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Diabetic Foot |
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ABSTRACT Surgical percutaneous bone biopsy specimen after a 14-day antibiotic free period represents the gold standard of care for diabetic foot osteomyelitis but may be difficult to implement in many institutions. We evaluate a simplified strategy based on the results of per-wound bone specimen culture. For that purpose, we retrospectively reviewed the charts of 80 consecutive patients with diabetic osteomyelitis and bone sample obtained via the wound after a careful debridement. The outcome was defined as favourable if there was a complete healing of the wound with no sign of infection and stable or improved bone X-ray 6 months after antibiotic therapy completion. Culture of bone specimen was positive in 96% of patients although half of the patients did receive a course of antimicrobials within 14 days the bone specimen was obtained. 129 bacteria were found in bone culture with a mean of 1.6+/-1 bacteria per patient (S. aureus: 33%; CNS: 14%; streptococci: 9%; enterococci: 12%; corynebacteriae: 4%; Gram negative bacilli: 20%; anaerobes: 4%). 46% of cultures were monomicrobial. The mean duration of follow-up from diagnosis was 17+/-1 months. Six months after antibiotics discontinuation, 7.5% (6) had died, 9 were considered as failure and 65 as cured. 54 of these 65 had follow-up data available at one year and remained in remission. In conclusion, a simplified procedure based on the culture of bone sample obtained via the ulcer after a careful debridement of the wound is a good option in the medical management of diabetic foot osteomyelitis. |
Diabetic Foot
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Culture Of
Per-Wound Bone Specimen: A Simplified Approach For The Medical
Management Of 