Cruciani M, Lipsky BA, Mengoli C, de Lalla F, et al.
The Cochrane database of systematic reviews. Date of publication 2013 Aug 17;volume (8):CD006810.
1. Cochrane Database Syst Rev. 2013 Aug 17;(8):CD006810. doi:
10.1002/14651858.CD006810.pub3.
Granulocyte-colony stimulating factors as adjunctive therapy for diabetic foot
infections.
Cruciani M(1), Lipsky BA, Mengoli C, de Lalla F.
Author information:
(1)Center of Community Medicine and Infectious Diseases Service, ULSS 20 Verona,
Via Germania, 20, Verona, Italy, 37135.
Update of
Cochrane Database Syst Rev. 2009;(3):CD006810.
BACKGROUND: Granulocyte-colony stimulating factor (G-CSF) increases the release
of neutrophil endothelial progenitor cells from the bone marrow and improves
neutrophil functions, which are often impaired in people with diabetes.
OBJECTIVES: To examine the effects of adjunctive G-CSF compared with placebo or
no growth factor added to usual care on rates of infection, cure and wound
healing in people with diabetes who have a foot infection.
SEARCH METHODS: In March 2013, for this second update, we searched the Cochrane
Wounds Group Specialised Register (searched 14 March 2013); the Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 2);
Ovid MEDLINE (1948 to March Week 1 2013); Ovid EMBASE (1974 to 2013 March 13);
Ovid MEDLINE (In-Process march 13,2013); and EBSCO CINAHL (1982 to 28 February
2013).
SELECTION CRITERIA: Randomised controlled trials (RCTs) that evaluated the effect
of adding G-CSF to usual care in people with a diabetic foot infection.
DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trial
eligibility, methodological quality and extracted data. We reported risk ratio
(RR) or, for continuous outcomes, mean differences (MD), with 95% confidence
intervals (CI). In the case of low or no heterogeneity we pooled studies using a
fixed-effect model.
MAIN RESULTS: We identified and included five eligible trials with a total of 167
patients. The investigators administered various G-CSF preparations, at different
doses and for different durations of time. Adding G-CSF did not significantly
affect the likelihood of resolution of infection or wound healing, but it was
associated with a significantly reduced likelihood of lower extremity surgical
interventions (RR 0.38; 95 % CI 0.21 to 0.70), including amputation (RR 0.41; 95
% CI 0.18 to 0.95). Moreover, providing G-CSF reduced the duration of hospital
stay (MD -1.40 days; 95% CI -2.27 to -0.53 days), but did not significantly
affect the duration of systemic antibiotic therapy (MD -0.27 days; 95% CI -1.30
to 0.77 days).
AUTHORS' CONCLUSIONS: The available evidence is limited, but suggests that
adjunctive G-CSF treatment in people with a diabetic foot infection, including
infected ulcers, does not appear to increase the likelihood of resolution of
infection or healing of the foot ulcer. However, it does appear to reduce the
need for surgical interventions, especially amputations, and the duration of
hospitalisation. Clinicians might consider adding G-CSF to the usual treatment of
diabetic foot infections, especially in patients with a limb-threatening
infection, but it is not clear which patients might benefit.
DOI: 10.1002/14651858.CD006810.pub3
PMID: 23955465 [Indexed for MEDLINE]
