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<p>Patients with diabetes mellitus have an increased susceptibility to infections and, consequently, a&#xa0;higher risk of postoperative infections. The most important preventive measure is optimized preoperative blood glucose control. However, the increased risk of infections should not lead to a&#xa0;more liberal indication for perioperative antibiotic prophylaxis (PAP). The indication and choice of perioperative antibiotic prophylaxis should be based on the surgical risk, as in patients without diabetes mellitus. Key factors include appropriate timing of antibiotic administration (30–60 min before skin incision) as well as dose adjustments in cases of obesity and impaired renal function. A&#xa0;postoperative extension of PAP is generally not indicated. In the diagnosis of diabetic foot osteomyelitis (DFO), performing a&#xa0;bone biopsy is considered the diagnostic gold standard. An antibiotic-free interval should be adhered to preoperatively. We recommend administering PAP, as with other surgical procedures, 30–60 min prior to the intervention. The treatment of DFO is complex and should be carried out in an interdisciplinary setting. In antibiotic therapy, empiric treatment should be avoided; the choice of antibiotic should be based on the pathogen identified in the bone biopsy.</p>

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Perioperatives Management von Menschen mit Diabetes mellitus: Antibiotikaprophylaxe

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Marie-Therese Leibenguth,
  • Sarah Waibel,
  • Siegbert Rieg

摘要

Patients with diabetes mellitus have an increased susceptibility to infections and, consequently, a higher risk of postoperative infections. The most important preventive measure is optimized preoperative blood glucose control. However, the increased risk of infections should not lead to a more liberal indication for perioperative antibiotic prophylaxis (PAP). The indication and choice of perioperative antibiotic prophylaxis should be based on the surgical risk, as in patients without diabetes mellitus. Key factors include appropriate timing of antibiotic administration (30–60 min before skin incision) as well as dose adjustments in cases of obesity and impaired renal function. A postoperative extension of PAP is generally not indicated. In the diagnosis of diabetic foot osteomyelitis (DFO), performing a bone biopsy is considered the diagnostic gold standard. An antibiotic-free interval should be adhered to preoperatively. We recommend administering PAP, as with other surgical procedures, 30–60 min prior to the intervention. The treatment of DFO is complex and should be carried out in an interdisciplinary setting. In antibiotic therapy, empiric treatment should be avoided; the choice of antibiotic should be based on the pathogen identified in the bone biopsy.