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

Devangi Ketankumar Madani, Mujahid Ahmad Saeed, Alok Tiwari, Miruna Delia David

Abstract


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.


Keywords


diabetes mellitus, antibiotics, amputation, osteomyelitis

Full Text:

PDF HTML

References


Animaw W, Seyoum Y. Increasing prevalence of diabetes mellitus in a developing country and its related factors. PloS One 2017;12(11):e0187670. https://doi.org/10.1371/journal.pone.0187670

Lipsky BA, Senneville E, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update) Diabetes Metab Res Rev 2020;36(S1):e3280. https://doi.org/10.1002/dmrr.3280

Giurato L, Meloni M, Izzo V, Uccioli L. Osteomyelitis in diabetic foot: a comprehensive overview. World J Diabetes 2017;8(4):135–42. https://dx.doi.org/10.4239%2Fwjd.v8.i4.135

Shiraev TP, Lipsky BA, Kwok TMY, Robinson DA. Utility of culturing marginal bone in patients undergoing lower limb amputation for infection. J Foot Ankle Surg 2019;58(5):847–51. https://doi.org/10.1053/j.jfas.2018.12.012

Lesens O, Desbiez F, Vidal M, et al. Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis. Clin Microbiol Infect 2011;17(2):285–91. https://doi.org/10.1111/j.1469-0691.2010.03194.x

Barwell ND, Devers MC, Kennon B, et al. Diabetic foot infection: antibiotic therapy and good practice recommendations. Int J Clin Pract 2017; 71(10):e13006-n/a. https://doi.org/10.1111/ijcp.13006

Atway S, Nerone VS, Springer KD, Woodruff DM. Rate of residual osteomyelitis after partial foot amputation in diabetic patients: a standardized method for evaluating bone margins with intraoperative culture. J Foot Ankle Surg 2012;51(6):749–52. https://doi.org/10.1053/j.jfas.2012.06.017

Kowalski TJ, Matsuda M, Sorenson MD, Gundrum JD, Agger WA. The effect of residual osteomyelitis at the resection margin in patients with surgically treated diabetic foot infection. J Foot Ankle Surg 2011;50(2):171–5. https://doi.org/10.1177%2F1938640018770285

Berendt AR, Peters EJG, Bakker K, et al. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev 2008;24(S1):S145–61. https://doi.org/10.1002/dmrr.836

National Institute of Health and Care Excellence (NICE). Diabetic foot problems: prevention and management, 2015. Available at: https://www.nice.org.uk/guidance/ng19/chapter/Recommendations#diabetic-foot-problems (accessed 27 July 2020).

Malone M, Fritz BG, Vickery K, et al. Analysis of proximal bone margins in diabetic foot osteomyelitis by conventional culture, DNA sequencing and microscopy. APMIS 2019;127(10):660–70. https://doi.org/10.1111/apm.12986




DOI: https://doi.org/10.15277/bjd.2021.285

Refbacks

  • There are currently no refbacks.


The Journal of the Association of British Clinical Diabetologists