Admission Time Deep Swab Specimens Compared With Surgical Bone Sampling in Hospitalized Individuals With Diabetic Foot Osteomyelitis and Soft Tissue Infection

2020 ◽  
pp. 153473462091638 ◽  
Author(s):  
Ana Belen Manas ◽  
Surabhi Taori ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
C. Manu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Soft Tissue Infection ◽  
Diabetic Foot ◽  
Tissue Infection ◽  
Surgical Debridement ◽  
Deep Wound ◽  
Negative Growth ◽  
Diabetic Foot Osteomyelitis ◽  
Prior Antibiotic Therapy

Whether deep swab cultures taken at admission reliably identify pathogens compared to surgical bone specimens in hospitalized individuals with diabetic foot osteomyelitis and soft tissue infection is unclear. Comparison of microbiological isolates between a deep wound swab (DWS) taken at the time of admission through the actively infected, discharging ulcer probing to the bone and the subsequent surgical bone sample (SBS) taken during surgical debridement was made. A total of 63 subjects (age 60.8 ± 13.5 years, 75% male, 80% Type 2 diabetes, HbA1C 8.9%±2.2%) were included. The proportion of Gram-positive (DWS 49% v SBS 52%) and Gram-negative (DWS 60% v SBS 60%) isolates was similar between the techniques. However, the overall concordance of isolates between the two techniques was only fair (κ=0.302). The best concordance was observed for Staphylococcus aureus (κ=0.571) and MRSA (κ=0.644). There was a correlation between number of isolates in SBS with prior antibiotic therapy of any duration (r= -0.358, p=0.005) and with the duration of ulceration (r=0.296, p=0.045); no clinical correlations were found for DWS. Prior antibiotic therapy (p=0.03) and duration of ulceration <8 weeks (p=0.025) were predictive of negative growth on SBS. In conclusion, we found only a fair concordance between deep wound swabs acquired at admission and surgical bone specimens in those presenting with a severe diabetic foot infection and features of osteomyelitis. Ensuring early surgical debridement of all infected tissue and obtaining bone specimens should be considered a clinical priority, which may also reduce the likelihood of negative growth on SBS.

scholarly journals Diagnosing Diabetic Foot Osteomyelitis in Patients Without Signs of Soft Tissue Infection by Coupling Hybrid 67Ga SPECT/CT With Bedside Percutaneous Bone Puncture

Diabetes Care ◽  
2013 ◽  
Vol 36 (8) ◽  
pp. 2203-2210 ◽  
Author(s):  
E. Aslangul ◽  
J. M'Bemba ◽  
N. Caillat-Vigneron ◽  
S. Coignard ◽  
E. Larger ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Diabetic Foot ◽  
Tissue Infection ◽  
Diabetic Foot Osteomyelitis

scholarly journals Real-world experience with dalbavancin therapy in gram-positive skin and soft tissue infection, bone and joint infection

Infection ◽  
2019 ◽  
Vol 47 (6) ◽  
pp. 1013-1020 ◽  
Author(s):  
Selma Tobudic ◽  
Christina Forstner ◽  
Heinz Burgmann ◽  
Heimo Lagler ◽  
Christoph Steininger ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Clinical Improvement ◽  
Soft Tissue Infection ◽  
Joint Infection ◽  
Tissue Infection ◽  
Oral Drug ◽  
Gram Positive ◽  
Positive Skin

Abstract Purpose Dalbavancin is a novel lipoglycopeptide with potent activity against several gram-positive pathogens, an excellent safety profile and a long elimination half-life. Methods In this case series observed at the University Hospital of Vienna between 2015 and 2017, all adult patients with gram-positive infections who received at least one dosage of dalbavancin were screened (n = 118). A total of 72 patients were included in the final analysis. The number of included patients stratified by the source of infection was: skin and soft tissue infection (SSTI) (n = 26), osteomyelitis (n = 20), spondylodiscitis (n = 14), acute septic arthritis (n = 4) and prosthetic joint infection (n = 8). Results In 46 patients (64%), clinical cure was detected at the end of dalbavancin therapy without additional antibiotic therapy. Of the 26 patients who received additional antibiotic therapy other than dalbavancin, 15 patients (21%) showed no clinical improvement under dalbavancin therapy, four patients (5%) had side effects (nausea n = 1, exanthema n = 2, hyperglycemia n = 1), and in seven patients (10%) clinical improvement under dalbavancin therapy was detected but antibiotic therapy was de-escalated to an oral drug. Conclusion We demonstrated high clinical effectiveness of dalbavancin for acute gram-positive infections primarily acute SSTI, acute septic arthritis, acute osteomyelitis and spondylodiscitis. In patients with biofilm-associated infection (chronic infection or joint prosthesis), source control was absolutely necessary for treatment success.

scholarly journals Posttraumatic Skin and Soft-Tissue Infection due toPseudomonas fulva

2016 ◽  
Vol 2016 ◽  
pp. 1-2 ◽  
Author(s):  
Fernando Cobo ◽  
Gemma Jiménez ◽  
Javier Rodríguez-Granger ◽  
Antonio Sampedro
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Soft Tissue Infection ◽  
Traffic Accident ◽  
Left Thigh ◽  
Species Level ◽  
Tissue Infection ◽  
Intravenous Antibiotic ◽  
Injured Area

We report a case of posttraumatic skin and soft-tissue infection in a patient with a left thigh wound after a traffic accident.Pseudomonas fulvawas isolated from a wound aspirate and was identified to the species level by Maldi-tof. The patient responded to drainage, debridement of wound, and two weeks of intravenous antibiotic therapy. Follow-up after 3 weeks was satisfactory with healthy cover of the injured area.

scholarly journals Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

2018 ◽  
Vol 56 (1) ◽  
pp. 3-8
Author(s):  
Dimitrios Velissaris ◽  
Nikolaos-Dimitrios Pantzaris ◽  
Christina Platanaki ◽  
Nikolina Antonopoulou ◽  
Charalampos Gogos
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Diabetic Foot ◽  
Assessment Tool ◽  
Tissue Infection ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Mortality And Morbidity ◽  
Diabetic Foot Infection ◽  
Patients With Diabetes

Abstract Diabetic foot ulcers (DFUs) are a very common cause of mortality and morbidity. The distinction between infected and non-infected DFU remains a very challenging task for clinicians in everyday practice. Even when infection is documented, the spectrum of diabetic foot infection is wide, ranging from cellulitis and soft tissue infection to osteomyelitis. Procalcitonin (PCT), a well-established sepsis biomarker, has been used in the diagnosis of several infections including osteomyelitis in patients with diabetes mellitus. This review gathers and presents all the relevant data, up until now, regarding the use of PCT as an assessment tool in diabetic patients with foot infection. Current evidence suggests that PCT levels could aid clinicians in distinguishing infected from non-infected DFUs as well as in the distinction between soft tissue infection and bone involvement, but further and larger studies are warranted to confirm these findings.

scholarly journals Two-Step Sequential Approach for Concomitant Skin and Soft Tissue Infection and Osteomyelitis Complicating the Diabetic Foot

Diabetes Care ◽  
2017 ◽  
Vol 40 (12) ◽  
pp. e170-e171 ◽  
Author(s):  
Naïma Berthol ◽  
Olivier Robineau ◽  
Anne Boucher ◽  
Nicolas Blondiaux ◽  
Eric Beltrand ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Diabetic Foot ◽  
Tissue Infection ◽  
Sequential Approach

scholarly journals ACR Appropriateness Criteria ® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot)

2017 ◽  
Vol 14 (5) ◽  
pp. S326-S337 ◽  
Author(s):  
Francesca D. Beaman ◽  
Paul F. von Herrmann ◽  
Mark J. Kransdorf ◽  
Ronald S. Adler ◽  
Behrang Amini ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Septic Arthritis ◽  
Soft Tissue Infection ◽  
Diabetic Foot ◽  
Tissue Infection ◽  
Appropriateness Criteria ◽  
Acr Appropriateness Criteria

scholarly journals Three versus six weeks of antibiotic therapy for diabetic foot osteomyelitis: A prospective, randomized, non-inferiority pilot trial

2020 ◽  
Author(s):  
Karim Gariani ◽  
Truong-Thanh Pham ◽  
Benjamin Kressmann ◽  
François R Jornayvaz ◽  
Giacomo Gastaldi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Cox Regression ◽  
Pilot Trial ◽  
Median Number ◽  
Hazard Ratio ◽  
Surgical Debridement ◽  
Systemic Antibiotic ◽  
Systemic Antibiotic Therapy ◽  
Diabetic Foot Osteomyelitis

Abstract Background In patients with diabetic foot osteomyelitis (DFO) who underwent surgical debridement, we investigated whether a short (3 weeks), compared with a long (6 weeks) duration of systemic antibiotic treatment is associated with non-inferior results for clinical remission and adverse events (AE). Methods In this prospective, randomized, non-inferiority, pilot trial, we randomized (allocation 1:1), patients with DFO after surgical debridement to either a 3-week or a 6-week course of antibiotic therapy. The minimal duration of follow-up after end of therapy was two months. We compared outcomes using Cox regression and non-inferiority analyses (25% margin, power 80%). Results Among 93 enrolled patients (18% females; median age 65 years), 44 were randomized to the 3-week arm and 49 to the 6-week arm. The median number of surgical debridement was 1 (range, 0-2 interventions). In the intention-to-treat (ITT) population, remission occurred in 37 (84%) of the patients in the 3-week arm compared to 36 (73%) in the 6-week arm (p=0.21). The number of AE was similar in the two study arms (17/44 vs. 16/49; p=0.51), as were the remission incidences in the per-protocol (PP) population (33/39 vs. 32/43; p=0.26). In multivariate analysis, treatment with the shorter antibiotic course was not significantly associated with remission (for the ITT population, hazard ratio 1.1, 95%CI 0.6-1.7; for the PP population hazard ratio 0.8, 95%CI 0.5-1.4). Conclusions In this randomized, controlled pilot trial, a post-debridement systemic antibiotic therapy course for DFO of 3-weeks gave similar (and statistically non-inferior) incidences of remission and AE to a course of 6 weeks.

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