Osteomyelitis in the diabetic foot

NewsBot · Jun 20, 2024

Clinical characteristics, treatment and efficacy of calcaneal osteomyelitis: A systematic review with synthesis analysis 1118 reported cases
Nan Jiang et al
Int J Surg. 2024 Jun 13

Background: Calcaneal osteomyelitis (CO) still poses great challenges to orthopaedic surgeons due to unique anatomic and functional features of the calcaneus. This study summarized the current data regarding clinical characteristics, treatment and efficacy of CO, based on an analysis of literature-reported cases.

Materials and methods: We searched the PubMed, Embase, and Cochrane Library databases to find English and Chinese studies reporting on CO patients between 2000 and 2021, with available data for synthesis analysis. The quality of the included studies was evaluated by the National Institutes of Health (NIH) assessment scale. Effective data were extracted and pooled for analysis.

Results: Altogether 198 studies involving 1118 patients were included, with a male-to-female ratio of 2.3 (724 males and 310 females). The median age at CO diagnosis was 46 years, with a median symptom duration of 3 months. Injury-related infections (524 cases) and diabetic foot infections (336 cases) were the two most common causes, with ulcer (468 cases) and wound sinus or exudation (209 cases) being the predominant symptoms. The overall positive culture rate was 80.2%, with polymicrobial infections accounting for 18.1%. Staphylococcus aureus was the most frequently detected pathogen (42.7%), with fungal-related infections isolated in 17 cases. Although most patients received surgical interventions (96.9%), the recurrence rate was 20.1%. The incidence of infection relapse following partial calcanectomy, total calcanectomy, debridement with implantation of local antibiotics, and debridement with or without flap or skin coverage were 31.7%, 45.0%, 16.8%, and 15.1%, respectively. The overall incidence of limb amputation was 12.4%, with all-cause and CO-related mortalities of 2.8% and 0.2%, separately.

Conclusions: CO shared similar characteristics with extremity chronic osteomyelitis, primarily affecting young males, with trauma and diabetic foot as the leading causes and Staphylococcus aureus as the most frequently detected pathogen. Despite surgery being the primary treatment modality, clinical outcomes remained unsatisfactory, marked by high rates of infection recurrence and limb amputation.
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NewsBot · Jun 29, 2024

Therapeutic effect of calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot
Wei-Feng Li et al
Zhongguo Gu Shang. 2024 Jun 25;37(6):6095-15

Objective: To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot.

Methods: From April 2018 to October 2021, a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot, including 2 males and 3 females, aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement, vancomycin bone cement implantation, negative pressure aspiration at stageⅠ, vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded, and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated.

Results: Five patients were successfully completed operation without lower extremity vascular occlusion, and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days, and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation, and 2 patients got excellent result, 2 good and 1 fair. Among them, 1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication), was recovered after treatment;the wound leakage complication occurred in 2 patients, and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients.

Conclusion: Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection, but also promote fracture healing, and obtain good clinical results.
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NewsBot · Jul 2, 2024

Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review
Akram Uddin et al
J Clin Med. 2024 May 24;13(11):3083

Background: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines 'Diabetic foot problems: prevention and management'. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021-31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient
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NewsBot · Jul 16, 2024

Diabetic Foot Osteomyelitis Undergoing Amputation: Epidemiology and Prognostic Factors for Treatment Failure
Yae Jee Baek et al
Open Forum Infect Dis. 2024 Jul 9;11(7)

Background: When treating diabetic foot osteomyelitis (DFO), it remains difficult to determine the presence of residual infection and the optimal treatment after bone resection. In this study, we aimed to investigate the clinical characteristics of and prognostic factors in patients with DFO undergoing amputation.

Methods: This retrospective study involved 101 patients with DFO who underwent amputation. Data on their demographics, clinical characteristics, tissue culture, and surgery type were collected. Patients were grouped according to primary closure status and clinical outcome postamputation. A good outcome was defined as a successful complete remission, characterized by the maintenance of complete wound healing with no sign of infection at 6 months postamputation. Multivariate logistic regression analysis was performed. Outcomes according to surgery type were also analyzed.

Results: Staphylococcus aureus (17%) and Pseudomonas species (14%) were the most prevalent pathogens. Gram-negative bacteria were isolated from 62% of patients. In patients with primary closure, hemodialysis and ankle brachial index (ABI) <0.6 were associated with poor outcomes. In patients with DFO, ABI <0.6 was the only prognostic factor associated with treatment failure. Antimicrobial stewardship allows patients who underwent major amputation to reduce the duration of antibiotic therapy compared to those after minor amputation, although it did not contribute to reducing mortality.

Conclusions: Peripheral artery disease and hemodialysis were associated with poor outcomes despite radical resection of the infected bone. Vigilant monitoring after amputation and antimicrobial stewardship implemented based on microbiological epidemiology, prognostic factors, and the type of surgery are important. A multidisciplinary team could assist in these activities to ensure treatment success.
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NewsBot · Jul 25, 2024

The Efficacy of Local Antibiotic Delivery Systems Therapy in the Management of Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis
Di Shen et al
Int J Low Extrem Wounds. 2024 Jul 21

Purpose: We aim to evaluate the efficacy of local antibiotic delivery systems in patients with diabetic foot osteomyelitis (DFO).

Methods: The Web of Science, PubMed, and Embase databases were searched for relevant publications until March 2024. All studies evaluating the efficacy of local antibiotic delivery systems in patients with DFO were included. We calculated pooled risk ratio (RR) with 95% CIs for binary outcomes and mean difference (MD) for continuous outcomes. The Cochrane's risk of bias tool and methodological index for non-randomized studies (MINORS) assessment were used to evaluate the quality of studies.

Results: A total of 9 studies with 491 patients were included in this analysis. The overall healing rate in antibiotic group was 0.85 (95% CI: 0.67, 0.97). Healing rates were significantly higher in the antibiotic group compared to the control group (RR: 1.18, 95% CI: 1.01, 1.38). Furthermore, recurrence rates and amputation rates have no significantly difference between the antibiotic group and the control group (RR: 0.30, 95% CI: 0.04, 2.12 and RR: 0.22, 95% CI:0.03, 1.91), along with no significantly difference in healing time and hospital stays(MD: -7.87, 95% CI: -20.81, 5.07 and MD:-2.33, 95% CI:-5.17, 0.50). No obvious publication bias was observed in the funnel plot (Egger's test, P = .99).

Conclusions: Our meta-analysis found that diabetic foot osteomyelitis patients treated with local antibiotic delivery systems had better healing rates than the control group. However, no significant differences were found in healing time, recurrence, hospital stays, or amputation rates. Larger randomized controlled trials are necessary in the future.
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NewsBot · Jul 29, 2024

Diabetic Foot Osteomyelitis in Patients with and without Peripheral Arterial Disease: Two Different Diseases?
Marco Meloni et al
Int J Low Extrem Wounds. 2024 Jul 21

The aim of the current study was to evaluate the outcomes of patients with diabetic foot osteomyelitis (DFO), comparing subjects with and without peripheral arterial disease (PAD). The study is a prospective study including a population of patients affected by a DFO located in the forefoot. All patients were managed by a surgical conservative approach defined by the removal of the infected bone, in association with the antibiotic therapy. Patients were divided into two groups: those with PAD (neuro-ischaemic DFO) and those without (neuropathic DFO). After 1 year of follow-up, the following outcome were evaluated and compared between groups: healing, healing time, minor amputation, major amputation, hospitalization, need for surgical re-intervention. Overall, 166 patients were included, 87(52.4%) of them had neuro-ischaemic DFO and 79 (47.6%) neuropathic DFO. Patients with neuro-ischaemic DFO in comparison to neuropathic DFO were older (72.5 ± 9 vs 64.1 ± 15.5 years, P < .0001), had longer diabetes duration (21.8 ± 5.6 vs 16.4 ± 7.6 years, P < .0001), higher rate of dialysis (13.8 vs 1.3%, P = .001) and ischaemic heart disease (79.3 vs 12.7%, P < .0001). Outcomes for neuro-ischaemic DFO and neuropathic DFO were: healing (96.5 vs 97.5%, P = .7), healing time (7.8 ± 6.2 vs 5.7 ± 3.7 weeks, P = .01), minor amputation (16.1 vs 3.8%, P = .006), major amputation (0 vs 0%, ns), hospitalization (90.8 vs 51.9%, P < .0001), surgical re-intervention (14.9 vs 8.8%, P = .004) respectively. In addition, PAD resulted in an independent predictor of minor amputation, hospitalization, and surgical re-intervention. DFO in patients with PAD was characterized by longer healing time, more cases of minor amputation, hospitalization, and surgical re-intervention. PAD independently predicted the risk of minor amputation, hospitalization, and surgical re-intervention, while it was not associated with the healing rate.
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NewsBot · Aug 7, 2024

Two-Step Conservative Surgery for Complicated Forms of Diabetes-Related Foot Osteomyelitis
Gerardo Víquez-Molina, José María Rojas-Bonilla, Javier Aragón-Sánchez
Int J Low Extrem Wounds. 2024 Aug 6

Diabetes-related foot osteomyelitis (DFO) is a common yet complex condition, often complicated by concurrent soft tissue infections (STIs). This study evaluates the efficacy of a two-step conservative surgical approach, hypothesizing that it offers comparable outcomes to a one-step procedure. Conducted on a cohort of 93 patients with DFO, the study categorized cases into two types: OM1 (osteomyelitis without STI) and OM2 (osteomyelitis with STI). OM2 was further subdivided into OM2a (early diagnosis) and OM2b (late diagnosis), with OM2 patients undergoing initial soft tissue debridement followed by elective bone surgery. The results indicated no significant differences in infection recurrence or amputation rates between the two surgical approaches, with recurrence observed in 20.7% of cases and amputations in 10.8%. The two-step procedure was associated with higher inflammatory responses and greater need for antibiotics and hospital admissions. However, these factors did not translate into increased recurrence or amputation compared to the one-step procedure. The study supports the two-step approach as a safe and effective method for managing complicated DFO cases, providing a viable alternative to immediate amputation or single-stage surgery. Despite some limitations, including regional specificity and potential underdiagnosis in late-diagnosed cases, the findings offer valuable insights for clinical management and suggest further research to refine treatment protocols. The study's strengths include confirmed histopathological diagnoses and consistent follow-up, reinforcing the validity of the two-step surgical approach for complex DFO treatment.
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NewsBot · Oct 11, 2024

Does complete resection of infected bone improve clinical outcomes in patients with diabetic foot osteomyelitis?
Lawrence A Lavery et al
Int Wound J. 2024 Oct;21(10):e70072

The objective of the study was to compare outcomes in patients with complete surgical resection versus partial resection of diabetic foot osteomyelitis (OM). A post hoc analysis of 171 patients with OM was performed using data from two randomized clinical trials. OM was confirmed with bone culture or histopathology. Surgical culture specimens were obtained from resected bone and sent for histopathology and microbiology. Residual osteomyelitis (RO) was defined as a positive resected margin on culture or histopathology. No residual osteomyelitis (NRO) was defined as no growth from bone culture and no histopathological inflammation in the biopsy of the resection margin. Data from the 12-month follow-up were used to determine clinical outcomes. During the index hospitalization, NRO patients had significantly shorter duration of antibiotic therapy (NRO 21.0, 13.0-38.0 vs. RO 37.0, 20.8-50.0, p <0.01) and more amputations than patients with RO (NRO 89.9% vs. RO 60.9%, p <0.01). During the 12-month follow-up, patients with NRO also had significantly shorter duration of antibiotic therapy (NRO 42, 21.0-66.5 vs. RO 50.5, 35.0-75.0, p = 0.02). During the 12-month follow-up, there was no difference in ulceration at the same site (NRO 3.7%, RO 4.3% p = 0.85), hospitalization (NRO 32.6%, RO 34.8%, p = 0.76), total re-infections (NRO 25.3%, RO 29.3%, p = 0.56), re-infection with osteomyelitis (NRO 13.3% vs. 13.5%, p = 0.36), amputation (NRO 8.8%, RO 5.4%, p = 0.86) and time to wound healing in days (NRO 94, 41.0-365 vs. RO 106, 42.8-365, p = 0.77). Successful treatment of osteomyelitis was achieved by 86.7% and 86.5% of patients. During the index hospitalization, patients with no residual osteomyelitis had more amputations and were treated with antibiotics for a shorter duration. During the 12-month follow-up, patients with no residual osteomyelitis had shorter durations of antibiotics. There were no differences in re-infection, amputation, re-ulceration or hospitalization
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NewsBot · Oct 12, 2024

Residual diabetic foot osteomyelitis after surgery leads to poor clinical outcomes: A systematic review and meta-analysis
Mario C Reyes et al
Wound Repair Regen. 2024 Oct 7

The aim of this meta-analysis is to compare the clinical outcomes in patients with and without residual osteomyelitis (ROM) after surgical bone resection for diabetic foot osteomyelitis (DFO). We completed a systematic literature search using PubMed, Scopus, and Embase using keywords DFO, Residual OM (ROM), and positive bone margins. The study outcomes included wound healing, antibiotic duration, amputation, and re-infection. Five hundred and thirty patients were included in the analysis; 319 had no residual osteomyelitis (NROM), and 211 had ROM. There was not a significant difference in the proportion of wounds that healed 0.6 (p = 0.1, 95% confidence intervals [95% CI] 0.3-1.3). The risk of infection was 2.0 times higher (OR = 2.0, p = 0.02, 95% CI 1.1-3.4), and the risk of amputation was 4.3 times higher (OR = 4.3, p = 0.0001, 95% CI 2.4-7.6) in patients with ROM. Patients with ROM received antibiotics significantly longer. The mean difference was 16.3 days (p = 0.02, 95% CI 11.1-21.1).
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NewsBot · Oct 14, 2024

High prescription rate of medications with rifampin drug-drug interactions in patients with diabetic foot osteomyelitis: should rifabutin be included in clinical trials for adjunctive therapy?
Christina Mallarino-Haeger, Allison Watson, Umnia Mahgoub, Lily Francis, Maryam Heydari, Muaaz Choudhary, Manuel Garcia-Toca, Manish Patel, Russell R Kempker, Maya Fayfman ... Show more
Open Forum Infectious Diseases, ofae582, https://doi.org/10.1093/ofid/ofae582

Rifampin may improve diabetic foot osteomyelitis (DFO) outcomes, but its extensive drug-drug interactions (DDIs) could hamper its use. Here, through a review of the medications prescribed to a cohort of 190 persons with DFO, we show that rifabutin, a rifamycin with fewer DDIs, would be easier to implement in practice.
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NewsBot · Oct 25, 2024

A Prospective
Observational Study of Different
Modalities of Diagnosis, Medical
Versus Surgical Treatment and
Outcome of Diabetic Foot Patients
with Osteomyelitis.
Rajesh Prajapati, Manisha
Singh, Ravindra Singh and Shubham
Jain,
Res. J. Med.
Sci., 18: 493‐499, doi: 10

Diabetes is one of the most prevalent diseases in society in which no medical
specialty should be exempted from understanding the disease and its
complications. Since diabetic foot complications are very prevalent and affect all
diabetics, causing significant burden in their lifestyle and loss of limb or life,
making it is important to study. Peripheral vascular changes and neurological
changes are induced by long‐standing untreated diabetes, which worsens the
path of the disease by ulceration, infections, deformities and other systemic
complications. There is a need to review clinical presentation, patho‐physiology
and categorize the lesion and classify for best management to minimize morbidity
in diabetic patients who were most often present with uncontrolled infection and
ulcerations leading to compromise of part of the foot or entire foot. The present
research proposes a systematic research on clinical presentation and diagnosis
and diabetic foot management in G.R. Medical College, Gwalior, so that more
could be learned about clinical presentation, pathophysiology and management
of DFO in this geographic area. An accrual study was conducted in patients who
presented with infected foot ulcer with history of diabetes mellitus or with raised
blood sugar levels. A population of 75 patients with diabetic foot was enrolled for
study. Detailed history, clinical examination, chemical and biochemical evaluation
was done. Assessment of peripheral neuropathy, lower limb pulsation and ABI
was done followed by wound assessment for number, location, dimension,
presence and nature of discharge, granulation tissue extent of necrosis extent
and type of gangrene scar of previous surgeries and deformities etc. Based on
above parameters foot ulcers were classified according to university of texas
wound classification system and patients were henceforth treated medically or
surgically and observations were made. There was more risk of developing DFO
with increasing duration of diabetes and more among in uncontrolled diabetic
patient and family history of diabetes mellitus. Maximum DFO patient present
with non‐healing foot ulcer with underlying infected bone. Most common
microorganisms grown from culture taken from the lesion was staphylococcus
aureus followed by streptococcus. Slightly higher healing with less recurrence
found in surgically managed DFO. Healing duration of lesions is similar in both
groups most lesions healed within 3 month. It can be concluded that Maximum
DFO patient present with non‐healing foot ulcer with underlying infected bone.
Deep tissue culture and bone culture helps to guide appropriate antibiotic
therapy. Slightly higher healing with less recurrence found in surgically managed
DFO. Healing duration of lesion are similar in both groups most lesion healed
within 3 months.
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NewsBot · Oct 31, 2024

Microbiologic and Histopathologic Features of Pedal Osteomyelitis
Julieta Madrid-Morales
Open Forum Infect Dis. 2024 Oct 5;11(10)

The value of microbiology and histopathology in the diagnosis of neuropathic foot osteomyelitis remains poorly understood. In this retrospective cohort study, we evaluated the concordance of microbiology and histopathology results from bone resections and found similar proportions of bacterial growth in samples with and without histopathologic evidence of osteomyelitis.
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NewsBot · Nov 1, 2024

doi: 10.1007/s00592-024-02386-y. Online ahead of print.
Predictors of Successful Antibiotic Treatment of Osteomyelitis in Diabetic Forefoot Infection
A Hassanin et al
Acta Diabetol. 2024 Nov 1.

Background: Osteomyelitis (OM) associated with diabetic foot ulceration (DFU) is a growing public health challenge worldwide. Since 2012 the number of patients presenting with DFU per year to our centre has doubled.

Objective: This study aims to evaluate outcomes from outpatient antibiotic therapy (OPAT) in the management of OM in DFU patients.

Methods: A retrospective analysis was performed of medical notes, radiology, and vascular laboratory reports for all DFU patients with OM treated from April 2016 to April 2020. Variables analyzed included age, gender, site of OM, WIfI Score (Wound Ischaemia and foot Infection Score), probe-to-bone test (PTB), imaging (X-ray/magnetic resonance imaging (MRI), co-morbidities (peripheral arterial disease (PAD), chronic kidney disease (CKD), hypertension (HTN), smoking, ischemic heart disease (IHD), and dyslipidaemia. Outcomes evaluated were healing, recurrent DFU, and freedom from amputation at 12 months.

Results: 185 patients were admitted with 264 infected digits (Male 223; Female 41). The mean age was 66 years. Only 168 (63.6%) were fully healed at 12 months. Of the 96 patients who failed to heal, 43 underwent a repeat course of prolonged antibiotics without improvement. Factors associated with treatment failure were PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene.

Conclusion: Extended outpatient antibiotic therapy (with an inpatient multidisciplinary approach) is an effective treatment for digital OM in DFU with a success rate of 63%. In recurrence, repeating prolonged antibiotics is unlikely to achieve healing. PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene are predictors of treatment failure.
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NewsBot · Nov 9, 2024

Evaluation of Antibiotic-Loaded Bone Cement in Treatment of Infected Diabetic Foot: Systematic Review and Meta-Analysis
Hua Chen, Ling Yao, Yu Zhou, Jiezhi Dai
Source

Background
Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic-loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot.

Methods
The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software.

Results
Nine articles with 565 patients were analysed in our meta-analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD = −1.64, 95% CI −2.27 to −1.02 p < 0.00001, I2 = 88%). The ABC group had a significantly decreased number of debridements (SMD = −2.47, 95% CI −4.24 to −0.70, p < 0.00001, I2 = 95%). The pooled data showed no significant difference (RR = 0.41, 95% CI 0.12 to 1.39, p = 0.84, I2 = 0%).

Conclusion
This is the first meta-analysis comparing the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. Antibiotic-loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications.
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NewsBot · Nov 13, 2024

Microbial profile of diabetic foot osteomyelitis from the northwest of England
Sara Metaoy, Iulia Rusu & Anand Pillai
Clinical Diabetes and Endocrinology: 09 November 2024

Background
Osteomyelitis of the diabetic foot is a common and challenging complication affecting patients with diabetic foot ulcers and infections. The complexity of these infections lies in their polymicrobial nature, high rates of persistence and recurrence. This study examined the microbiological profile of diabetic foot osteomyelitis from a teaching hospital in Northwest England and their resistance patterns to understand its impact on infection persistence and to direct effective treatment.

Methods
A retrospective review of 105 patients who underwent surgical management for diabetic foot osteomyelitis between 2019 and 2024. We analysed three consecutive culture samples for each patient to assess for the microbiological profile and resistance patterns of these infections and to monitor infection recurrence and persistence rates.

Results
A total of 105 patients were identified. Infection eradication was noted in 42% of the cohort, infection persistence in 18%, and late infection recurrence in 40%. Polymicrobial growth was evident in 72% of our study sample. Gram-positive bacteria made up the majority of the bacterial isolates in all 3 culture samples, 74.81% in sample 1, 69.31% in sample 2, and 55.1% in sample 3. Staphylococcus aureus was the most prevalent gram-positive bacteria, at 52.38% in sample 1, 36.19% in sample 2, and 18.09% in sample 3, followed by Haemolytic Streptococcus, Enterococcus and Corynebacterium. The frequently identified gram-negative bacteria were Pseudomonas in sample 1 (7.61%), E. coli and Proteus in sample 2 (5,71%), Pseudomonas and Proteus in sample 3 (2.85%). Gram-positive bacteria were resistant to penicillin and macrolides with resistance of staphylococcus aureus to clarithromycin identified among all 3 culture samples. Gram-negative bacteria were most resistant to amoxicillin. Staphylococcus aureus was responsible for infection persistence in most of our cohort (12/19) 63.15%. Among those patients, Staphylococcus was resistant to clarithromycin in 6 of the cases. The 5-year mortality rate for our study sample was 32.38%.

Conclusion
This study highlights the prevalence of polymicrobial growth and multi-drug resistant pathogens in the scope of diabetic foot osteomyelitis. It highlights the predominance of Staphylococcus aureus and its resistant strains among patients affected by diabetic foot osteomyelitis in Greater Manchester.
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NewsBot · Nov 24, 2024

Fungal Osteomyelitis of a Diabetic Foot Infection Caused by Trichosporon asahii: A Case Report
Frost, Livia BS; Xu, Ya MD, PhD; Fukuta, Yuriko MD, PhD, CWSP
Advances in Skin & Wound Care 37(11&12) 1-4, 11/12 2024. | DOI: 10.1097/ASW.0000000000000223

Diabetic foot bacterial osteomyelitis is a serious infection that can lead to major amputations. However, fungal osteomyelitis in a diabetic foot ulcer is uncommon and has been underrecognized. It typically occurs in patients with underlying immunocompromised status and is associated with poor outcomes. Fungal osteomyelitis might be overlooked or diagnosed late because of underrecognition and the inability to differentiate it from bacterial osteomyelitis without specific laboratory testing, such as fungal culture of bone and histopathology including fungal stain. Treating fungal osteomyelitis involves a long course of antifungal treatment, along with surgical management and intensive wound care. In this report, the authors describe the case of a 78-year-old woman with peripheral arterial disease and diabetes who developed dry gangrene complicated by osteomyelitis due to the fungus Trichosporon asahii in the distal phalange of her right hallux. Initially, her pain and erythema around the gangrene improved with voriconazole; however, her gangrene worsened, likely because of nonadherence to wound care and offloading, and her comorbidities. Ultimately, she underwent a right foot guillotine transmetatarsal amputation. The authors also review the literature on fungal osteomyelitis, particularly in the context of diabetic foot infections and Trichosporon asahii infections.
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Osteomyelitis in the diabetic foot

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Non-surgical management of osteomyelitis in the diabetic foot

Probe-to-Bone Test for Diagnosing Diabetic Foot Osteomyelitis

Osteomyelitis help

Sever's disease complicated with osteomyelitis

Charcot Foot and Osteomyelitis

Osteomyelitis in Diabetes: A Marrowing Experience No Longer? - Dr F. Javier Aragón Sánchez MD - DF

osteomyelitis and removal of fibula

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Osteomyelitis in the diabetic foot

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Non-surgical management of osteomyelitis in the diabetic foot

Probe-to-Bone Test for Diagnosing Diabetic Foot Osteomyelitis

Osteomyelitis help

Sever's disease complicated with osteomyelitis

Charcot Foot and Osteomyelitis

Osteomyelitis in Diabetes: A Marrowing Experience No Longer? - Dr F. Javier Aragón Sánchez MD - DF

osteomyelitis and removal of fibula

Share This Page

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