scholarly journals Deferring Amputation in Diabetic Foot Osteomyelitis: Doing More Harm Than Good?

2021 ◽  
Author(s):  
Shiwei Zhou ◽  
Brian M Schmidt ◽  
Oryan Henig ◽  
Keith S Kaye
Keyword(s):  
Medical Therapy ◽  
Diabetic Foot ◽  
Knee Amputation ◽  
Diabetic Foot Osteomyelitis

Abstract In a cohort of patients with diabetic foot osteomyelitis who were recommended to undergo below-knee amputation, those who deferred amputation and chose medical therapy were more likely to die during the follow up time compared to those who proceeded with amputation.

scholarly journals 318. Deferring Amputation in Diabetic Foot Osteomyelitis: Doing more Harm than Good?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S231-S232
Author(s):  
Shiwei Zhou ◽  
Brian M Schmidt ◽  
Oryan Henig ◽  
Keith S Kaye
Keyword(s):  
Diabetic Foot ◽  
Medical Management ◽  
Wound Care ◽  
Cohort Analysis ◽  
Severity Of Illness ◽  
Complete Healing ◽  
Knee Amputation ◽  
Management Group ◽  
One Year ◽  
Diabetic Foot Osteomyelitis

Abstract Background Diabetic foot osteomyelitis (DFO) is a leading cause of below knee amputation (BKA). Even when medical treatment is deemed unlikely to succeed, patients with DFO are often resistant to amputation. Methods An observational cohort analysis was done on patients with DFO at Michigan Medicine who were evaluated by podiatry and recommended BKA from Oct 2015 - Jun 2019. Primary outcome was mortality after BKA recommendation. Secondary outcomes were healing of affected limb, rate of BKA or above knee amputation (AKA) and total antibiotic days in the 6 months following. All intravenous antibiotics and oral courses of linezolid and fluoroquinolones were captured. Results Of 44 patients with DFO, 18 chose BKA, 26 chose medical management with wound care. Mean age of the cohort was 61, 68% male, 80% white with a median Charlson Comorbidity Index of 6 (IQR 4,7). The two groups were similar with regards to demographics and comorbid conditions. Those who chose medical management did so because their infection was non-life-threatening and they desired to avoid amputation. One-year mortality was greater in patients who were medically managed compared to those who had BKA (23.1% vs 0%, OR 11.7, 95% CI 0.6–222.9). Considering only the 33 patients who were followed for at least 2 years, 2-year mortality was also greater in the medically managed group compared to the BKA group (38.5% vs 5.6%, OR 10.6, 95% CI 1.2–92.7, Figure 1). Fewer patients in the medical management group had complete healing of their wound/stump compared to the BKA group (46.2% vs 88.9%, OR 9.3, 95% CI 1.8–49.1). In the medically managed group, 18 (69%) patients went on to require BKA or AKA at a median of 76.5 days compared to 2 (11%) in the BKA group who required AKA at 1 and 11 days following recommendation. Median antibiotic days were significantly greater in the medically managed group compared to the BKA group (55 IQR 42,78 vs 17 IQR 10,37, p=0.0017). Conclusion In this cohort of DFO patients where BKA was recommended, medical management was associated with increased mortality, poor healing of the affected limb, and excess antibiotic exposure compared to BKA. These findings are particularly notable as case mix and severity of illness were similar between the two groups. This study can be used to inform providers and patients in cases where BKA is recommended. Disclosures All Authors: No reported disclosures

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

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.

Successful Limb-sparing Treatment Strategy for Diabetic Foot Osteomyelitis

2012 ◽  
Vol 102 (4) ◽  
pp. 273-277 ◽  
Author(s):  
Alison M. Beieler ◽  
Timothy C. Jenkins ◽  
Connie S. Price ◽  
Carla C. Saveli ◽  
Merribeth Bruntz ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
Surgical Margin ◽  
Initial Therapy ◽  
Surgical Debridement ◽  
Knee Amputation ◽  
End Point ◽  
Below The Knee ◽  
Diabetic Foot Osteomyelitis

Background: Diabetic foot osteomyelitis is common and causes substantial morbidity, including major amputations, yet the optimal treatment approach is unclear. We evaluated an approach to limb salvage that combines early surgical debridement or limited amputation with antimicrobial therapy. Methods: We conducted a retrospective cohort study of patients treated between May 1, 2005, and May 31, 2007. The primary end point was cure, defined as not requiring further treatment for osteomyelitis of the affected limb. The secondary end point was limb salvage, defined as not requiring a below-the-knee amputation or a more proximal amputation. Results: Fifty patients with diabetic foot osteomyelitis met the study criteria. Initial surgical management included local amputation in 43 patients (86%) and debridement without amputation in seven (14%). Most infections (n = 30; 60%) were polymicrobial, and Staphylococcus aureus was the most common pathogen (n = 23; 46%). Parenteral antibiotics were used in 45 patients (90%). Patients who had pathologic evidence of osteomyelitis at the surgical margin received therapy for a median of 43 days (interquartile range [IQR], 36–56 days), whereas those without evidence of residual osteomyelitis received therapy for a median of 19 days (IQR, 13–40 days). Overall, 32 patients (64%) were considered cured after a median follow-up of 26 months (IQR, 12–38 months). Fifteen of 18 patients (83%) who failed initial therapy were treated again with limb-sparing surgery. Limb salvage was achieved in 47 patients (94%), with only three patients (6%) requiring below-the-knee amputation. Conclusions: In patients with diabetic foot osteomyelitis, surgical debridement or limited amputation plus antimicrobial therapy is effective at achieving clinical cure and limb salvage. (J Am Podiatr Med Assoc 102(4): 273–277, 2012)

Risk Factors for Below-the-Knee Amputation in Diabetic Foot Osteomyelitis After Minor Amputation

2019 ◽  
Vol 109 (2) ◽  
pp. 91-97 ◽  
Author(s):  
Whitney Miller ◽  
Chrystal Berg ◽  
Michael L. Wilson ◽  
Susan Heard ◽  
Bryan Knepper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Interquartile Range ◽  
Knee Amputation ◽  
Below The Knee ◽  
Minor Amputation ◽  
Increased Risk ◽  
Transmetatarsal Amputation ◽  
The Impact ◽  
Diabetic Foot Osteomyelitis

Background:Below-the-knee amputation (BKA) can be a detrimental outcome of diabetic foot osteomyelitis (DFO). Ideal treatment of DFO is controversial, but studies suggest minor amputation reduces the risk of BKA. We evaluated risk factors for BKA after minor amputation for DFO.Methods:This is a retrospective cohort of patients discharged from Denver Health Medical Center from February 1, 2012, through December 31, 2014. Patients who underwent minor amputation for diagnosis of DFO were eligible for inclusion. The outcome evaluated was BKA in the 6 months after minor amputation.Results:Of 153 episodes with DFO that met the study criteria, 11 (7%) had BKA. Failure to heal surgical incision at 3 months (P < .001) and transmetatarsal amputation (P = .009) were associated with BKA in the 6 months after minor amputation. Peripheral vascular disease was associated with failure to heal but not with BKA (P = .009). Severe infection, bacteremia, hemoglobin A1c, and positive histopathologic margins of bone and soft tissue were not associated with BKA. The median antibiotic duration was 42 days for positive histopathologic bone resection margin (interquartile range, 32–47 days) and 16 days for negative margin (interquartile range, 8–29 days). Longer duration of antibiotics was not associated with lower risk of BKA.Conclusions:Patients who fail to heal amputation sites in 3 months or who have transmetatarsal amputation are at increased risk for BKA. Future studies should evaluate the impact of aggressive wound care or whether failure to heal is a marker of another variable.

scholarly journals Long-Term Complications after Surgical or Medical Treatment of Predominantly Forefoot Diabetic Foot Osteomyelitis: 1 Year Follow Up

2021 ◽  
Vol 10 (9) ◽  
pp. 1943
Author(s):  
Aroa Tardáguila-García ◽  
Yolanda García-Álvarez ◽  
Esther García-Morales ◽  
Mateo López-Moral ◽  
Irene Sanz-Corbalán ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Diabetic Foot ◽  
Prospective Observational Study ◽  
Group Versus ◽  
Medical Group ◽  
Long Term Follow Up ◽  
Surgical Group ◽  
Diabetic Foot Osteomyelitis

Aim: To compare long-term complications according to the treatment received for management of diabetic foot osteomyelitis (surgical or medical) at 1 year follow up. Design and Participants: A prospective observational study was conducted involving 116 patients with diabetic foot osteomyelitis. The patients received surgical or medical treatment based on the principles described in the literature. To register the development of a complication, both groups of treatments were followed-up 1 year after the ulcer had healed. Results: Ninety-six (82.8%) patients received surgical treatment and 20 (17.2%) medical treatment. No differences were found in the time to healing between both groups of treatment, 15.7 ± 9.2 weeks in the surgical group versus 16.4 ± 12.1 weeks in the medical group; p = 0.103. During follow up, 85 (73.3%) patients developed complications without differences between both groups, 68 (70.8%) in the surgical group versus 17 (85%) in the medical group (p = 0.193). The most common complication in both groups was re-ulceration. We did not observe significant differences comparing complication-free time survival between both treatments (p = 0.665). Conclusion: The onset of complications after healing in patients who suffered from diabetic foot osteomyelitis was not associated with the treatment received. Surgical and medical approaches to the management of diabetic foot osteomyelitis produced similar results in long-term follow up.

scholarly journals Risk Factors for Below the Knee Amputation in Diabetic Foot Osteomyelitis

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Whitney Hernandez ◽  
Heather Young ◽  
Bryan Knepper ◽  
Susan Heard ◽  
Michael Wilson
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Knee Amputation ◽  
Below The Knee ◽  
Diabetic Foot Osteomyelitis

scholarly journals Utility of Blood Parameters to Detect Complications during Long-Term Follow-Up in Patients with Diabetic Foot Osteomyelitis

2020 ◽  
Vol 9 (11) ◽  
pp. 3768
Author(s):  
Aroa Tardáguila-García ◽  
Yolanda García Álvarez ◽  
Esther García-Morales ◽  
Francisco Javier Álvaro-Afonso ◽  
Irene Sanz-Corbalán ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Characteristic Curve ◽  
Glycosylated Hemoglobin ◽  
Diagnostic Value ◽  
Blood Parameters ◽  
Blood Parameter ◽  
Cross Sectional ◽  
Hemoglobin C ◽  
Diabetic Foot Osteomyelitis

The evidence is still unclear regarding the role of blood parameters in detecting complications in patients who suffer from diabetic foot osteomyelitis (DFO). In this study, the aim was to identify the capacity of different blood parameters in the diagnosis and prediction of the onset of complications. A cross-sectional prospective study was carried out with 116 DFO patients. The following blood parameters were evaluated during 1 year of follow-up: leukocytes, neutrophils, lymphocytes, monocytes, eosinophils, basophils, erythrocyte sedimentation rate (ESR), glycemia, glycosylated hemoglobin, C-reactive protein (CRP), alkaline phosphatase, albumin, and creatinine. Complication events were assessed for each participant during the study period. We investigated the association between blood parameter values and the onset of complication events by conducting a receiver operating characteristic curve analysis. Eighty-five (73.3%) patients developed complications. Regarding blood parameters, higher values of lymphocytes and albumin were predictive factors at the 12-month follow-up once the ulcer had healed. Higher values of ESR had predictive and diagnostic value for the onset of complication events, and higher values of CRP and hyperglycemia were diagnostic factors since they were elevated during the occurrence of an event. In conclusion, after suffering from DFO, the elevation of lymphocytes, ESR, CRP, albumin, and glycemia could be useful in detecting and diagnosing patients who are likely to develop a complication. Serial blood tests are a useful tool for early detection by healthcare professionals to prevent complications.

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.

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