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


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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?

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ΣΑΚΧΑΡΩΔΗΣ ΔΙΑΒΗΤΗΣ ΚΑΙ ΛΟΙΜΩΞΕΙΣ ΛΥΔΙΑ ΛΕΩΝΙΔΟΥ ΠΑΘΟΛΟΓΟΣ-ΛΟΙΜΩΞΙΟΛΟΓΟΣ ΙΑΤΡΟΣ ΚΕΕΛΠΝΟ

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?


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?


?


ID in Diabetes

?


  • 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


?

  • (Staph .aureus )


  • (TNF-a IL-1)

    • Staphylococcus aureus

2

1

4

3


(>50%)



  • 2-4


  • Staphylococcus aureus, gram Mycobacterium tuberculosis

  • 3 S.aureus

  • . , .

    Rueda AM et al. J Infect2010;60:99

    !!


TB

  • 2-8

  • 4-14 -

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


  • :

  • Tamm-Horsfall


  • , ,

    :Escherichiacoli 85%

    :7-14 days

    -

    4-5

    ,


    • >105 cfu/ml ,

    • 3-4

    • !

      • 80%

      • : , ,

    Am J Epidemiol 2005;161:557

    Diabetologia 2005;48:1288

    Arch Inf Med 2006;166:2222



    2 ()

    Dx: Potassium hydroxide (KOH) test

    Rx: miconazole, clotrimazole, ketoconazole


    Epidermophyton, trichophyton,microsporum

    Dx: Potassium hydroxide (KOH) test

    Rx: - 6 terbinafine 250mg OD

    :


    • S.Aureus

      ( )

    • .


    ID in Diabetes


    30


    -

    / ,

    / .

    4

    9

    12

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


    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



      • vs.

      • vs.


    Wagner


    Classification


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


    Gram

    Gram

    1

    2

    3

    4


    ;


    • :

      • >2 x 2cm

      • >1-2

    • 6

    • ,


    Probe to bone (+) -


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


    ;

    Gold standard:


    MRI


    • .




    (70-90%)

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

    >60

    Ro 85%

    CT scan

    60-80%

    2 (, , , shock)


    : , ,

    ,

    (gram )

    ()

    :15-25%

    er119test.blogspot.com/2007/09/emphysematous


    mucorales (mucor, rhizopus, absidia)

    (Rhiropus)

    2/3

    -> , .

    , , , , , .

    , , , .

    NEJM 1995;333:564

    NEJM 1995;333:564

    25%-60%


    .



    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


    -

    • , .

    • ,

    • :

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

      • Posaconazole: 400mg/12hourly

      • : ,

    • , , ,


    • 90%

    • : , pH

    • : Pseudomonas aeruginosa (Aspergillus spp, Staphylococcus aureus)

    • , ,

    • -



    , (VI XII)

    MRI/CT

    10-20% -> 100%

    (750mg x 2) 3 12


    ! (20-50%)

    S. aureus, anaerobes, and Group A streptococci

    :

    , , , , !


    :

    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.


    :

    • Staphylococcus aureus

    • Streptococcus spp

    • ( )

    • Pseudomonas aeruginosa


    .

    , , .

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

    Ro: 89%.

    u/s: .

    15-52%. 24 71%

    SOS

    Fournier


    Fournier

    • /, /, + ,

    • +,

    • -

    • : , ,

    • ,


    • C

    • , ,

    • ( , )

    • ( )

    • Fournier



    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.


    :

    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 Principles of Prevention of Foot Ulcers

    • Podiatric care

    • Pulse examination

    • Protective shoes

    • Pressure reduction

    • Prophylactic surgery

    • Patient Education


    , ,

    /


    • !!

    • >

    • >

    • > , ,


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