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Infections in patients with diabetes mellitus: Importance of early recognition, treatment, and prevention

机译:糖尿病患者的感染:早期识别,治疗和预防的重要性

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摘要

PURPOSE: To review the spectrum of infectious complications in patients with diabetes, common presentations and warning signs, therapeutic options, and strategies for prevention. EPIDEMIOLOGY: There is evidence that patients with diabetes are more susceptible to infection than are nondiabetic patients. Moreover, patients with diabetes have about double the risk of infection-related mortality. REVIEW SUMMARY: The risk of microvascular and macrovascular complications increases with older age in patients with diabetes; these complications presumably increase the risk of infection. Several defects in cell-mediated immunity also have been noted in patients with diabetes. Common infections that can cause serious complications in patients with diabetes include community-acquired pneumonia, urinary tract infections, necrotizing fasciitis, and foot ulcers. Certain rare infectious diseases occur predominantly in patients with diabetes, including malignant otitis externa, rhinocerebral mucormycosis, emphysematouscholecystitis, and emphysematous pyelonephritis. Because these conditions can have serious complications, progress rapidly, and/or be life-threatening, prompt recognition and treatment is imperative. Glycemic control, screening for foot ulcers and educating patients about foot care, and vaccination against pneumococcus and influenza are critically important strategies for preventing infection. TYPE OF AVAILABLE EVIDENCE: Nationally recognized treatment guidelines, randomized controlled trials, prospective and retrospective cohort studies, case-control studies, meta-analyses, nonsystematic reviews. GRADE OF AVAILABLE EVIDENCE: Fair to good. CONCLUSION: Anticipating serious complications of common infections in patients with diabetes is as important as appreciating rare disease entities that affect these patients disproportionately. Primary care clinicians should be aware of how infections present in patients with diabetes in order to provide early diagnosis and aggressive treatment.
机译:目的:回顾糖尿病患者的感染并发症的范围,常见表现和警告信号,治疗选择和预防策略。流行病学:有证据表明,糖尿病患者比非糖尿病患者更容易感染。此外,糖尿病患者的感染相关死亡风险大约是两倍。综述摘要:糖尿病患者中随着年龄的增长,微血管和大血管并发症的风险增加。这些并发症可能会增加感染的风险。在糖尿病患者中也已经注意到细胞介导的免疫的一些缺陷。可能导致糖尿病患者严重并发症的常见感染包括社区获得性肺炎,尿路感染,坏死性筋膜炎和足溃疡。某些罕见的传染病主要发生在糖尿病患者中,包括恶性外耳炎,鼻脑黏膜真菌病,肺气肿性胆囊炎和肺气肿性肾盂肾炎。由于这些疾病可能会带来严重的并发症,迅速发展和/或危及生命,因此必须迅速识别和治疗。血糖控制,筛查足部溃疡和对患者进行足部护理教育以及针对肺炎球菌和流感的疫苗接种是预防感染的重要重要策略。可用证据的类型:国家认可的治疗指南,随机对照试验,前瞻性和回顾性队列研究,病例对照研究,荟萃分析,非系统评价。可用的证据等级:一般到良好。结论:预期糖尿病患者常见感染的严重并发症与重视罕见疾病实体的影响一样重要。初级保健临床医生应了解糖尿病患者中感染的情况,以便提供早期诊断和积极治疗。

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