This presentation is the property of its rightful owner.
Sponsored Links
1 / 67

ΣΑΚΧΑΡΩΔΗΣ ΔΙΑΒΗΤΗΣ ΚΑΙ ΛΟΙΜΩΞΕΙΣ ΛΥΔΙΑ ΛΕΩΝΙΔΟΥ ΠΑΘΟΛΟΓΟΣ-ΛΟΙΜΩΞΙΟΛΟΓΟΣ ΙΑΤΡΟΣ ΚΕΕΛΠΝΟ PowerPoint PPT Presentation


  • 203 Views
  • Uploaded on
  • Presentation posted in: General

ΣΑΚΧΑΡΩΔΗΣ ΔΙΑΒΗΤΗΣ ΚΑΙ ΛΟΙΜΩΞΕΙΣ ΛΥΔΙΑ ΛΕΩΝΙΔΟΥ ΠΑΘΟΛΟΓΟΣ-ΛΟΙΜΩΞΙΟΛΟΓΟΣ ΙΑΤΡΟΣ ΚΕΕΛΠΝΟ. Δεν υπάρχει σύγκρουση συμφερόντων. Γιατί οι λοιμώξεις είναι πιο συχνές σε διαβητικούς?. ΣΔ ΚΑΙ ΛΟΙΜΩΞΕΙΣ. Γιατί οι λοιμώξεις είναι πιο συχνές σε διαβητικούς?

Download Presentation

ΣΑΚΧΑΡΩΔΗΣ ΔΙΑΒΗΤΗΣ ΚΑΙ ΛΟΙΜΩΞΕΙΣ ΛΥΔΙΑ ΛΕΩΝΙΔΟΥ ΠΑΘΟΛΟΓΟΣ-ΛΟΙΜΩΞΙΟΛΟΓΟΣ ΙΑΤΡΟΣ ΚΕΕΛΠΝΟ

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


6439550

-


6439550


6439550

?


6439550

?


6439550

?


6439550

?


6439550

ID in Diabetes

?


6439550

  • 265 3

    (127 ,138 )

  • :47

  • : 65

  • : 153

stress (): ( ) 126mg/dl 200 mg/dl 2 24

Leonidou et al. Stress-induced hyperglycemia in patients with severe sepsis: a compromising factor for survival. Am J Med Sci. 2008 Dec;336(6):467-71


6439550

?

  • (Staph .aureus )


6439550

  • (TNF-a IL-1)

    • Staphylococcus aureus

2

1

4

3


6439550

(>50%)


6439550


6439550

  • 2-4


6439550

  • Staphylococcus aureus, gram Mycobacterium tuberculosis

  • 3 S.aureus

  • . , .

    Rueda AM et al. J Infect2010;60:99

    !!


6439550

TB

  • 2-8

  • 4-14 -

    Dooley K , Chaisson RE. Lancet Infect Dis 2009; 9: 737


6439550

  • :

  • Tamm-Horsfall


  • 6439550

    , ,

    :Escherichiacoli 85%

    :7-14 days

    -

    4-5

    ,


    6439550

    • >105 cfu/ml ,

    • 3-4

    • !

      • 80%

      • : , ,

    Am J Epidemiol 2005;161:557

    Diabetologia 2005;48:1288

    Arch Inf Med 2006;166:2222


    6439550


    6439550

    2 ()

    Dx: Potassium hydroxide (KOH) test

    Rx: miconazole, clotrimazole, ketoconazole


    6439550

    Epidermophyton, trichophyton,microsporum

    Dx: Potassium hydroxide (KOH) test

    Rx: - 6 terbinafine 250mg OD

    :


    6439550

    • S.Aureus

      ( )

    • .


    6439550

    ID in Diabetes


    6439550

    30


    6439550

    -

    / ,

    / .

    4

    9

    12

    World Health Organization, International Working Group on the Diabetic Foot, 1999


    6439550

    FOOT ULCERS IN DIABETES

    Precipitate 85% of amputations: Rule of 15

    • 15% of diabetes patientsFoot ulcer in lifetime

    • 15% of foot ulcersOsteomyelitis

    • 15% of foot ulcersAmputation

      ClinicalCareoftheDiabeticFoot, 2005


    6439550


    6439550

      • vs.

      • vs.


    Wagner

    Wagner


    6439550

    Classification


    6439550

    IDSA Guidelines for Diabetic Foot Infections CID 2004: 39(1 Oct) 885-910


    6439550

    Gram

    Gram

    1

    2

    3

    4


    6439550

    ;


    6439550

    • :

      • >2 x 2cm

      • >1-2

    • 6

    • ,


    6439550

    Probe to bone (+) -


    6439550

    Rajbhandari et al. Diabet Med 2000; 17:74-77


    6439550

    ;

    Gold standard:


    6439550

    MRI


    6439550

    • .


    6439550


    6439550


    6439550

    (70-90%)

    E.coli ( ) enterobacter, klebsiella, proteus, streptococcus and candida

    >60

    Ro 85%

    CT scan

    60-80%

    2 (, , , shock)


    6439550

    : , ,

    ,

    (gram )

    ()

    :15-25%

    er119test.blogspot.com/2007/09/emphysematous


    6439550

    mucorales (mucor, rhizopus, absidia)

    (Rhiropus)

    2/3

    -> , .

    , , , , , .

    , , , .

    NEJM 1995;333:564

    NEJM 1995;333:564

    25%-60%


    6439550

    .


    6439550


    6439550

    CT MRI

    , Lactophenol-blue stain KOH

    Sabouraud dextrose agar sporangia and rhizoids

    Mucor: Lactophenol-blue stain

    CT Scan of brain

    Fungal culture in SDA

    Biopsy

    NEJM 1995; 333:564


    6439550

    -

    • , .

    • ,

    • :

      • Liposomal amphotericin B: 7-10mg/kg V

      • Posaconazole: 400mg/12hourly

      • : ,

    • , , ,


    6439550

    • 90%

    • : , pH

    • : Pseudomonas aeruginosa (Aspergillus spp, Staphylococcus aureus)

    • , ,

    • -


    6439550


    6439550

    , (VI XII)

    MRI/CT

    10-20% -> 100%

    (750mg x 2) 3 12


    6439550

    ! (20-50%)

    S. aureus, anaerobes, and Group A streptococci

    :

    , , , , !


    6439550

    :

    piperacillin/tazobactam 4.5g IV every 6 hours

    +

    clindamycin 600-900mg IV every 8 hours

    +

    vancomycin 15-20mg/kg IV every 12 hours

    fluoroquinolone

    Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913.


    6439550

    :

    • Staphylococcus aureus

    • Streptococcus spp

    • ( )

    • Pseudomonas aeruginosa


    Fournier

    .

    , , .

    E. Coli, Pseudomonas, Streptococcus,S. Aureus, Bacteroides, Clostridium, Salmonella, Klebsiella, Enterococcus .

    Ro: 89%.

    u/s: .

    15-52%. 24 71%

    SOS

    Fournier


    Fournier1

    Fournier

    • /, /, + ,

    • +,

    • -

    • : , ,

    • ,


    6439550

    • C

    • , ,

    • ( , )

    • ( )

    • Fournier


    6439550


    6439550

    Tight blood glucose control

    American Diabetes Association. Standard of Medical Care in Diabetes-2011. Diabetes Care. 2011;34:S11-S61.

    The American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus 2007. EndocrPract. 2007;13:S3-S76.


    6439550

    :

    LDL < 100mg/dL <70mg/dL i (MI, )

    < 150mg/dL

    HDL > 40mg/dL and >50mg/dL

    <130/80 mmHg

    American Diabetes Association. Standard of Medical Care in Diabetes-2011. Diabetes Care. 2011;34:S11-S61.


    Six p rinciples of prevention of foot ulcers

    Six Principles of Prevention of Foot Ulcers

    • Podiatric care

    • Pulse examination

    • Protective shoes

    • Pressure reduction

    • Prophylactic surgery

    • Patient Education


    6439550

    , ,

    /


    6439550

    • !!

    • >

    • >

    • > , ,


  • Login