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

Evaluation of the Ex-PRESS® P-50 implant under scleral flap in combined cataract and glaucoma surgery

Aim: To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS® P-50 for combined cataract surgery and glaucoma. Methods: Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS® P-50 model placed under scleral flap was performed. Results: Out of 40 eyes of 40 patients (55% male and 45% female) completed the study during one-year follow-up. The mean of age was 76.6±11.02y. The intraocular pressure (IOP) decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg (Wilcoxon signed ranks test, P<0.001). A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control (<21 mm Hg). Conclusion: Combined surgery of phacoemulsification with ExPRESS® P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation

Brain activity changes with emotional words in different stages of psychosis

BackgroundTo date, a large number of functional magnetic resonance imaging (fMRI) studies have been conducted on psychosis. However, little is known about changes in brain functioning in psychotic patients using an emotional auditory paradigm at different stages of the disease. Such knowledge is important for advancing our understanding of the disorder and thus creating more targeted interventions. This study aimed to investigate whether individuals with first-episode psychosis (FEP) and chronic schizophrenia show abnormal brain responses to emotional auditory processing and to compare the responses between FEP and chronic schizophrenia. MethodsPatients with FEP (n = 31) or chronic schizophrenia (n = 23) and healthy controls (HCs, n = 31) underwent an fMRI scan while presented with both emotional and nonemotional words. ResultsUsing HC as a reference, patients with FEP showed decreased right temporal activation, while patients with chronic schizophrenia showed increased bilateral temporal activation. When comparing the patient groups, individuals with FEP showed lower frontal lobe activation. ConclusionTo the best of our knowledge, this is the first study with an emotional auditory paradigm used in psychotic patients at different stages of the disease. Our results suggested that the temporal lobe might be a key issue in the physiopathology of psychosis, although abnormal activation could also be derived from a connectivity problem. There is lower activation in the early stage and evolution to greater activation when patients become chronic. This study highlights the relevance of using emotional paradigms to better understand brain activation at different stages of psychosis

Prototyping of petalets for the Phase-II Upgrade of the silicon strip tracking detector of the ATLAS Experiment

In the high luminosity era of the Large Hadron Collider, the HL-LHC, the instantaneous luminosity is expected to reach unprecedented values, resulting in about 200 proton-proton interactions in a typical bunch crossing. To cope with the resultant increase in occupancy, bandwidth and radiation damage, the ATLAS Inner Detector will be replaced by an all-silicon system, the Inner Tracker (ITk). The ITk consists of a silicon pixel and a strip detector and exploits the concept of modularity. Prototyping and testing of various strip detector components has been carried out. This paper presents the developments and results obtained with reduced-size structures equivalent to those foreseen to be used in the forward region of the silicon strip detector. Referred to as petalets, these structures are built around a composite sandwich with embedded cooling pipes and electrical tapes for routing the signals and power. Detector modules built using electronic flex boards and silicon strip sensors are glued on both the front and back side surfaces of the carbon structure. Details are given on the assembly, testing and evaluation of several petalets. Measurement results of both mechanical and electrical quantities are shown. Moreover, an outlook is given for improved prototyping plans for large structures.Comment: 22 pages for submission for Journal of Instrumentatio

Relationship of YKL-40 and adiponectin and subclinical atherosclerosis in asymptomatic patients with type 1 diabetes mellitus from a European Mediterranean population

Background: The glycoprotein YKL-40 is a new marker of early inflammation and endothelial dysfunction. Adiponectin is a collagen-like protein with anti-atherogenic and anti-inflammatory effects. Increased concentrations of both markers have been reported in patients with type 1 diabetes (T1D). Aim: To assess the possible role of YKL-40 and adiponectin as a marker of subclinical cardiovascular disease in asymptomatic patients with type 1 diabetes with no history of ischemic or macrovascular heart disease and its relationship with other classic inflammatory biomarkers.Methods: Concentrations of YKL-40, adiponectin, IL-6, IL-1β, TNF- α, hsCRP and homocysteine were determined in 150 T1D patients (58 % men, age: 38.6 ± 8.1 years, 20.4 ± 8.1 years of evolution, BMI: 25.1 ± 3.6 kg/m2; HbA1c 8.1 ± 2.3 %, 48 % smokers; 26 % retinopathy, microalbuminuria 9 %) and 50 controls age, sex and smoke condition matched. Subclinical atherosclerosis was assessed by a carotid ultrasonography and a computed tomography for evaluation of calcium artery calcification score (CACS). Results: 82 % of T1D patients and 92 % of controls had a calcium score of 0. T1D patients showed a significantly higher mean common carotid artery intima media thickness (CIMT) compared to controls (0.55 ± 0.14 vs 0.48 ± 0.14 mm, p = 0.01). Concentrations of YKL-40 and adiponectin were significantly higher in T1D [42.6 (10.4-195.0) vs ±28.7 (11.0-51.2) ng/ml, p = 0.001 and 15.8 ± 9.1 vs. 12.4 ± 5.3 mg/ml, p = 0.008], with no differences when compared to other inflammatory parameters. In T1D patients no association was found between YKL-40 and adiponectin and screening test for subclinical arterial disease (neither CACS nor CIMT). A positive correlation was found between levels of YKL-40 and age and duration of disease (r = 0.28, p = 0.003; r = 0.35, p = 0.001). There were no differences in the YKL-40 in relation to the presence or absence of retinopathy or nephropathy. Levels of adiponectin were higher in patients with nephropathy (21.84 ± 8.15 vs. 14.88 ± 8.27 mg/ml, p = 0.008). Conclusions: Type 1 diabetes patients from a Mediterranean area with a longer disease evolution, although a lower degree of subclinical disease, showed significatively higher concentrations of YKL-40 and adiponectin compared with the controls. Therefore, we conclude that YKL-40 and adiponectin are early inflammatory markers in diabetic subjects even in the presence of a low atherosclerotic background

Investigations into the impact of locally modified sensor architectures on the detection efficiency of silicon micro-strip sensors

The High Luminosity Upgrade of the LHC will require the replacement of the Inner Detector of ATLAS with the Inner Tracker (ITk) in order to cope with higher radiation levels and higher track densities. Prototype silicon strip detector modules are currently developed and their performance is studied in both particle test beams and X-ray beams. In previous test beam measurements of prototype modules, the response of silicon sensors has been studied in detailed scans across individual sensor strips. These scans found instances of sensor strips collecting charge across areas on the sensor deviating from the geometrical width of a sensor strip. The variations have been linked to local features of the sensor architecture. This paper presents results of detailed sensor measurements in both X-ray and particle beams investigating the impact of sensor features (metal pads and p-stops) on the sensor strip response

Impact of Virologic Breakthrough and HBIG Regimen on Hepatitis B Recurrence After Liver Transplantation

The availability of hepatitis B immune globulin (HBIG) and several oral antiviral therapies has reduced but not eliminated hepatitis B virus (HBV) recurrence. We aimed to determine the rate of HBV recurrence after orthotopic liver transplantation (OLT) in relation to virologic breakthrough pre-OLT and HBIG regimens post-OLT. Data from the NIH HBV-OLT database were analyzed. A total of 183 patients transplanted between 2001 and 2007 followed for a median of 42 months (range 1–81) post-OLT were studied. At transplant, 29% were hepatitis B e antigen (HBeAg) (+), 38.5% had HBV DNA > 5 log 10 copies/mL, 74% were receiving antiviral therapy. Twenty-five patients experienced virologic breakthrough before OLT. Post-OLT, 26%, 22%, 40% and 12% of patients received intravenous (IV) high-dose, IV low-dose, intramuscular low-dose and a finite duration of HBIG, respectively as maintenance prophylaxis. All but two patients also received antiviral therapy. Cumulative rates of HBV recurrence at 1 and 5 years were 3% and 9%, respectively. Multivariate analysis showed that listing HBeAg status and HBV DNA level at OLT were the only factors associated with HBV recurrence. In conclusion, low rates of HBV recurrence can be accomplished with all the HBIG regimens used when combined with antiviral therapy including patients with breakthrough pre-OLT as long as rescue therapy is administered pre- and post-OLT.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79358/1/j.1600-6143.2010.03046.x.pd

A double-sided, shield-less stave prototype for the ATLAS upgrade strip tracker for the high luminosity LHC

A detailed description of the integration structures for the barrel region of the silicon strips tracker of the ATLAS Phase-II upgrade for the upgrade of the Large Hadron Collider, the so-called High Luminosity LHC (HL-LHC), is presented. This paper focuses on one of the latest demonstrator prototypes recently assembled, with numerous unique features. It consists of a shortened, shield-less, and double sided stave, with two candidate power distributions implemented. Thermal and electrical performances of the prototype are presented, as well as a description of the assembly procedures and tools