Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review

first_page settings Order Article Reprints Open AccessReview Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review by Laura Soldevila-Boixader 1,2,*, Alberto Pérez Fernández 3, Javier Muñoz Laguna 4,5 [ORCID] and Ilker Uçkay 1 1 Infectiology, Unit for Applied and Clinical Research, Balgrist University Hospital, 8008 Zurich, Switzerland 2 Infectious Diseases Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain 3 Orthopedics Department, Head of the Foot and Ankle Unit and Coordinator of Diabetic Foot Unit, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain 4 EBPI-UZWH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland 5 University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland * Author to whom correspondence should be addressed. Antibiotics 2023, 12(1), 124; https://doi.org/10.3390/antibiotics12010124 Received: 15 December 2022 / Revised: 3 January 2023 / Accepted: 5 January 2023 / Published: 9 January 2023 (This article belongs to the Special Issue Feature Papers in Therapy of Diabetic Foot Infections) Download Browse Figure Versions Notes Abstract Along with the increasing global burden of diabetes, diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO) remain major challenges for patients and society. Despite progress in the development of prominent international guidelines, the optimal medical treatment for DFI and DFO remains unclear as to whether local antibiotics, that is, topical agents and local delivery systems, should be used alone or concomitant to conventional systemic antibiotics. To better inform clinicians in this evolving field, we performed a narrative review and summarized key relevant observational studies and clinical trials of non-prophylactic local antibiotics for the treatment of DFI and DFO, both alone and in combination with systemic antibiotics. We searched PubMed for studies published between January 2000 and October 2022, identified 388 potentially eligible records, and included 19 studies. Our findings highlight that evidence for adding local antibiotic delivery systems to standard DFO treatment remains limited. Furthermore, we found that so far, local antibiotic interventions have mainly targeted forefoot DFO, although there is marked variation in the design of the included studies. Suggestive evidence emerging from observational studies underscores that the addition of local agents to conventional systemic antibiotics might help to shorten the clinical healing time and overall recovery rates in infected diabetic foot ulcers, although the effectiveness of local antibiotics as a standalone approach remains overlooked. In conclusion, despite the heterogeneous body of evidence, the possibility that the addition of local antibiotics to conventional systemic treatment may improve outcomes in DFI and DFO cannot be ruled out. Antibiotic stewardship principles call for further research to elucidate the potential benefits of local antibiotics alone and in combination with conventional systemic antibiotics for the treatment of DFI and DFO. Keywords: diabetic foot infection; osteomyelitis; local antibiotics; topical antibiotics; local delivery antibiotic system

Trypsin/α-amylase inhibitors and thionins: possible defence proteins from barley

This chapter reviews recent work on the trypsin/α-amylase inhibitor and thionin protein families. The genomic distribution of protein genes in barley and related species, gene expression and in vitro activities are considered. Some of the evidence of a possible defence role against stored products pests for inhibitors and thionins is briefly discusse

Tecnologías del hidrógeno

El interés por las tecnologías del hidrógeno ha crecido en los últimos años, principalmente porque una economía basada en el hidrógeno puede dar respuesta a los grandes desafíos de la economía global del futuro: seguridad energética y cambio climático. Aprovechando este impulso, cada vez son más los países que están implementando un número creciente de políticas en favor del hidrógeno. Prueba de ello es la Estrategia Europea del Hidrógeno que establece al hidrógeno como un elemento esencial en| la descarbonización total del actual sistema energético para alcanzar el compromiso de la UE con la neutralidad de carbono en 2050. No obstante, el desarrollo exitoso de las tecnologías del hidrógeno requiere que todos los actores, incluidos los sectores público y privado, aumenten sus esfuerzos para acelerar su despliegue y hacer que su implantación a gran escala resulte competitiva. Los grupos de investigación que forman parte del área de trabajo de tecnologías del hidrógeno, dentro de la Plataforma Temática Interdisciplinar PTI Mobility 2030 del CSIC, trabajan en este sentido, desarrollando su labor en áreas tan diversas como la generación, el almacenamiento, la distribución y los usos del hidrógeno. The interest in hydrogen technologies has grown in recent years, mainly because an economy based on hydrogen can help to solve important challenges related to the global economy of the future: energy security and climate change. Taking advantage of this momentum, more and more countries are implementing a growing number of policies related to hydrogen. Indeed, the European Hydrogen Strategy establishes hydrogen as essential drivers for the total decarbonization of the current energy system in order to achieve the Ells commitment related to carbon neutrality by 2050. However, the successful development of the hydrogen technologies requires the collaboration of the public and private sectors to accelerate its deployment and make more competitive its implementation at large-scale. The research groups that take part of the line of work dedicated to hydrogen technologies, within the CSIC Interdisciplinary Thematic Platform PTI Mobility 2030, work in this regard, developing their investigations in several important areas related to the hydrogen technologies such as hydrogen generation, storage, distribution and uses

Neutrino Probes of the Nature of Light Dark Matter

Dark matter particles gravitationally trapped inside the Sun may annihilate into Standard Model particles, producing a flux of neutrinos. The prospects of detecting these neutrinos in future multi-\kton{} neutrino detectors designed for other physics searches are explored here. We study the capabilities of a 34/100 \kton{} liquid argon detector and a 100 \kton{} magnetized iron calorimeter detector. These detectors are expected to determine the energy and the direction of the incoming neutrino with unprecedented precision allowing for tests of the dark matter nature at very low dark matter masses, in the range of 5-50 GeV. By suppressing the atmospheric background with angular cuts, these techniques would be sensitive to dark matter - nucleon spin dependent cross sections at the fb level, reaching down to a few ab for the most favorable annihilation channels and detector technology.Comment: Minor changes and clarifications, matches JCAP versio

Overexpression of Dyrk1A Is Implicated in Several Cognitive, Electrophysiological and Neuromorphological Alterations Found in a Mouse Model of Down Syndrome

Down syndrome (DS) phenotypes result from the overexpression of several dosage-sensitive genes. The DYRK1A (dual-specificity tyrosine-(Y)-phosphorylation regulated kinase 1A) gene, which has been implicated in the behavioral and neuronal alterations that are characteristic of DS, plays a role in neuronal progenitor proliferation, neuronal differentiation and long-term potentiation (LTP) mechanisms that contribute to the cognitive deficits found in DS. The purpose of this study was to evaluate the effect of Dyrk1A overexpression on the behavioral and cognitive alterations in the Ts65Dn (TS) mouse model, which is the most commonly utilized mouse model of DS, as well as on several neuromorphological and electrophysiological properties proposed to underlie these deficits. In this study, we analyzed the phenotypic differences in the progeny obtained from crosses of TS females and heterozygous Dyrk1A (+/-) male mice. Our results revealed that normalization of the Dyrk1A copy number in TS mice improved working and reference memory based on the Morris water maze and contextual conditioning based on the fear conditioning test and rescued hippocampal LTP. Concomitant with these functional improvements, normalization of the Dyrk1A expression level in TS mice restored the proliferation and differentiation of hippocampal cells in the adult dentate gyrus (DG) and the density of GABAergic and glutamatergic synapse markers in the molecular layer of the hippocampus. However, normalization of the Dyrk1A gene dosage did not affect other structural (e.g., the density of mature hippocampal granule cells, the DG volume and the subgranular zone area) or behavioral (i.e., hyperactivity/attention) alterations found in the TS mouse. These results suggest that Dyrk1A overexpression is involved in some of the cognitive, electrophysiological and neuromorphological alterations, but not in the structural alterations found in DS, and suggest that pharmacological strategies targeting this gene may improve the treatment of DS-associated learning disabilities

Predictors of Visceral Leishmaniasis Relapse in HIV-Infected Patients: A Systematic Review

Visceral leishmaniasis (VL) is the most serious form of an insect-transmitted parasitic disease prevalent in 70 countries. The disease is caused by species of the L. donovani complex found in different geographical regions. These parasites have substantially different clinical, drug susceptibility and epidemiological characteristics. According to data from the World Health Organization, the areas where HIV-Leishmania co-infection is distributed are extensive. HIV infection increases the risk of developing VL, reduces the likelihood of a therapeutic response, and greatly increases the probability of relapse. A better understanding of the factors promoting relapses is essential; therefore we performed a systematic review of articles involving all articles assessing the predictors of VL relapse in HIV-infected individuals older than 14 years of age. Out of 178 relevant articles, 18 met the inclusion criteria and in total, data from 1017 patients were analyzed. We identified previous episodes of VL relapse, CD4+ lymphocyte count fewer than 100 cells/mL at VL diagnosis, and the absence of an increase in CD4+ counts at follow-up as major factors associated with VL relapse. Knowledge of relapse predictors can help to identify patients with different degrees of risk, facilitate and direct prophylaxis choices, and aid in patient counseling

Risks of dengue secondary infective biting associated with aedes aegypti in home environments in Monterrey, Mexico

Abstract. Secondary dengue virus infections are a major risk for developing dengue hemorrhagic fever. Recent exposure to infectious bites of Aedes aegypti (L.) females in previously diagnosed dengue cases fulfills the epidemiological model of dengue hemorrhagic fever. A study was comprised of 357 (89.2%) dengue and 43 (10.8%) dengue hemorrhagic fever cases confirmed by laboratory tests and clinical manifestations. An entomological survey was done in homes and backyards. Concurrently, a questionnaire was used to assess the impact of healthpromotion campaigns through knowledge of the vector and its epidemiological role. Seventy-six (28.4%) of the 268 (67.0%) total wet or dry oviposition sites were positive for the presence of larvae or pupae, while adult Ae. aegypti were found in 32 (8.0%). One hundred thirty-two (33%) householders who formerly had dengue fever or dengue hemorrhagic fever had knowledge of either larval or adult dengue vector stages. According to gender distribution, 145 (36.2%) and 14 (3.5%) of the males confirmed with cases of dengue and dengue hemorrhagic fever lived in houses with 17.9 and 2% of the Ae. aegypti larval and pupal habitats. Houses with females who had dengue and dengue hemorrhagic fever were 212 (53%) and 29 (7.3%), with containers with immature Ae. aegypti in 19.4 and 7%, respectively. Lack of sustainability of government-targeted health education campaigns is the major problem for involving communities in prevention and control of dengu

A High Accurate Approximation for a Galactic Newtonian Nonlinear Model Validated by Employing Observational Data

This article proposes Perturbation Method (PM) to solve nonlinear problems. As case study PM is employed to provide a detailed study of a nonlinear galactic model. Our approach is rather elementary and seeks to explain as much detail as possible the material of this work.In particular our solution gives rise qualitatively, to the known flat rotation curves. In fact, we compare the numerical solution and the obtained approximation by employing observational data proving the validity and high accuracy of the model under study

7th Drug hypersensitivity meeting: part two

No abstract availabl