Patient's question:
What should be done about sepsis with skin infection in diabetes?Doctor's answer:
Infection is a serious complication of diabetes and is widely recognized as one of the factors contributing to the significant increase in morbidity and mortality among diabetic patients. The most common sites of infection are respiratory tract infections, followed by urinary tract infections, skin infections, gastrointestinal infections, fungal infections, and sepsis is also not uncommon. Due to the weakened immune defense function in diabetic patients compared to healthy individuals, they are more susceptible to infections, which tend to be more severe. Infections can also exacerbate the diabetic condition, making treatment more challenging. The combination of diabetes and infection can cause symptoms to manifest in previously asymptomatic patients, and severe cases may lead to life-threatening conditions such as diabetic ketoacidosis and hyperosmolar coma. Therefore, the rational use of anti-infective drugs is crucial when diabetes is complicated by infection. Skin infections in diabetic patients are commonly characterized by recurrent, stubborn, and multiple boils and carbuncles, as Staphylococcus aureus is the primary causative agent. Treatment often involves penicillin derivatives that are resistant to penicillinase, such as oxacillin and dicloxacillin.Diabetic foot is a chronic complication of diabetes that is difficult to treat, has a high rate of disability, and significantly impacts the functional status of limbs and the prognosis of patients' lives. Early signs include small water blisters that dry into needle-sized ring-shaped scales. Over time, they fail to heal, leading to cracking in winter due to dryness, accompanied by varying degrees of itching. Diabetic foot gangrene often complicates bacterial infections. Moreover, the weakened immune resistance in diabetic patients makes it difficult to control infections, and bacterial infections further accelerate the progression of diabetic foot gangrene, creating a vicious cycle of mutual causation. Since diabetic foot infections are often caused by multiple microorganisms, treatments may include β-lactam drugs, β-lactamase inhibitors, and fluoroquinolones. When using antimicrobial drugs, it is important to control blood sugar, improve blood circulation, and employ comprehensive treatment including systemic support therapy and local treatment of the affected foot to facilitate early recovery.
When treating infections in diabetic patients, the rational use of antimicrobial drugs should adhere to the following points:
(1) The use of antibiotics should be guided by drug sensitivity testing, and sensitive bactericidal agents should be selected;
(2) Sufficient dosage and duration of medication should be used to thoroughly control the infection;
(3) Intravenous administration should be given to severe patients;
(4) Due to the microvascular lesions in diabetic patients, which can lead to kidney damage, drugs with significant nephrotoxicity should be avoided.