ANTIBIOTIC RESISTANCE AND CHOICE OF THERAPY IN PURULENT-INFLAMMATORY DISEASES OF SOFT TISSUES IN PATIENTS WITH DIABETES MELLITUS AND NEPHROPATHY

Abstract

Purulent-inflammatory diseases of soft tissues are a common complication in patients with diabetes mellitus and are especially aggravated in the presence of diabetic nephropathy, leading to a severe clinical course, high rates of hospitalization and the risk of amputations. Progressive decline in renal function exacerbates immune defense disorders, alters the pharmacokinetics of antibiotics, and limits the choice of antibacterial drugs due to nephrotoxicity. At the same time, the prevalence of antibiotic-resistant strains, including methicillin-resistant Staphylococcus aureus, ESBL-producing enterobacteriaceae, and multidrug-resistant pseudomonads, is increasing, making both empirical and targeted therapy difficult. This review discusses the key aspects of the pathogenesis of infectious complications in diabetic nephropathy, the mechanisms of antibiotic resistance in this group of patients, the features of the choice and dosing of antibacterial drugs, as well as modern approaches to combined treatment and promising areas of antimicrobial therapy.