Alternative yöntemler eşliğinde takip ettiğimiz diyabetik ayak enfeksiyonlarımız
Yükleniyor...
Tarih
2017
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Yüzüncü Yıl Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Diyabetik ayak enfeksiyonları multidisipliner yaklaşım ve yoğun bir emek gerektirmesi açısından ayrı bir önem arz etmektedir. Halen hastaların organize takibi açısından pekçok hastanede sıkıntılar yaşanmaktadır. Benzer sıkıntıları yaşayan bir Üniversite Hastanesi olarak diyabetik ayak konseyi eşliğinde takip ettiğimiz hasta deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntem: Kasım 2015 ile mart 2016 tarihleri arasında Dicle Üniversitesi Hastanesi'nde, diyabetik ayak enfeksiyon tanılı 36 hasta çalışmaya alındı. Wagner evrelemesi ile hastalar sınıflandırıldı. Hastaların yaş, cins, diyabet süresi, HbA1c seviyeleri, yara gelişim süresi, yara yerleşim yeri, ayağın vasküler ve nöropati durumunun değerlendirilmesi yapılarak osteomyelit varlığının tespiti için ayağın direk grafisi ve gerekli hastalarda manyetik rezonans görüntüleme yapıldı. Ayağın enfeksiyon ciddiyetine göre ampirik antimikrobiyal tedavi planlanmadan önce uygun ve steril şartlarda yara kültürleri alındı. Bulgular: Hastaların 21'i erkek olup yaş ortalamaları 46 ± 21 yıl idi. Hastaların 26 'si Wagner evre 3 ve üzeri idi. Hastaların 2'si septik tabloda iken diğerleri stabil idi. Ampirik tedavi olarak ampisillin-sulbaktam, piperasilintazobaktam, sefaperazon-sulbaktam, sefepim ve meropenem tedavileri başlanırken septik tabloda olan iki hastamıza meropenem ve daptomisin tedavisi başlandı. Hastalarımızın 21'i cerrahi işlem gördü. Bir hastaya debridman amacıyla kurtçuk tedavisi uygulandı. Yara bakımı ve granülasyon dokusu geliştirmek için 2 hastaya vacuum assisted closure, 2 hastaya Vacuum Assisted Closure + Epidermal Growth Factor, 2 hastaya Vacuum Assisted Closure + Hiperbarik Oksijen Tedavisi ve toplam 7 hastamıza greft ve/veya flep çevrildi. Sonuç: Mevcut tedavilerle dış merkezlerde diz altı ampütasyon önerilen 3 hastadan 1'i 2-3-4 parmak amputasyonu, diğer 2'si ise hiç amputasyon yapılmadan kurtarıldı.
Objective: Diabetic foot infection is particularly important as it requires an intense effort and multidisciplinary approach. Many hospitals are still having trouble in terms of organizing follow-up of patients. As a University Hospital facing similar difficulties, we aimed to share our patient experience that we followed accompanied by the council. Material and Method: 36 patients with diabetic foot infections were included to the study at Dicle University Hospital, between November 2015 and March 2016. The Wagner Grading System was used for the classification of each patient. Patients were grouped according to their age, sex, duration of diabetes, glycated hemoglobin levels, the vascular status of the foot and duration of ulcer. The patients underwent a plain radiography and magnetic resonance imaging if necessary for detecting osteomyelitis by evaluating foot neuropathy and vascular status. The samples of wound obtained under sterile conditions were cultured before empiric antimicrobial treatment. Results: 21 of the patients were male and their mean age was 46 ± 21 years. 26 of the patients were Wagner >= 3. While 2 of the patients were in septic status, the others were stable. While we started ampicillin-sulbactam, piperacillin-tazobactam, cefoperazone-sulbactam, cefepime and meropenem as empirical therapy, it was started meropenem plus daptomisin to our two patients who had in septic status, 21 of our patients were underwent surgical procedures. The maggot debridement therapy was applied to one patient. Vacuum Assisted Closure (2 patients), Vacuum Assisted Closure + Epidermal Growth Factor (2 patients), Vacuum Assisted Closure + Hyperbaric Oxygen Therapy (2 patients) were planned for wound care and improving the granulation tissue, and it were performed to 7 patients graft and / or flap. Conclusion: While 1 out of 3 patients suggested below knee amputation in outer centers were only rescued with the second, third and fourth finger amputation, the other 2 were rescued without amputation.
Objective: Diabetic foot infection is particularly important as it requires an intense effort and multidisciplinary approach. Many hospitals are still having trouble in terms of organizing follow-up of patients. As a University Hospital facing similar difficulties, we aimed to share our patient experience that we followed accompanied by the council. Material and Method: 36 patients with diabetic foot infections were included to the study at Dicle University Hospital, between November 2015 and March 2016. The Wagner Grading System was used for the classification of each patient. Patients were grouped according to their age, sex, duration of diabetes, glycated hemoglobin levels, the vascular status of the foot and duration of ulcer. The patients underwent a plain radiography and magnetic resonance imaging if necessary for detecting osteomyelitis by evaluating foot neuropathy and vascular status. The samples of wound obtained under sterile conditions were cultured before empiric antimicrobial treatment. Results: 21 of the patients were male and their mean age was 46 ± 21 years. 26 of the patients were Wagner >= 3. While 2 of the patients were in septic status, the others were stable. While we started ampicillin-sulbactam, piperacillin-tazobactam, cefoperazone-sulbactam, cefepime and meropenem as empirical therapy, it was started meropenem plus daptomisin to our two patients who had in septic status, 21 of our patients were underwent surgical procedures. The maggot debridement therapy was applied to one patient. Vacuum Assisted Closure (2 patients), Vacuum Assisted Closure + Epidermal Growth Factor (2 patients), Vacuum Assisted Closure + Hyperbaric Oxygen Therapy (2 patients) were planned for wound care and improving the granulation tissue, and it were performed to 7 patients graft and / or flap. Conclusion: While 1 out of 3 patients suggested below knee amputation in outer centers were only rescued with the second, third and fourth finger amputation, the other 2 were rescued without amputation.
Açıklama
Anahtar Kelimeler
Diyabetik ayak infeksiyonları, Amputasyon, Alternative yöntemler, Diabetic foot infection, Amputation, Alternative methods
Kaynak
Van Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
24
Sayı
2
Künye
Bozkurt, F., Alan, B., Dayan, S., Selçuk, T., Aslan, E., Deveci, Ö. ve diğerleri. (2017). Alternative yöntemler eşliğinde takip ettiğimiz diyabetik ayak enfeksiyonlarımız. Van Tıp Dergisi, 24(2), 71-77.
