Local Antibiotic Delivery Systems in Diabetic Foot Osteomyelitis: A Brief Review

Diabetic foot osteomyelitis (DFO) is a severe, difficult to treat infection. Local antibiotic delivery has been studied as a potential therapeutic adjunct following surgery for DFO. This review aims to summarize the evidence on local antibiotic delivery systems in DFO. PubMed database was searched up to March 2020. Overall, 16 studies were identified and included: 3 randomized controlled trials (RCTs), 3 retrospective studies (RSs), and 10 case series. In the RCTs, gentamicin-impregnated collagen sponges significantly improved clinical healing rates and slightly improved duration of hospitalization. In the RSs, antibiotic-impregnated calcium sulfate beads non-significantly improved all healing parameters, but did not reduce post-operative amputation rates or time of healing. The majority of case series used calcium sulfate beads, achieving adequate rates of healing and eradication of infection. In conclusion, evidence for add-on local antibiotic delivery in DFO is still limited; more data are needed to assess this therapeutic measure.

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Local Antibiotic Delivery Systems in the Surgical Treatment of Diabetic Foot Osteomyelitis: Again, No Benefit?

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620973961 ◽

2020 ◽

pp. 153473462097396

Author(s):

Christos Chatzipapas ◽

Ioannis E. Kougioumtzis ◽

Makrina Karaglani ◽

Periklis Panagopoulos ◽

Maria Panopoulou ◽

...

Keyword(s):

Surgical Treatment ◽

Diabetic Foot ◽

Calcium Sulfate ◽

Antibiotic Administration ◽

Group A ◽

Group B ◽

Local Antibiotic ◽

Local Antibiotic Therapy ◽

Diabetic Foot Osteomyelitis ◽

Antibiotic Delivery

This retrospective study aimed to compare the outcomes and healing parameters of 3 groups of surgical treatment combined with and without local antibiotic administration in diabetic foot osteomyelitis (DFO). Overall, 25 patients with DFO who met the criteria were included in the study. Surgical debridement was used with systemic antibiotic administration alone (group A; n = 8) or combined with local application of antibiotic-loaded polymethylmethacrylate beads (group B; n = 9) or antibiotic-loaded hydroxyapatite and calcium sulfate beads (group C; n = 8). In total, 87.5% patients in group A, 100% in group B, and 87.5% in group C healed ( P = .543). Median time to healing was 17 weeks in group A, 18 weeks in group B, and 19 weeks in group C ( P = .094). One patient (12.5%) in group A was amputated. DFO recurrence rate was 12.5% in group A and 12.5% in group C ( P = .543). Median hospitalization was 9 days in group A, 8 days in group B, and 9 days in group C ( P = .081). In conclusion, adjunctive local antibiotic therapy was not shown to improve outcomes in surgically treated DFO.

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Local Antibiotic Delivery Systems in Diabetic Foot Osteomyelitis

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734614566937 ◽

2015 ◽

Vol 14 (1) ◽

pp. 87-91 ◽

Cited By ~ 15

Author(s):

Periklis Panagopoulos ◽

Georgios Drosos ◽

Efstratios Maltezos ◽

Nikolaos Papanas

Keyword(s):

Diabetic Foot ◽

Delivery Systems ◽

Local Antibiotic ◽

Diabetic Foot Osteomyelitis ◽

Antibiotic Delivery

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A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics

The Bone & Joint Journal ◽

10.1302/0301-620x.100b11.bjj-2018-0720 ◽

2018 ◽

Vol 100-B (11) ◽

pp. 1409-1415 ◽

Cited By ~ 1

Author(s):

B. A. Marson ◽

S. R. Deshmukh ◽

D. J. C. Grindlay ◽

B. J. Ollivere ◽

B. E. Scammell

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Surgical Management ◽

Case Series ◽

Diabetic Patients ◽

Local Antibiotics ◽

Wound Breakdown ◽

Patients With Diabetes ◽

Local Antibiotic ◽

Antibiotic Delivery

Aims Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. Materials and Methods Databases were searched to identify eligible studies and 13 were identified for inclusion. Results Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. Conclusion There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409–15.

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Antibiotic Bone Cement Combined With Other Comprehensive Interventions in the Treatment of Diabetic Foot Osteomyelitis

10.21203/rs.3.rs-431432/v1 ◽

2021 ◽

Author(s):

Fanyu Bu ◽

Xiaofeng Guo ◽

Peng Xu ◽

Jin Wang ◽

Mingyu Xue ◽

...

Keyword(s):

Bone Cement ◽

Diabetic Foot ◽

Pathogenic Bacteria ◽

Healing Time ◽

Foot Ulcers ◽

Diabetic Patients ◽

Ulcer Recurrence ◽

Duration Of Hospitalization ◽

Diabetic Foot Osteomyelitis

Abstract BackgroundDiabetic foot osteomyelitis (DFO) is serious chronic complication that causes disability or death in diabetic patients. Antibiotic-loaded bone cement is an effective sustained-release system for the treatment of chronic osteomyelitis and induces biofilm formation. This study aimed to valuate the outcomes and summarize the experiences of bone cement loaded with vancomycin combined with other comprehensive interventions in the treatment of DFO.MethodsOne hundred and twelve involved feet in 93 patients (43–92 years old) with DFO treated with antibiotic-loaded bone cement combined with other comprehensive interventions were retrospectively analyzed. The durations of oral and intravenous antibiotics and hospitalization, ulcer healing times, recurrence and rehospitalization rates, and the rates of amputation above the ankle were evaluated at the last follow-up. One hundred and forty four pathogenic bacteria were co-cultured from the secretions of deep wounds from foot ulcers. The Maryland criteria were used to evaluate the recoveries of foot functions. ResultsEighty seven patients with 105 involved feet were followed up successfully over an average period of 14 months. All wounds exhibited good union on follow up, and DFO was cured. The average durations of oral and intravenous antibiotic administrations were 12.2 ± 1.5 and 10.8 ± 2.5 days, respectively. The average duration of hospitalization was 14.0 ± 2.7 days and the healing time for the ulcers was 37.8 ± 6.3 days. Rehospitalization presented in 21 (18.8％) foot ulcers among those with ulcer recurrence. No patients required amputation above the ankle. According to the Maryland criteria, 31, 45, 26, and three feet were rated as excellent, good, fair, and failures, respectively. Overall, 72% were rated as excellent-good. ConclusionsThe rate of amputation above the ankle was significantly reduced with the use of comprehensive interventions to retain foot function and improve quality of life. This management strategy in the treatment of DFO is effective and comprehensive comprehensive; therefore, it should be more frequently used in clinical settings.

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Radiographic and Histologic Assessment of Calcium Sulfate in Experimental Animal Models and Clinical Use as a Resorbable Bone-Graft Substitute, a Bone-Graft Expander, and a Method for Local Antibiotic Delivery

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200100021-00003 ◽

2001 ◽

Vol 83 ◽

pp. 8-18 ◽

Cited By ~ 80

Author(s):

Thomas M. Turner ◽

Robert M. Urban ◽

Steven Gitelis ◽

Ken N. Kuo ◽

Gunnar B.J. Andersson

Keyword(s):

Animal Models ◽

Bone Graft ◽

Experimental Animal ◽

Calcium Sulfate ◽

Bone Graft Substitute ◽

Clinical Use ◽

Experimental Animal Models ◽

Local Antibiotic ◽

Antibiotic Delivery

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Local Delivery of Antibiotics in the Context of Chronic Diabetic Foot Infection with Bony Involvement: A Case Series of 102 Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00440 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0044

Author(s):

James Widnall ◽

David Harvey ◽

Paul Evans ◽

Gillian Jackson ◽

Simon Platt

Keyword(s):

Dead Space ◽

Salvage Surgery ◽

Case Series ◽

Calcium Sulphate ◽

Surgical Debridement ◽

P Value ◽

Space Management ◽

Bony Involvement ◽

Local Antibiotic ◽

Antibiotic Delivery

Category: Diabetes Introduction/Purpose: Diabetic foot infection (DFI) is a devastating condition which poses risk to both life and limb. Treatment principles revolve around surgical debridement, dead space management, delivery of both local and systemic antibiotics and soft tissue cover. Dead space management and local antibiotic delivery can be achieved simultaneously by using an antibiotic loaded bone substitute. We report our retrospective case series of patients treated with surgical management involving local antibiotic delivery via calcium sulphate bone substitute (Stimulan™; Biocomposites, Keele, UK). Methods: All patients between January 2015 and June 2018 with DFI and proven bony involvement presenting to our university teaching hospital were treated via our extensive MDT approach. A total of 102 patients were included. Surgical debridement was performed along with simultaneous insertion of 10 ml calcium sulphate with 1 g vancomycin and 240 mg gentamycin. Outcome was classified as resolved, requiring prolonged treatment from other medical (endocrinologist) or surgical (plastic surgery, limb reconstruction) services or salvage surgery in the form of proximal amputation. Results: 45.1% of patients had a partial amputation at the index surgery. 52% had bony debridement and just 2.9% had soft tissue debridement in conjunction with calcium sulphate insertion. The surgical wound was primarily closed in 56.8% of patients. 7 patients had delayed wound closure and 36.2% of patients healed via secondary intention. 74 patients (72.5%) had resolution of their DFI with bony involvement following surgical intervention. 21 (20.6%) patients needed further treatment from allied specialties. 7 (6.9%) patients required salvage surgery in the form of a below knee amputation. There was no correlation between either closure type (2 p-value 0.75) or index surgery type and outcome (2 p-value 0.64). Conclusion: DFI is a difficult clinical scenario to treat effectively. An MDT approach is undoubtedly key to a good outcome. We believe that the use of calcium sulphate can be a useful adjunct at the time of surgical debridement to aid in both dead space management and allow local antibiotic delivery.

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