Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.

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Comparison of Tc-99m Methylene Diphosphonate, Tc-99m Human Immune Globulin, and Tc-99m–Labeled White Blood Cell Scintigraphy in the Diabetic Foot

Clinical Nuclear Medicine ◽

10.1097/00003072-200112000-00005 ◽

2001 ◽

Vol 26 (12) ◽

pp. 1016-1021 ◽

Cited By ~ 23

Author(s):

Seher N. Ünal ◽

Hulya Birinci ◽

Selçuk Baktiroğlu ◽

Sema Cantez

Keyword(s):

Blood Cell ◽

Immune Globulin ◽

White Blood Cell ◽

Diabetic Foot ◽

Methylene Diphosphonate ◽

White Blood Cell Scintigraphy ◽

Human Immune

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Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET

Diabetes Care ◽

10.2337/dc17-0532 ◽

2017 ◽

Vol 40 (8) ◽

pp. 1111-1120 ◽

Cited By ~ 38

Author(s):

Chiara Lauri ◽

Menno Tamminga ◽

Andor W.J.M. Glaudemans ◽

Luis Eduardo Juárez Orozco ◽

Paola A. Erba ◽

...

Keyword(s):

Systematic Review ◽

Blood Cell ◽

White Blood Cell ◽

Diabetic Foot ◽

Fdg Pet ◽

Imaging Techniques ◽

Meta Analysis ◽

White Blood Cell Scintigraphy

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Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

International Journal of Nephrology ◽

10.1155/2016/6217135 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Pichaya Tantiyavarong ◽

Opas Traitanon ◽

Piyatida Chuengsaman ◽

Jayanton Patumanond ◽

Adis Tasanarong

Keyword(s):

Peritoneal Dialysis ◽

Blood Cell ◽

Cell Count ◽

Antibiotic Treatment ◽

White Blood Cell Count ◽

White Blood Cell ◽

Early Response ◽

Delayed Response ◽

Blood Cell Count ◽

Failure Patterns

Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment.Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis.Results. There were 644 episodes in 455 patients: 378 (58.7%) of early response, 122 (18.9%) of delayed response, and 144 (22.3%) of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (pvalue < 0.001 for all comparisons).Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter.

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Clinical Characteristics Associated with Antibiotic Treatment Failure for Tuboovarian Abscesses

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2016/5120293 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 13

Author(s):

Huma Farid ◽

Trevin C. Lau ◽

Anatte E. Karmon ◽

Aaron K. Styer

Keyword(s):

Blood Cell ◽

Treatment Failure ◽

Cell Count ◽

Antibiotic Treatment ◽

White Blood Cell Count ◽

White Blood Cell ◽

Clinical Characteristics ◽

Maximum Diameter ◽

Blood Cell Count ◽

Parenteral Antibiotic

Objective. Although parenteral antibiotic treatment is a standard approach for tuboovarian abscesses, a significant proportion of patients fail therapy and require interventional radiology (IR) guided drainage. The objective of this study is to assess if specific clinical factors are associated with antibiotic treatment failure.Study Design. Retrospective medical record review of patients hospitalized for tuboovarian abscesses from 2001 through 2012 was performed. Clinical characteristics were compared for patients who underwent successful parenteral antibiotic treatment, failed antibiotic treatment necessitating subsequent IR drainage, initial drainage with concurrent antibiotics, and surgery.Results. One hundred thirteen patients admitted for inpatient treatment were identified. Sixty-one (54%) patients were treated with antibiotics alone. Within this group, 24.6% failed antibiotic treatment and required drainage. Mean white blood cell count (K/μL) (18.7±5.94versus13.9±5.12) (p=0.003), mean maximum diameter of tuboovarian abscess (cm) (6.8±2.9versus5.2±2.0) (p=0.03), and length of stay (days) (9.47±7.43versus4.59±2.4) (p=0.002) were significantly greater for patients who failed antibiotic treatment.Conclusions. Admission white blood cell count greater than 16 K/μL and abscess size greater than 5.18 cm are associated with antibiotic treatment failure. These factors may provide guidance for initial selection of IR guided drainage.

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Value of white blood cell count with differential in the acute diabetic foot infection

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-86-5-224 ◽

1996 ◽

Vol 86 (5) ◽

pp. 224-227 ◽

Cited By ~ 44

Author(s):

DG Armstrong ◽

TA Perales ◽

RT Murff ◽

GW Edelson ◽

JG Welchon

Keyword(s):

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Diabetic Foot ◽

Polymorphonuclear Leukocyte ◽

White Cell ◽

Blood Cell Count ◽

Diabetic Foot Infection ◽

Cell Counts

The authors reviewed the admission leukocyte indices of 338 consecutive admissions (203 males, 135 females, mean age of 60.2 +/- 12.9 years) with a primary diagnosis of diabetic foot infection in a multicenter retrospective study. The mean white blood cell count on admission for all subjects studied was calculated at 11.9 +/- 5.4 x 103 cells/mm3. Of all white blood cell counts secured for patients admitted with a diabetic foot infection, 56% (189 out of 338) were within normal limits. The average automated polymorphonuclear leukocyte percentage was calculated at 71.4 +/- 11.1% (normal range 40% to 80%). Normal polymorphonuclear leukocyte values were present in 83.7% of subjects. The authors stress that the diagnosis of a diabetic pedal infection is made primarily on the basis of clinical signs and symptoms, and that a normal white cell count and white cell differential should not deter the physician from taking appropriate action to mitigate the propagation of a potentially limb-threatening pedal infection.

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Erythrocyte Sedimentation Rate Combined With the Probe-to-Bone Test for Fast and Early Diagnosis of Diabetic Foot Osteomyelitis

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620923278 ◽

2020 ◽

pp. 153473462092327 ◽

Cited By ~ 1

Author(s):

Jun Xu ◽

Fang Cheng ◽

Yanming Li ◽

Jinghang Zhang ◽

Shuhong Feng ◽

...

Keyword(s):

Blood Cell ◽

Sedimentation Rate ◽

Diabetic Foot ◽

Predictive Value ◽

C Reactive Protein ◽

Blood Cell Count ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Sensitivity Specificity ◽

Diabetic Foot Osteomyelitis

This study aimed to investigate the erythrocyte sedimentation rate (ESR) optimal cutoff point in Chinese patients with diabetic foot osteomyelitis (DFO) and to evaluate the screening value of ESR combined with probe-to-bone (PTB) test for a fast diagnosis of DFO in early stage. A total of 204 diabetic inpatients with foot infection were tested for white blood cell count, neutrophil %, C reactive protein, and ESR at admission within 24 hours. All patients were performed PTB test. Patients with DFO (111) were confirmed by bone biopsy, the other patients (86) had only soft tissue infection. Although white blood cell count, neutrophil %, C-reactive protein, and ESR were different between the 2 groups, only area under curve of ESR was 0.832, with the value as a diagnostic indicator. The best cut point of ESR was >43 mm/h; the sensitivity, specificity, positive predictive value (+PV), and negative predictive value (−PV) were 82.9%, 70.5%, 0.78, and 0.77, respectively. ESR combined with PTB test (serial test), the sensitivity, specificity, +PV, −PV, positive likelihood ratio (+LR), and negative LR (−LR) were 63.56%, 98%, 0.97, 0.67, 31.75, and 0.37, respectively. ESR combined with PTB test (parallel test), the sensitivity, specificity, +PV, −PV, +LR, and −LR were 96%, 65.7%, 0.78, 093, 2.8, and 0.06, respectively, combined with PTB test is simple, favorable for application, and can early fast screening patients with DFO in high-risk patients.

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