Información del artículo
Resumen
Introducción
Uno de los aspectos más graves de las úlceras del pie diabético es la infección, pues empeora su pronóstico y dificulta su tratamiento. El conocimiento de su gravedad, la detección precoz del microorganismo responsable y la determinación de su antibiograma son aspectos prioritarios en el tratamiento de estos pacientes. El uso frecuente de antibióticos en los pacientes con pie diabético hace que las resistencias antimicrobianas sean uno de los factores a tener en cuenta a la hora de elegir un antibiótico, especialmente para evitar un tratamiento empírico inadecuado con el aumento de morbilidad y mortalidad que conlleva. Esto ha hecho que se investiguen y desarrollen nuevo fármacos para el tratamiento de estas infecciones, como el linezolid o el ertapenem, ya en el mercado, o la tigeciclina, la daptomicina y la dalbavancina, en vías de comercialización.
DesarrolloSe analizan el papel y el impacto de estos nuevos antibióticos en las infecciones del pie diabético basándose en los recientes ensayos clínicos publicados.
ConclusiónLa utilización racional de los nuevos fármacos descritos puede mejorar los resultados de las infecciones del pie diabético.
Palabras clave:
Antibióticos
Infección
Pie diabético
Resistencias
Staphylococcus aureus
Summary
Introduction
One of the most serious aspects of diabetic foot ulcers is infection, since this leads to a poorer prognosis and makes treatment more complicated. Being aware of its severity, early detection of the microorganism causing the infection and determining its antibiogram are priority aspects in the treatment of these patients. The frequent use of antibiotics in patients with diabetic foot makes antimicrobial resistance a factor to be taken into account when it comes to choosing an antibiotic, especially to prevent administration of unsuitable empirical treatment with the increased morbidity and mortality this entails. This has led to research and development of new drugs for the treatment of these infections, as is the case for example of linezolid or ertapenem, which are already on the market, or tigecycline and dalbavancin, which are on their way to being commercialised in the future.
DevelopmentThe role played by these new antibiotics and the impact they have on diabetic foot infections are analysed on the basis of recently reported clinical trials.
ConclusionsThe rational use of the new drugs described here can improve outcomes in cases of diabetic foot infection.
Key words:
Antibiotics
Diabetic foot
Infection
Resistances
Staphylococcus aureus
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Bibliografía
[1.]
Armstrong D.G., Lipsky B.A..
Advances in the treatment of diabetic foot infections.
Diabetes Technol Ther, 6 (2004), pp. 167-177
[2.]
Boulton A.J., Vileikyte L., Ragnarson-Tennvall G., Apelqvist J..
The global burden of diabetic foot disease.
Lancet, 366 (2005), pp. 1719-1724
[3.]
Centers for Disease Control and Prevention.
The public health of diabetes mellitus in the United Status, Department of Health and Human Services, (1997),
[4.]
Akbari C.M., Macsata R., Smith B.M., Sidawy A.N..
Overview of the diabetic foot.
Semin Vasc Surg., 16 (2003), pp. 3-11
[5.]
Jeffcoate W.J., Harding K.G..
Diabetic foot ulcers.
Lancet, 361 (2003), pp. 1545-1551
[6.]
Marinel.lo J., Blanes J.I., Escudero J.R., Ibáñez V., Rodríguez J..
Consenso sobre pie diabético.
Angiología, 49 (1997), pp. 193-230
[7.]
Marinel.lo J., Blanes J.I., Escudero J.R., Ibáñez V., Rodríguez J..
Pie diabético.
Infección en Angiología y Cirugía Vascular, pp. 339-352
[8.]
Marinel.lo-Roura J., Blanes-Mompó J.I., Escudero-Rodríguez J.R., Ibáñez-Esquembre V., Rodríguez-Olay J..
Tratado de pie diabético, Jarpio, (1999),
[9.]
Fejfarová V., Jirkovaská A., Boucek P., Skibová J..
Association between the presence of resistant pathogens and frequency of amputations in patients with diabetic foot [abstract]..
European Association for the Study of Diabetes-Diabetic Foot Study Group, Hungary, (2002),
[10.]
Tentolouris N., Jude E.B., Smirnof I., Knowles E.A., Boulton A.J.M..
Methicillin-resistant Staphylococcus aureus: an increasing problem in a diabetic foot clinic.
Diabet Med., 16 (1999), pp. 767-771
[11.]
Cavanagh P.R., Lipsky B.A., Bradbury A.W., Botek G..
Treatment for diabetic foot ulcers.
Lancet, 366 (2005), pp. 1725-1735
[12.]
Shah P.M..
The need for new therapeutic agents: what is the pipeline?.
Clin Microbiol Infect, 11 (2005), pp. 36-42
[13.]
Kanafani Z.A., Fowler V.G. Jr.
Staphylococcus aureus infections: new challenges from an old pathogen.
Enferm Infecc Microbiol Clin, 24 (2006), pp. 182-193
[14.]
Singh N., Armstrong D.G., Lipsky B.A..
Preventing foot ulcers inpatients with diabetes.
JAMA, 293 (2005), pp. 217-228
[15.]
International Diabetes Federation. Time to act: diabetes and foot care. Brussels: International Diabetes Federation; 2005.
[16.]
Lavery L.A., Armstrong D.G., Wunderlich R.P., Tredwell J., Boulton A.J.M..
Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort.
Diabetes Care, 26 (2003), pp. 1435-1438
[17.]
Ramsey S.D., Newton K., Blough D., McCulloch D.K., Sandhu N., Reiber G.E., et al.
Incidence, outcomes, and cost of foot ulcers in patients with diabetes.
Diabetes Care, 22 (1999), pp. 382-387
[18.]
Armstrong D.G., Lavery L.A., Harkless L.B., Van Houtum W.H..
Amputation and reamputation of the diabetic foot.
J Am Podiatr Med Assoc, 87 (1997), pp. 255-259
[19.]
Wheat L.J., Allen S.D., Henry M., Kernek C.B., Siders J.A., Kuebler T., et al.
Diabetic foot infections: bacteriologic analysis.
Arch Intern Med., 146 (1986), pp. 1935-1940
[20.]
Sapico F.L., Witte J.L., Canawati H.N., Montgomerie J.Z., Bessman A.N..
The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features.
Rev Infect Dis., 6 (1984), pp. S171-S176
[21.]
Lipsky B.A., Armstrong D.G., Citron D.M., Tice A.D., Morgenstern D.E., Abramson M.A..
Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial.
Lancet, 366 (2005), pp. 1695-1703
[22.]
Lipsky B.A., Itani K., Norden C., Linezolid Diabetic Foot Infections Study Group.
Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillin-sulbactam/amoxicillin-clavulanate.
Clin Infect Dis., 38 (2004), pp. 17-24
[23.]
Dang C.N., Prasad Y.D.M., Boulton A.J.M., Jude E.B..
Methicillinresistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem.
Diabet Med., 20 (2003), pp. 159-161
[24.]
Bowler P.G., Duerden B.I., Armstrong D.G..
Wound microbiology and associated approaches to wound management.
Clin Microbiol Rev., 14 (2001), pp. 244-269
[25.]
Lipsky B.A., Berendt A.R., Deery H.G., Embil J.M., Joseph W.S., Karchmer A.W., et al.
Diagnosis and treatment of diabetic foot infections.
Clin Infect Dis., 39 (2004), pp. 885-910
[26.]
Lipsky B.A..
International Consensus Group on Diagnosing and Treating the Infected Diabetic Foot. Report from the International Consensus on Diagnosing and Treating the Infected Diabetic Foot.
Diabetes Metab Res Rev., 20 (2004), pp. S68-S77
[27.]
Lazzarini L., Lipsky B.A., Mader J.T..
Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials?.
Int J Infect Dis., 9 (2005), pp. 127-138
[28.]
Jeffcoate W.J., Lipsky B.A..
Controversies in diagnosing and managing osteomyelitis of the foot in diabetes.
Clin Infect Dis., 39 (2004), pp. S115-S122
[29.]
DiNubile M.J., Lipsky B.A..
Complicated infections of skin and skin structures: when the infection is more than skin deep.
J Antimicrob Chemother, 53 (2004), pp. 37-50
[30.]
Shah P.M., Isaacs R.D..
Ertapenem, the first of a new group of carbapenems.
J Antimicrob Chemother, 52 (2003), pp. 538-542
[31.]
Loza E., Morosini M.I., Cantón R., Almaraz F., Reig M., Baquero F..
Comparative in vitro activity of ertapenem against aerobic and anaerobic bacteria.
Rev Esp Quimioter, 16 (2003), pp. 209-215
[32.]
Livermore D.M., Carter M.W., Bagel S., Wiedemann B., Baquero F., Loza E., et al.
In vitro activities of ertapenem (MK-0826) against recent clinical bacteria collected in Europe and Australia.
Antimicrob Agents Chemother, 45 (2001), pp. 1860-1867
[33.]
DiNubile M.J., Chow J.W., Satishchandran V., Polis A., Motyl M.R., Abramson M.A., et al.
Acquisition of resistant bowel flora during a double-blind randomized clinical trial of ertapenem versus piperacillin-tazobactam therapy for intraabdominal infections.
Antimicrob Agents Chemother, 49 (2005), pp. 3217-3221
[34.]
Laethem T., De Lepeleire I., McCrea J., Zhang J., Majumdar A., Musson D., et al.
Tissue penetration by ertapenem, a parenteral carbapenem administered once daily, in suction-induced skin blister fluid in healthy young volunteers.
Antimicrob Agents Chemother, 47 (2003), pp. 1439-1442
[35.]
Bouza E., Muñoz P..
Linezolid: pharmacokinetic characteristics and clinical studies.
Clin Microbiol Infect, 7 (2001), pp. 75-82
[36.]
Cercenado E., García-Garrote F., Bouza E..
In vitro activity of linezolid against multiply resistant gram-positive clinical isolates.
J Antimicrob Chemother, 47 (2001), pp. 77-81
[37.]
Alcalá L., Ruiz-Serrano M.J., Pérez-Fernández Turégano C., García de Viedma D., Díaz-Infantes M., Marín-Arriaza M., et al.
In vitro activities of linezolid against clinical isolates of Mycobacterium tuberculosis that are susceptible or resistant to first-line antituberculous drugs.
Antimicrob Agents Chemother, 47 (2003), pp. 416-417
[38.]
Honeybourne D., Tobin C., Jevons G., Andrews J., Wise R..
Intrapulmonary penetration of linezolid.
J Antimicrob Chemother, 51 (2003), pp. 1431-1434
[39.]
Spellberg B., Yoo T., Bayer A.S..
Reversal of linezolid-associated cytopenias, but not peripheral neuropathy, by administration of vitamin B6.
J Antimicrob Chemother, 54 (2004), pp. 832-835
[40.]
Frippiat F., Bergiers C., Michel C., Dujardin J.P., Derue G..
Severe bilateral optic neuritis associated with prolonged linezolid therapy.
J Antimicrob Chemother, 53 (2004), pp. 1114-1115
[41.]
Wunderink R.G., Rello J., Cammarata S.K., Croos-Dabrera R.V., Kollef M.H..
Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia.
Chest, 124 (2003), pp. 1789-1797
[42.]
Kalil A.C., Puumala S., Stoner J., Weigelt J., Itani K., Stevens D., et al.
Is Linezolid superior to vancomycin for complicated skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus?.
Antimicrob Agents Chemother, 50 (2006), pp. 1910-1911
[43.]
Weigelt J., Itani K., Stevens D., Lau W., Dryden M., Knirsch C., Linezolid CSSTI Study Group.
Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections.
Antimicrob Agents Chemother, 49 (2005), pp. 2260-2266
[44.]
Sharpe J.N., Shively E.H., Polk H.C. Jr.
Clinical and economic outcomes of oral linezolid versus intravenous vancomycin in the treatment of MRSA-complicated, lower-extremity skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus.
Am J Surg., 189 (2005), pp. 425-428
[45.]
Itani K.M., Weigelt J., Li J.Z., Duttagupta S..
Linezolid reduces length of stay and duration of intravenous treatment compared with vancomycin for complicated skin and soft tissue infections due to suspected or proven methicillin-resistant Staphylococcus aureus (MRSA).
Int J Antimicrob Agents, 26 (2005), pp. 442-448
[46.]
Dehghanyar P., Burger C., Zeitlinger M., Islinger F., Kovar F., Muller M., et al.
Penetration of linezolid into soft tissues of healthy volunteers after single and multiple doses.
Antimicrob Agents Chemother, 49 (2005), pp. 2367-2371
[47.]
Rello J..
Pharmacokinetics, pharmacodynamics, safety and tolerability of tigecycline.
J Chemother, 17 (2005), pp. 12-22
[48.]
Zhanel G.G., Karlowsky J.A., Rubinstein E., Hoban D.J..
Tigecycline: a novel glycylcycline antibiotic.
Expert Rev Anti Infect Ther, 4 (2006), pp. 9-25
[49.]
Bradford P.A., Weaver-Sands D.T., Petersen P.J..
In vitro activity of tigecycline against isolates from patients enrolled in phase 3 clinical trials of treatment for complicated skin and skinstructure infections and complicated intra-abdominal infections.
Clin Infect Dis., 41 (2005), pp. S315-S332
[50.]
Wilcox M.H..
Efficacy of tigecycline in complicated skin and skin structure infections and complicated intra-abdominal infections.
J Chemother, 17 (2005), pp. 23-29
[51.]
Breedt J., Teras J., Gardovskis J., Maritz F.J., Vaasna T., Ross D.P., Tigecycline 305 cSSSI Study Group, et al.
Safety and efficacy of tigecycline in treatment of skin and skin structure infections: results of a double-blind phase 3 comparison study with vancomycin-aztreonam.
Antimicrob Agents Chemother, 49 (2005), pp. 4658-4666
[52.]
Livermore D.M..
Tigecycline: what is it and where should it be used?.
J Antimicrob Chemother, 56 (2005), pp. 611-614
[53.]
Noskin G.A..
Tigecycline: a new glycylcycline for treatment of serious infections.
Clin Infect Dis., 41 (2005), pp. S303-S314
[54.]
Arbeit R.D., Maki D., Tally F.P., Campanaro E., Eisenstein B.I., Daptomycin 98-01 and 99-01 Investigators.
The safety and efficacy of daptomycin for the treatment of complicated skin and skin-structure infections.
Clin Infect Dis., 38 (2004), pp. 1673-1681
[55.]
Silverman J.A., Mortin L.I., Vanpraagh A.D., Li T., Alder J..
Inhibition of daptomycin by pulmonary surfactant: in vitro modeling and clinical impact.
J Infect Dis., 191 (2005), pp. 2149-2152
[56.]
Lipsky B.A., Stoutenburgh U..
Daptomycin for treating infected diabetic foot ulcers: evidence from a randomized, controlled trial comparing daptomycin with vancomycin or semisynthetic penicillins for complicated skin and skin-structure infections.
J Antimicrob Chemother, 55 (2005), pp. 240-245
[57.]
Lin S.W., Carver P.L., DePestel D.D..
Dalbavancin: a new option for the treatment of gram-positive infections.
Ann Pharmacother, 40 (2006), pp. 449-460
[58.]
Jones R.N., Stilwell M.G., Sader H.S., Fritsche T.R., Goldstein B.P..
Spectrum and potency of dalbavancin tested against 3322 gram-positive cocci isolated in the United States Surveillance Program (2004).
Diagn Microbiol Infect Dis., 54 (2006), pp. 149-153
[59.]
Jáuregui L.E., Babazadeh S., Seltzer E., Goldberg L., Krievins D., Frederick M., et al.
Randomized, double-blind comparison of once-weekly dalbavancin versus twice-daily linezolid therapy for the treatment of complicated skin and skin structure infections.
Clin Infect Dis., 41 (2005), pp. 1407-1415
[60.]
Raad I., Darouiche R., Vázquez J., Lentnek A., Hachem R., Hanna H., et al.
Efficacy and safety of weekly dalbavancin therapy for catheter-related bloodstream infection caused by grampositive pathogens.
Clin Infect Dis., 40 (2005), pp. 374-380
[61.]
Lipsky B.A., Berendt A.R., Deery H.G., Embil J.M., Joseph W.S., Karchmer A.W., et al.
Diagnosis and treatment of diabetic foot infections.
Clin Infect Dis., 39 (2004), pp. 885
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