In diabetic patients undergoing medical management of foot osteomyelitis, bone culture-based antibiotic therapy improves the chances of successful treatment, according to findings published in the April issue of Diabetes Care.
"The question of surgical versus nonsurgical treatment for diabetic patients with osteomyelitis of the foot remains subject to debate," Dr. Eric Senneville, of Dron Hospital, Tourcoing, France, and colleagues write. They add, "It was traditionally thought that these infections could not be treated without resecting the infected bone."
In a retrospective study, the authors reviewed the medical records of 50 diabetic patients who were treated without surgery for osteomyelitis of the toe or metatarsal head of a nonischemic foot in nine French diabetic foot centers. Overall, 24 demographic, clinical, and therapeutic factors, including bone versus swab culture-based antibiotic therapy, were analyzed.
On average, study subjects were 62 years old and had been diabetic for 16 years. The mean foot wound duration was 20 weeks, and the mean duration of antibiotic treatment was 11.5 weeks. Overall, 22 patients (44%) had bone biopsy-based therapy, and 28 (56%) had swab culture-based therapy.
The team defined remission as the absence of any sign of infection at the initial or a contiguous site at least 1 year after the end of treatment.
At an average follow-up of 12.8 months, remission had been achieved in 18 (81.8%) patients treated on the basis of bone culture results and in 14 (50%) of patients with swab culture-based therapy (p=0.02)," the researchers report.
They add that on both univariate and multivariate analysis, "Bone culture-based antibiotic therapy was the only variable associated with remission."
"In summary," the authors conclude, "our results provide arguments for recommending the use of bone biopsy in diabetic patients treated nonsurgically for osteomyelitis of the foot."
Diabetes Care 2008;31:637-642.
Reviewed By Ramaz Mitaishvili, MD
