scholarly journals Diagnosing Diabetic Foot Osteomyelitis: Narrative Review and a Suggested 2-Step Score-Based Diagnostic Pathway for Clinicians

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Anurag Markanday
Keyword(s):  
Diabetic Foot ◽  
English Language ◽  
Bone Biopsy ◽  
Clinical Signs ◽  
Initial Assessment ◽  
Medline Search ◽  
Diagnostic Pathway ◽  
Diabetic Foot Infections ◽  
Meta Analyses ◽  
Diabetic Foot Osteomyelitis

Abstract The diabetic foot infection remains a major cause of morbidity and mortality in many patients and remains a challenging diagnosis for most clinicians. Diagnosis is largely based on clinical signs supplemented by various imaging tests. Magnetic resonance imaging (MRI) is not readily available to many clinicians, and bone biopsy, which is the accepted criterion standard for diagnosis, is rarely performed routinely. This evidence-based review and the proposed diagnostic scoring pathway substratifies the current International Working Group on the Diabetes Foot guidelines for diagnosing diabetic foot osteomyelitis into a convenient 2-step diagnostic pathway for clinicians. This proposed diagnostic approach will need further validation prospectively, but it can serve as a useful diagnostic tool during the initial assessment and management of diabetic foot infections. A MEDLINE search of English-language articles on diabetic foot osteomyelitis published between 1986 and March 2014 was conducted. Additional articles were also identified through a search of references from the retrieved articles, published guidelines, systematic reviews, and meta-analyses.

scholarly journals Are surrogate markers for diabetic foot osteomyelitis remission reliable?

2020 ◽  
Author(s):  
Peter A Crisologo ◽  
Matthew Malone ◽  
Javier La Fontaine ◽  
Orhan Oz ◽  
Kavita Bhavan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Surrogate Marker ◽  
Surrogate Markers ◽  
Bone Culture ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Index Site ◽  
Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

scholarly journals Percutaneous Bone Biopsy for Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Marcos C Schechter ◽  
Mohammed K Ali ◽  
Benjamin B Risk ◽  
Adam D Singer ◽  
Gabriel Santamarina ◽  
...  
Keyword(s):  
Adverse Events ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Meta Analysis ◽  
Positive Culture ◽  
High Yield ◽  
Analysis Model ◽  
Antibiotic Management ◽  
Culture Positive ◽  
Diabetic Foot Osteomyelitis

Abstract Background Diabetes is the leading cause of lower extremity nontraumatic amputation globally, and diabetic foot osteomyelitis (DFO) is usually the terminal event before limb loss. Although guidelines recommend percutaneous bone biopsy (PBB) for microbiological diagnosis of DFO in several common scenarios, it is unclear how frequently PBBs yield positive cultures and whether they cause harm or improve outcomes. Methods We searched the PubMed, EMBASE, and Cochrane Trials databases for articles in any language published up to December 31, 2019, reporting the frequency of culture-positive PBBs. We calculated the pooled proportion of culture-positive PBBs using a random-effects meta-analysis model and reported on PBB-related adverse events, DFO outcomes, and antibiotic adjustment based on PBB culture results where available. Results Among 861 articles, 11 studies met inclusion criteria and included 780 patients with 837 PBBs. Mean age ranged between 56.6 and 71.0 years old. The proportion of males ranged from 62% to 86%. All studies were longitudinal observational cohorts, and 10 were from Europe. The range of culture-positive PBBs was 56%–99%, and the pooled proportion of PBBs with a positive culture was 84% (95% confidence interval, 73%–91%). There was heterogeneity between studies and no consistency in definitions used to define adverse events. Impact of PBB on DFO outcomes or antibiotic management were seldom reported. Conclusions This meta-analysis suggests PBBs have a high yield of culture-positive results. However, this is an understudied topic, especially in low- and middle-income countries, and the current literature provides very limited data regarding procedure safety and impact on clinical outcomes or antibiotic management.

scholarly journals Acute Phase Reactants in Infections: Evidence-Based Review and a Guide for Clinicians

2015 ◽  
Vol 2 (3) ◽  
Author(s):  
Anurag Markanday
Keyword(s):  
Acute Phase ◽  
English Language ◽  
Biological Marker ◽  
Acute Phase Reactants ◽  
Medline Search ◽  
Reactive Protein ◽  
Guidance Strategies ◽  
Published Evidence ◽  
Meta Analyses

Abstract Acute-phase reactants such as erythrocyte sedimentation rate and C-reactive protein have traditionally been used as markers for inflammation and as a measure of “sickness index” in infectious and noninfectious conditions. In the last decade, more data have become available on the wider and more specific role for these markers in the management of complex infections. This includes the potential role in early diagnosis, in differentiating infectious from noninfectious causes, as a prognostic marker, and in antibiotic guidance strategies. A better defined role for biological markers as a supplement to clinical assessment may lead to more judicious antibiotic prescriptions, and it has the potential for a long-term favorable impact on antimicrobial stewardship and antibiotic resistance. Procalcitonin as a biological marker has been of particular interest in this regard. This review examines the current published evidence and summarizes the role of various acute-phase markers in infections. A MEDLINE search of English-language articles on acute-phase reactants and infections published between 1986 and March 2015 was conducted. Additional articles were also identified through a search of references from the retrieved articles, published guidelines, systematic reviews, and meta-analyses.

Blood cultures after bone biopsy in diabetic foot osteomyelitis

2017 ◽  
Vol 89 (1) ◽  
pp. 78-79 ◽  
Author(s):  
Paule Letertre-Gibert ◽  
Françoise Desbiez ◽  
Magali Vidal ◽  
Natacha Mrozek ◽  
Pereira Bruno ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Blood Cultures ◽  
Diabetic Foot Osteomyelitis

scholarly journals Time-to-Report of the Bone Culture and Microbiologic Adequacy of Empiric Antibiotics in Patient’s with Diabetic Foot Osteomyelitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S94-S95
Author(s):  
Hyun Kyung Kim ◽  
Olga Vasylyeva
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Anaerobic Bacteria ◽  
Accurate Method ◽  
Bone Culture ◽  
Culture Result ◽  
Gram Positive ◽  
Diabetic Foot Infection ◽  
Superficial Wound ◽  
Diabetic Foot Osteomyelitis

Abstract Background Bone cultures in diabetic foot infection is the most accurate method to identify causative pathogen, while there is only 30% concordance between superficial wound swab and bone biopsy cultures. Diabetic foot infection is commonly polymicrobial, therefore report on the bone biopsy culture may come with several updates before it is finalized. Our study is aimed to describe how often additional pathogens were identified after patients’ discharge on antibiotics therapy for diabetic foot osteomyelitis, and evaluate microbiological appropriateness of antibiotic regimen upon discharge based on the final result of the bone culture. Methods Medical records of the patients 18 years old or older, who had inpatient bone biopsy, deep tissue debridement or amputation for diabetic foot infection, were reviewed from January 2014 through Dec 2015 in Rochester Regional Health System. Antibiotic regimens for the patients discharged before final culture result were evaluated for microbiological appropriateness by two reviewers trained in infectious diseases. Results In total, 198 procedures were screened, 158 procedures met inclusion criteria, out of which 74 patients with 80 procedures (51%) were discharged before the final culture result was available. Average time from procedure to the final culture report was 6 days, and from discharge to the final culture was 3.7 days. In most of the cases (70%, 56 out of 80) the patients were discharged on empiric regimen discordant with final culture result. Predominant organisms were Gram-positive bacteria 74%, with Gram negatives 24%, and yeast 2%. Most infections were polymicrobial (81%), mixed with anaerobic bacteria in 37%. The most frequent isolates were Staphylococcus aureus (15%), Corynebacterium (14%), anaerobic Gram-positive cocci (12%), and Staphylococcus epidermidis (8%). All negative Gram stains (31%, 25 out of 80) had positive growth on culture. Conclusion Half of the patients with diabetic foot osteomyelitis, who underwent bone biopsy, were discharged before final culture results were available. Most of them were discharged on empiric regimen discordant with final culture. This data suggests that careful outpatient follow-up on the final culture would likely result in modification of antibiotics therapy to target newly reported pathogen. Disclosures All authors: No reported disclosures.

Statistical Reliability of Bone Biopsy for the Diagnosis of Diabetic Foot Osteomyelitis

2013 ◽  
Vol 52 (5) ◽  
pp. 692 ◽  
Author(s):  
A. Cecilia-Matilla ◽  
J.L. Lázaro-Martínez ◽  
J. Aragón-Sánchez
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Statistical Reliability ◽  
Diabetic Foot Osteomyelitis

scholarly journals Culture of Percutaneous Bone Biopsy Specimens For Diagnosis of Diabetic Foot Osteomyelitis: Concordance With Ulcer Swab Cultures

2006 ◽  
Vol 42 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Eric Senneville ◽  
Hugues Melliez ◽  
Eric Beltrand ◽  
Laurence Legout ◽  
Michel Valette ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Biopsy Specimens ◽  
Diabetic Foot Osteomyelitis

Statistical Reliability of Bone Biopsy for the Diagnosis of Diabetic Foot Osteomyelitis

2011 ◽  
Vol 50 (6) ◽  
pp. 663-667 ◽  
Author(s):  
Andrew J. Meyr ◽  
Salil Singh ◽  
Xinmin Zhang ◽  
Natalya Khilko ◽  
Abir Mukherjee ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Statistical Reliability ◽  
Diabetic Foot Osteomyelitis

Clinical Management of Bleeding Risk With Antidepressants

2018 ◽  
Vol 53 (2) ◽  
pp. 186-194 ◽  
Author(s):  
Alexandra L. Bixby ◽  
Amy VandenBerg ◽  
Jolene R. Bostwick
Keyword(s):  
At Risk ◽  
English Language ◽  
Data Extraction ◽  
Antidepressive Agents ◽  
Bleeding Risk ◽  
Medline Search ◽  
Risk Of Bleeding ◽  
Patients At Risk ◽  
High Bleeding Risk ◽  
Meta Analyses

Objective: This nonsystematic review describes risk of bleeding in treatment with serotonin reuptake inhibitors (SRIs) and provide recommendations for the management of patients at risk of bleeding. Data Sources: Articles were identified by English-language MEDLINE search published prior to June 2018 using the terms SRI, serotonin and noradrenaline reuptake inhibitors, OR antidepressive agents, AND hemorrhage OR stroke. Study Selection and Data Extraction: Meta-analyses were utilized to identify information regarding risk of bleeding with antidepressants. Individual studies were included if they had information regarding bleeding risk with specific SRIs, timing of risk, or risk with medications of interest. Data Synthesis: SRIs increase risk of bleeding by 1.16- to 2.36-fold. The risk is synergistic between SRIs and nonsteroidal anti-inflammatory drugs (NSAIDs; odds ratio [OR] range between studies 3.17-10.9). Acid-reducing medications may mitigate risk of gastrointestinal bleeds in chronic NSAIDs and SRI users (OR range between studies 0.98-1.1). Antidepressants with low or no affinity for the serotonin transporter, such as bupropion or mirtazapine, may be appropriate alternatives for patients at risk of bleeding. Relevance to Patient Care and Clinical Practice: This review includes data regarding bleeding risk for specific antidepressants, concomitant medications, and risk related to duration of SRI use. Considerations and evidence-based recommendations are provided for management of SRI users at high bleeding risk. Conclusions: Clinicians must be aware of the risk of bleeding with SRI use, especially for patients taking NSAIDs. Patient education is prudent for those prescribed NSAIDs and SRIs concurrently.

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