Feasibility of Percutaneous Bone Biopsy as Part of the Management of Diabetic Foot Osteomyelitis in a 100% Neuropathic, Grade 3 IDSA/IWGDF Population on an Outpatient Basis

2020 ◽  
Vol 19 (4) ◽  
pp. 382-387
Author(s):  
Olga Anna Kosmopoulou ◽  
Isabelle J. Dumont
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Ambulatory Setting ◽  
Outpatient Basis ◽  
Bone Culture ◽  
Causative Microorganism ◽  
Patients With Diabetes ◽  
Diabetic Foot Osteomyelitis

The present study aimed to evaluate the feasibility of percutaneous bone biopsy in an ambulatory setting as part of the management of diabetic foot osteomyelitis (DFO) on an outpatient basis. DFO may complicate some cases of apparently nonsevere foot infections in patients with diabetes and greatly increase the risk of a lower extremity amputation. It has been suggested that bone culture–based antibiotic therapy is a predictive factor of success in patients with diabetes treated nonsurgically for osteomyelitis of the foot. It is recommended to identify the causative microorganism(s) by the means of either a surgical or percutaneous bone biopsy taken appropriately to select the proper antibiotic therapy. Percutaneous bone biopsy in patients not requiring surgery is, however, not performed in everyday practice as it should be according to the current recommendations. In the present retrospective study, we report a series of 23 consecutive patients with a suspicion of DFO in whom 28 bone samples were collected by percutaneous biopsy at the bedside in an outpatient setting. The percentage of positive cultures was in accordance with that reported in the literature. The mean number of isolates per specimen was 1.04. After a mean 12-month follow-up, the remission was almost of 78%. No adverse event related to the bone biopsy was noted. After a 1-year follow-up, no recurrence was recorded among the patients in remission. The results of the present study suggest that bedside percutaneous bone biopsy performed in the ambulatory setting is a valuable and safe tool in the management of DFO on an outpatient basis.

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 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.

scholarly journals Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene

2021 ◽  
Vol 9 ◽  
pp. 205031212110291
Author(s):  
Targ Elgzyri ◽  
Jan Apelqvist ◽  
Eero Lindholm ◽  
Hedvig Örneholm ◽  
Magdalena Annersten Gershater
Keyword(s):  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Foot Ulcer ◽  
Major Amputation ◽  
Severe Form ◽  
Foot Ulcers ◽  
Vascular Intervention ◽  
Co Morbidity ◽  
Patients With Diabetes

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3–234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35–95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3–234) weeks; for auto-amputated, 48 (10–228) weeks; for minor amputated, 48 (6–234) weeks; and for major amputation, 32 (3–116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

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.

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 Diabetic Foot Osteomyelitis: Frequent Pathogens and Conservative Antibiotic Therapy

2021 ◽  
Author(s):  
Nicolas Vogel ◽  
Tanja Huber ◽  
Ilker Uçkay
Keyword(s):  
Diabetes Mellitus ◽  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Conservative Therapy ◽  
State Of The Art ◽  
Psychological Aspects ◽  
Clinical Recommendation ◽  
National Guidance ◽  
Diabetic Foot Osteomyelitis

Chronic diabetic foot osteomyelitis (DFO) is a frequent complication in adult polyneuropathy patients with long-standing diabetes mellitus. Regarding the conservative therapy, there are several crucial steps in adequate diagnosing and approaches. The management should be performed in a multidisciplinary approach following the findings of recent research, general principles of antibiotic therapy for bone; and according to (inter-)national guidance. In this chapter we emphasize the overview on the state-of-the-art management regarding the diagnosis and antibiotic therapy in DFO. In contrast, in this general narrative review and clinical recommendation, we skip the surgical, vascular and psychological aspects.

scholarly journals The role of remnant bone microbiological cultures in managing diabetic foot osteomyelitis

2021 ◽  
Author(s):  
Devangi Ketankumar Madani ◽  
Mujahid Ahmad Saeed ◽  
Alok Tiwari ◽  
Miruna Delia David
Keyword(s):  
Diabetic Foot ◽  
Group B Streptococcus ◽  
Bone Culture ◽  
Streptococcus Group ◽  
Streptococcus Anginosus ◽  
Bone Segment ◽  
Forefoot Amputation ◽  
Group B ◽  
The Impact ◽  
Diabetic Foot Osteomyelitis

Aim: Effective treatment of diabetic foot osteomyelitis can reduce the risk of major amputations. Our primary aim was to compare the yield in cultures from the proximal and distal segments of bone excised intraoperatively and the impact on antibiotic choice and duration.Methods: Patients with a confirmed diagnosis of osteomyelitis on bone culture results, where both proximal and distal bone segment samples had been collected, were retrospectively reviewed. Microbiological data were examined to identify true pathogens and studied against antimicrobial choice and duration of prescribing.Results: A total of 47 forefoot amputation cases were studied. In 89% of cases, definite or likely pathogens were isolated from the deep tissues cultured. Definite pathogens (Staphylococcus aureus, Group B streptococcus, Group G streptococcus and Streptococcus anginosus) were identified in 32% of cases; in 73% of these, definite pathogens were grown in both the proximal and distal bone segments.Conclusion: Sampling of remnant bone culture can help in reducing the duration of antibiotic treatment in patients (27% of cases in our series) as it is challenging to correctly estimate intraoperatively whether clear surgical margins have been adequately achieved when resecting infected bone.

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