糖尿病足感染中的厌氧菌:病理生理学、流行病学、毒力和管理。

IF 19 1区 医学 Q1 MICROBIOLOGY
Clinical Microbiology Reviews Pub Date : 2024-09-12 Epub Date: 2024-05-31 DOI:10.1128/cmr.00143-23
Fanny Villa, Hélène Marchandin, Jean-Philippe Lavigne, Sophie Schuldiner, Nicolas Cellier, Albert Sotto, Paul Loubet
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引用次数: 0

摘要

摘要糖尿病足感染(DFI)是一个全球性的公共卫生问题。糖尿病足感染是一种多微生物、生物膜相关性感染,涉及复杂的细菌群落,这些细菌群落由功能相当的病原菌群组成,其中包括厌氧菌。事实上,在这种情况下,多种病理生理因素都有利于厌氧菌的生长。然而,由于厌氧菌的检测难度很大,因此厌氧菌在伤口演变过程中的流行率、作用和贡献仍然不甚明了。本文回顾的基于培养的研究显示,厌氧菌在患者中的加权平均比例为 17%。相比之下,通过 16S rRNA 基因测序鉴定出厌氧菌的患者加权平均比例为 83.8%。与不依赖培养的方法相比,培养法不仅在很大程度上低估了厌氧菌的存在,而且也低估了厌氧菌的多样性,但这两种方法都显示,厌氧革兰阴性杆菌和革兰阳性球菌是 DFI 中最常发现的厌氧菌。厌氧菌更多地出现在较深的病灶中,它们的检测与发热、病灶恶臭、溃疡深度和持续时间有关。更具体地说,Peptoniphilus 菌属的最初大量存在与溃疡愈合受损有关,Fusobacterium 菌属的检测与 DFI 的持续时间显著相关,而 Bacteroides 菌属的存在与截肢显著相关。对 DFI 中厌氧菌的抗菌药耐药性的研究仍然较少,在 DFI 中最常发现的厌氧菌耐药性不断增加的背景下,有必要对其进行更多的研究。DFI患者中涉及厌氧菌的比例很高,人们对所发现的厌氧菌种类、毒力因素及其在伤口演变中的潜在作用有了更多了解,因此建议在中度和重度DFI患者中结合清创和对厌氧菌有效的抗生素治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anaerobes in diabetic foot infections: pathophysiology, epidemiology, virulence, and management.

SUMMARYDiabetic foot infections (DFI) are a public health problem worldwide. DFI are polymicrobial, biofilm-associated infections involving complex bacterial communities organized in functional equivalent pathogroups, all including anaerobes. Indeed, multiple pathophysiological factors favor the growth of anaerobes in this context. However, the prevalence, role, and contribution of anaerobes in wound evolution remain poorly characterized due to their challenging detection. Studies based on culture reviewed herein showed a weighted average of 17% of patients with anaerobes. Comparatively, the weighted average of patients with anaerobes identified by 16S rRNA gene sequencing was 83.8%. Culture largely underestimated not only the presence but also the diversity of anaerobes compared with cultivation-independent approaches but both methods showed that anaerobic Gram-negative bacilli and Gram-positive cocci were the most commonly identified in DFI. Anaerobes were more present in deeper lesions, and their detection was associated with fever, malodorous lesions, and ulcer depth and duration. More specifically, initial abundance of Peptoniphilus spp. was associated with ulcer-impaired healing, Fusobacterium spp. detection was significantly correlated with the duration of DFI, and the presence of Bacteroides spp. was significantly associated with amputation. Antimicrobial resistance of anaerobes in DFI remains slightly studied and warrants more consideration in the context of increasing resistance of the most frequently identified anaerobes in DFI. The high rate of patients with DFI-involving anaerobes, the increased knowledge on the species identified, their virulence factors, and their potential role in wound evolution support recommendations combining debridement and antibiotic therapy effective on anaerobes in moderate and severe DFI.

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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
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