Antibióticos sistêmicos nas infecções do pé relacionadas ao diabetes mellitus: uma revisão integrativa da literatura
Systemic antibiotics for diabetes mellitus‐related foot infections: an integrative literature review
Catarina França dos Santos; Vanessa Prado dos Santos; Lucas de Mello Ferreira; Neima Prado dos Santos; André Brito Queiroz; Valter Castelli Júnior; Roberto Augusto Caffaro; Carlos Alberto Silveira Alves
Resumo
Palavras-chave
Abstract
Evidence on antibiotic therapy for diabetic foot infections can help clinical management. The objective of this study was to identify the evidence on systemic antibiotics for treatment of diabetes mellitus-related foot infections. An integrative literature review was conducted of randomized clinical trials, systematic reviews, and meta-analyses. The keywords “Diabetic foot” AND “Antibiotics” were used to search PubMed and 15 articles were selected (nine randomized clinical trials, four systematic reviews, and two meta-analyses). Seven randomized clinical trials revealed clinical results that were comparable for beta lactam antibiotics with beta-lactamase inhibitors, carbapenems, and fluoroquinolones. Two randomized clinical trials found significant differences comparing ertapenem and tigecycline and in analyses of subsets with severe infections between piperacillin-tazobactam and ertapenem. The literature revealed comparable clinical results for different systemic antibiotics used to treat foot infections related to diabetes, except for the difference between ertapenem and tigecycline, which did not meet the parameters for non-inferiority, highlighting the need for higher-quality evidence.
Keywords
References
1 Ong KL, Stafford LK, McLaughlin SA, et al. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203-34.
2 Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-16.
3 McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers. Diabetes Care. 2023;46(1):209-21.
4 Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-75.
5 Mills JL Sr, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220-34.e1.
6 Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clin Infect Dis. 2012;54(12):e132-73.
7 Senneville E, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev. 2024;40(3):e3687.
8 Boulton AJM, Armstrong DG, Hardman MJ, et al. Diagnosis and management of diabetic foot infections. Arlington: American Diabetes Association; 2020 [citado 2023 maio 9].
9 Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.
10 Peters EJG, Albalawi Z, van Asten SA, et al. Interventions in the management of diabetes-related foot infections: A systematic review. Diabetes Metab Res Rev. 2024;40(3):e3730.
11 Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
12 Clay PG, Graham MR, Lindsey CC, Lamp KC, Freeman C, Glaros A. Clinical efficacy, tolerability, and cost savings associated with the use of open-label metronidazole plus ceftriaxone once daily compared with ticarcillin/clavulanate every 6 hours as empiric treatment for diabetic lower-extremity infections in older males. Am J Geriatr Pharmacother. 2004;2(3):181-9.
13 Grayson ML, Gibbons GW, Habershaw GM, et al. Use of ampicillin/sulbactam versus imipenem/cilastatin in the treatment of limb-threatening foot infections in diabetic patients. Clin Infect Dis. 1994;18(5):683-93.
14 Lauf L, Ozsvár 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.
15 Lipsky BA, Baker PD, Landon GC, Fernau R. Antibiotic therapy for diabetic foot infections: comparison of two parenteral-to-oral regimens. Clin Infect Dis. 1997;24(4):643-8.
16 Lipsky BA, Itani K, Norden C. Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillin-sulbactam/amoxicillin-clavulanate. Clin Infect Dis. 2004;38(1):17-24.
17 Lipsky BA, Armstrong DG, Citron DM, Tice AD, Morgenstern DE, Abramson MA. Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial. Lancet. 2005;366(9498):1695-703.
18 Saltoglu N, Dalkiran A, Tetiker T, et al. Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital. Clin Microbiol Infect. 2010;16(8):1252-7.
19 Schaper NC, Dryden M, Kujath P, et al. Efficacy and safety of IV/PO moxifloxacin and IV piperacillin/tazobactam followed by PO amoxicillin/clavulanic acid in the treatment of diabetic foot infections: results of the RELIEF study. Infection. 2013;41(1):175-86.
20 Xu Z-R, Ran X-W, Xian Y, et al. Ertapenem versus piperacillin/tazobactam for diabetic foot infections in China: a Phase 3, multicentre, randomized, double-blind, active-controlled, non-inferiority trial. J Antimicrob Chemother. 2016;71(6):1688-96.
21 Nelson EA, O’Meara S, Golder S, Dalton J, Craig D, Iglesias C. Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med. 2006;23(4):348-59.
22 Tchero H, Kangambega P, Noubou L, Becsangele B, Fluieraru S, Teot L. Antibiotic therapy of diabetic foot infections: a systematic review of randomized controlled trials. Wound Repair Regen. 2018;26(5):381-91.
23 Pratama V, Risni HW, Yunir E, Sauriasari R. A systematic review of randomized controlled trials of antibiotic use in diabetic foot ulcer infections: focus on clinical cure. Infect Chemother. 2022;54(1):125-39.
24 Gurusamy KS, Koti R, Toon CD, Wilson P, Davidson BR. Antibiotic therapy for the treatment of methicillin-resistant
25 Selva Olid AS, Solà 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.
26 Collignon PJ, Conly JM, Andremont A, McEwen SA, Aidara-Kane A. World Health Organization Ranking of antimicrobials according to their importance in human medicine: a critical step for developing risk management strategies to control antimicrobial resistance from food animal production. Clin Infect Dis. 2016;63(8):1087-93.
27 Armstrong DG, Lavery LA, Harkless LB. Validation of a Diabetic Wound Classification System: the contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998;21(5):855-9.
28 MacDonald KE, Boeckh S, Stacey HJ, Jones JD. The microbiology of diabetic foot infections: a meta-analysis. BMC Infect Dis. 2021;21(1):770.
29 Palomo AT, Pires APM, Matielo MF, et al. Microbiology of diabetic foot infections in a Tertiary Care Hospital in São Paulo, Brazil. Antibiotics. 2022;11(8):1125.
30 Perim MC, Borges JC, Celeste SRC, et al. Aerobic bacterial profile and antibiotic resistance in patients with diabetic foot infections. Rev Soc Bras Med Trop. 2015;48(5):546-54.
31 Santos VP, Andrade Barberino MGM, Alves CAS. Microbiological species and antibiotic resistance in diabetic and nondiabetic lower extremity wounds: a comparative cross-sectional study. Int J Low Extrem Wounds. 2024;23(2):338-46.
32 Fernandes LF, Pimenta FC, Fernandes FF. Isolamento e perfil de suscetibilidade de bactérias de pé diabético e úlcera de estase venosa de pacientes admitidos no pronto-socorro do principal hospital universitário do estado de Goiás, Brasil. J Vasc Bras. 2007;6(3):211-7.
33 Centers for Disease Control and Prevention. Antibiotic resistance threatens everyone. Atlanta: CDC; 2022 [citado 2022 set 19].
34 Monteiro‐Soares M, Russell D, Boyko EJ, et al. Guidelines on the classification of diabetic foot ulcers (IWGDF 2019). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3273.
Submitted date:
07/24/2025
Accepted date:
12/04/2025
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email