound care: a position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association. J Antimicrob Chemother. 2016;71(11):3026-35. http://doi.org/10.1093/jac/dkw287. PMid:27494918. http://doi.org/10.1093/jac/dkw287...
190 Uçkay I, Berli M, Sendi P, Lipsky BA. Principles and practice of antibiotic stewardship in the management of diabetic foot infections. Curr Opin Infect Dis. 2019;32(2):95-101. http://doi.org/10.1097/QCO.0000000000000530. PMid:30664029. http://doi.org/10.1097/QCO.0000000000000...
191 Uçkay I, Kressmann B, Malacarne S, et al. A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection. BMC Infect Dis. 2018;18(1):361. http://doi.org/10.1186/s12879-018-3253-z. PMid:30068306. http://doi.org/10.1186/s12879-018-3253-z...
192 Lauf L, Ozsvar Z, Mitha I, et al. Phase 3 study comparing tigecycline and ertapenem in patients with diabetic foot infections with and without osteomyelitis. Diagn Microbiol Infect Dis. 2014;78(4):469-80. http://doi.org/10.1016/j.diagmicrobio.2013.12.007. PMid:24439136. http://doi.org/10.1016/j.diagmicrobio.20...
193 Siami G, Christou N, Eiseman I, Tack KJ. Clinafloxacin versus piperacillin-tazobactam in treatment of patients with severe skin and soft tissue infections. Antimicrob Agents Chemother. 2001;45(2):525-31. http://doi.org/10.1128/AAC.45.2.525-531.2001. PMid:11158750. http://doi.org/10.1128/AAC.45.2.525-531....
194 Vick-Fragoso R, Hernández-Oliva G, Cruz-Alcázar J, et al. Efficacy and safety of sequential intravenous/oral moxifloxacin vs intravenous/oral amoxicillin/clavulanate for complicated skin and skin structure infections. Infection. 2009;37(5):407-17. http://doi.org/10.1007/s15010-009-8468-x. PMid:19768381. http://doi.org/10.1007/s15010-009-8468-x...
-195195 Abbas M, Uckay I, Lipsky BA. In diabetic foot infections antibiotics are to treat infection, not to heal wounds. Expert Opin Pharmacother. 2015;16(6):821-32. http://doi.org/10.1517/14656566.2015.1021780. PMid:25736920. http://doi.org/10.1517/14656566.2015.102...
,199199 Uçkay I, Kressmann B, Di Tommaso S, et al. A randomized controlled trial of the safety and efficacy of a topical gentamicin-collagen sponge in diabetic patients with a mild foot ulcer infection. SAGE Open Med. 2018;6:2050312118773950. http://doi.org/10.1177/2050312118773950. PMid:29785265. http://doi.org/10.1177/2050312118773950...
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14. Reavalie e adeque a terapia antibiótica de acordo com os resultados de sensibilidade obtidos nas culturas coletadas e não utiliza antimicrobianos para feridas não infectadas com o objetivo de evitar infecção ou acelerar a cicatrização. |
Classe I/nível de eviência C200200 Gardner SE, Haleem A, Jao YL, et al. Cultures of diabetic foot ulcers without clinical signs of infection do not predict outcomes. Diabetes Care. 2014;37(10):2693-701. http://doi.org/10.2337/dc14-0051. PMid:25011945. http://doi.org/10.2337/dc14-0051...
,201201 Ulcay A, Karakas A, Mutluoglu M, Uzun G, Turhan V, Ay H. Antibiotherapy with and without bone debridement in diabetic foot osteomyelitis: a retrospective cohor t study. Pak J Med Sci. 2014;30(1):28-31. PMid:24639825.
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15. Considere reavaliar o tratamento e coletar novas culturas em caso de falha de tratamento após o tempo esperado. |
Classe IIb/nível de evidência C1313 Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3266. http://doi.org/10.1002/dmrr.3266. PMid:32176447. http://doi.org/10.1002/dmrr.3266...
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16. O tratamento da osteomielite pode não envolver a ressecção cirúrgica do osso quando limitado ao antepé. Nos outros casos, considerar ressecção cirúrgica principalmente quando apresentar infecção de tecidos moles associados. |
Classe IIb/nível de evidência B201201 Ulcay A, Karakas A, Mutluoglu M, Uzun G, Turhan V, Ay H. Antibiotherapy with and without bone debridement in diabetic foot osteomyelitis: a retrospective cohor t study. Pak J Med Sci. 2014;30(1):28-31. PMid:24639825.
202 Senneville E, Lombart A, Beltrand E, et al. Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study. Diabetes Care. 2008;31(4):637-42. http://doi.org/10.2337/dc07-1744. PMid:18184898. http://doi.org/10.2337/dc07-1744...
203 Game FL, Jeffcoate WJ. Primarily non-surgical management of osteomyelitis of the foot in diabetes. Diabetologia. 2008;51(6):962-7. http://doi.org/10.1007/s00125-008-0976-1. PMid:18385975. http://doi.org/10.1007/s00125-008-0976-1...
204 Acharya S, Soliman M, Egun A, Rajbhandari SM. Conservative management of diabetic foot osteomyelitis. Diabetes Res Clin Pract. 2013;101(3):e18-20. http://doi.org/10.1016/j.diabres.2013.06.010. PMid:23850116. http://doi.org/10.1016/j.diabres.2013.06...
205 Lesens O, Desbiez F, Theis C, et al. Staphylococcusaureus-related diabetic osteomyelitis: medical or surgical management? A French and Spanish retrospective cohort. Int J Low Extrem Wounds. 2015;14(3):284-90. http://doi.org/10.1177/1534734614559931. PMid:25515373. http://doi.org/10.1177/1534734614559931...
206 Lázaro-Martínez JL, Aragón-Sánchez J, García-Morales E. Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial. Diabetes Care. 2014;37(3):789-95. http://doi.org/10.2337/dc13-1526. PMid:24130347. http://doi.org/10.2337/dc13-1526...
-207207 Lipsky BA. Treating diabetic foot osteomyelitis primarily with surgery or antibiotics: have we answered the question? Diabetes Care. 2014;37(3):593-5. http://doi.org/10.2337/dc13-2510. PMid:24558076. http://doi.org/10.2337/dc13-2510...
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17. Durante a ressecção óssea cirúrgica sugerimos a coleta de um fragmento da porção óssea restante para realização de cultura e avaliação de infecção residual. |
Classe IIb/nível de evidência C208208 Kowalski TJ, Matsuda M, Sorenson MD, Gundrum JD, Agger WA. The effect of residual osteomyelitis at the resection margin in patients with surgically treated diabetic foot infection. J Foot Ankle Surg. 2011;50(2):171-5. http://doi.org/10.1053/j.jfas.2010.12.009. PMid:21354001. http://doi.org/10.1053/j.jfas.2010.12.00...
209 Atway S, Nerone VS, Springer KD, Woodruff DM. Rate of residual osteomyelitis after partial foot amputation in diabetic patients: a standardized method for evaluating bone margins with intraoperative culture. J Foot Ankle Surg. 2012;51(6):749-52. http://doi.org/10.1053/j.jfas.2012.06.017. PMid:22819618. http://doi.org/10.1053/j.jfas.2012.06.01...
210 Hachmöller A. Outcome of minor amputations at the diabetic foot in relation to bone histopathology: a clinical audit. Zentralbl Chir. 2007;132(6):491-6. PMid:18098075.-211211 Mijuskovic B, Kuehl R, Widmer AF, et al. Culture of bone biopsy specimens overestimates rate of residual osteomyelitis after toe or forefoot amputation. J Bone Joint Surg Am. 2018;100(17):1448-54. http://doi.org/10.2106/JBJS.17.01152. PMid:30180052. http://doi.org/10.2106/JBJS.17.01152...
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18. O tratamento antibiótico da osteomielite pode ser abreviado caso o foco de todo o osso seja retirado e a cultura do fragmento residual coletado seja negativa. Em caso de cultura positiva, seguir tratamento por 6 semanas. |
Classe IIb/nível de evidência C208208 Kowalski TJ, Matsuda M, Sorenson MD, Gundrum JD, Agger WA. The effect of residual osteomyelitis at the resection margin in patients with surgically treated diabetic foot infection. J Foot Ankle Surg. 2011;50(2):171-5. http://doi.org/10.1053/j.jfas.2010.12.009. PMid:21354001. http://doi.org/10.1053/j.jfas.2010.12.00...
209 Atway S, Nerone VS, Springer KD, Woodruff DM. Rate of residual osteomyelitis after partial foot amputation in diabetic patients: a standardized method for evaluating bone margins with intraoperative culture. J Foot Ankle Surg. 2012;51(6):749-52. http://doi.org/10.1053/j.jfas.2012.06.017. PMid:22819618. http://doi.org/10.1053/j.jfas.2012.06.01...
210 Hachmöller A. Outcome of minor amputations at the diabetic foot in relation to bone histopathology: a clinical audit. Zentralbl Chir. 2007;132(6):491-6. PMid:18098075.-211211 Mijuskovic B, Kuehl R, Widmer AF, et al. Culture of bone biopsy specimens overestimates rate of residual osteomyelitis after toe or forefoot amputation. J Bone Joint Surg Am. 2018;100(17):1448-54. http://doi.org/10.2106/JBJS.17.01152. PMid:30180052. http://doi.org/10.2106/JBJS.17.01152...
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19. Não utilize oxigenoterapia hiperbárica, oxigenoterapia tópica, uso rotineiro de antissépticos tópicos, preparações com prata, ou terapia por pressão negativa para tratamento de úlceras se a única indicação for para tratar a infecção. |
Classe III/nível de evidência B212212 Savvidou OD, Kaspiris A, Bolia IK, et al. Effectiveness of hyperbaric oxygen therapy for the management of chronic osteomyelitis: a systematic review of the literature. Orthopedics. 2018;41(4):193-9. http://doi.org/10.3928/01477447-20180628-02. PMid:30035798. http://doi.org/10.3928/01477447-20180628...
213 Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med. 1992;38(3):112-4, 111. PMid:1303408.
214 Dissemond J, Kroger K, Storck M, Risse A, Engels P. Topical oxygen wound therapies for chronic wounds: a review. J Wound Care. 2015;24(2):53-4, 56-60, 62-3. http://doi.org/10.12968/jowc.2015.24.2.53. PMid:25647433. http://doi.org/10.12968/jowc.2015.24.2.5...
-215215 Game FL, Apelqvist J, Attinger C, et al. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):154-68. http://doi.org/10.1002/dmrr.2707. PMid:26344936. http://doi.org/10.1002/dmrr.2707...
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