629-P: Bedside Blind Bone Biopsy for Diagnosis of Diabetic Foot Osteitis Allows Similar Healing Rate as Conventional Bone Biopsy

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 629-P
Author(s):  
FLORINE FÉRON ◽  
LOUIS POTIER ◽  
GAUTHIER PÉAN DE PONFILLY ◽  
DIANE-CÉ CILE GAUTHIER ◽  
ANNE-LISE MUNIER ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Rate ◽  
Bone Biopsy

scholarly journals The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

2021 ◽  
Vol 10 (7) ◽  
pp. 1495
Author(s):  
Yu-Chi Wang ◽  
Hsiao-Chen Lee ◽  
Chien-Lin Chen ◽  
Ming-Chun Kuo ◽  
Savitha Ramachandran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Early Period ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Management ◽  
Control Group ◽  
Diabetic Patients ◽  
High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

Culture Concordance in Different Sections of the Metatarsal Head: Interpretations of Microbiological Results

2021 ◽  
pp. 153473462110037
Author(s):  
Raul Juan Molines-Barroso ◽  
Esther García-Morales ◽  
David Sevillano-Fernández ◽  
Yolanda García-Álvarez ◽  
Francisco J. Álvaro-Afonso ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Bacterial Load ◽  
False Negative ◽  
Metatarsal Bone ◽  
High Rate ◽  
Microbiological Analysis ◽  
High Tendency ◽  
Metatarsal Bones ◽  
Bone Biopsies

Microbiological cultures of per-wound bone biopsies have shown a lack of correlation and a high rate of false-negative results when compared with bone biopsy cultures in diabetic foot osteomyelitis. The selection of samples from the area of active osteomyelitis, which contains a complete census of the microorganisms responsible for the infection, is essential to properly guide antimicrobial treatment. We aimed to comparatively evaluate the quantitative and qualitative cultures taken from different areas, in metatarsal heads resected for osteomyelitis. For this purpose, we consecutively selected 13 metatarsal heads from 12 outpatients with plantar ulcers admitted to our diabetic foot unit. Metatarsal heads were divided transversally into 3 portions: plantar (A), central (B), and dorsal (C), and the 39 resulting samples were cultured. Qualitative and quantitative microbiological analysis was performed, and the isolated species and bacterial load, total and species specific, were compared between the 3 metatarsal bone segments. The primary outcome of the study was the bacterial diversity detected in the different bone sections. Cultures were positive in 12 of the 13 included metatarsal heads (92%). A total of 34 organisms were isolated from all specimens. Ten of the 12 cultures (83%) were polymicrobial. Ten of the 13 metatarsal heads (77%) had identical microbiological results in each of the 3 bone sections. The largest number of microorganisms was found in the central section. The overall concordance between sections was 91%. The predominant microorganisms were coagulase-negative staphylococci (41%). Statistical differences were not found in the bioburden between sections (range 3.25-3.41 log10 colony-forming unit/g for all sections; P = .511). The results of our study suggest that microorganisms exhibit a high tendency to spread along the metatarsal bone and that the degree of progression along the bone is species dependent. The central portions of metatarsal bones tend to accumulate a higher diversity of species. Thus, we recommend this area of bone for targeted biopsy in patients with suspected osteomyelitis.

Healing Rate of Diabetic Foot Wounds When Treated with Serial Debridement in the Presence of Antithrombotic Therapy

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Jack Route
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Antithrombotic Therapy ◽  
Healing Rate ◽  
Standard Of Care ◽  
Significant Negative Correlation ◽  
Arterial Disease ◽  
Wound Area ◽  
Negative Effect ◽  
Peripheral Arterial

Background Previous study indicates that pharmacologic antithrombotic therapy may be an inhibitory factor for wound healing and should merit consideration among the other core factors in wound healing optimization. Methods This study provides a retrospective analysis of the effect of antithrombotic therapy on wound healing rates of uncomplicated diabetic foot ulcerations. Wounds treated with standard of care in the presence of clinical anticoagulation were compared to control wounds. Results The results indicate a statistically significant negative correlation between antithrombotic therapy and diabetic foot wound healing rate. This represents the first study focusing on this correlation in the uncomplicated diabetic foot wound. Conclusions This retrospective study demonstrates that antithrombotic therapy has a statistically significant negative effect on healing rates of uncomplicated diabetic foot ulcerations. Both wound area and depth improvement over 4 weeks was significantly better in treated patients who were not on antithrombotic therapy for comorbidity not associated with peripheral arterial disease.

scholarly journals Percutaneous Bone Biopsy for Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Marcos C Schechter ◽  
Mohammed K Ali ◽  
Benjamin B Risk ◽  
Adam D Singer ◽  
Gabriel Santamarina ◽  
...  
Keyword(s):  
Adverse Events ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Meta Analysis ◽  
Positive Culture ◽  
High Yield ◽  
Analysis Model ◽  
Antibiotic Management ◽  
Culture Positive ◽  
Diabetic Foot Osteomyelitis

Abstract Background Diabetes is the leading cause of lower extremity nontraumatic amputation globally, and diabetic foot osteomyelitis (DFO) is usually the terminal event before limb loss. Although guidelines recommend percutaneous bone biopsy (PBB) for microbiological diagnosis of DFO in several common scenarios, it is unclear how frequently PBBs yield positive cultures and whether they cause harm or improve outcomes. Methods We searched the PubMed, EMBASE, and Cochrane Trials databases for articles in any language published up to December 31, 2019, reporting the frequency of culture-positive PBBs. We calculated the pooled proportion of culture-positive PBBs using a random-effects meta-analysis model and reported on PBB-related adverse events, DFO outcomes, and antibiotic adjustment based on PBB culture results where available. Results Among 861 articles, 11 studies met inclusion criteria and included 780 patients with 837 PBBs. Mean age ranged between 56.6 and 71.0 years old. The proportion of males ranged from 62% to 86%. All studies were longitudinal observational cohorts, and 10 were from Europe. The range of culture-positive PBBs was 56%–99%, and the pooled proportion of PBBs with a positive culture was 84% (95% confidence interval, 73%–91%). There was heterogeneity between studies and no consistency in definitions used to define adverse events. Impact of PBB on DFO outcomes or antibiotic management were seldom reported. Conclusions This meta-analysis suggests PBBs have a high yield of culture-positive results. However, this is an understudied topic, especially in low- and middle-income countries, and the current literature provides very limited data regarding procedure safety and impact on clinical outcomes or antibiotic management.

Association Between Cigarette Smoking and Diabetic Foot Healing: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 17 (4) ◽  
pp. 247-257 ◽  
Author(s):  
Xue-Lei Fu ◽  
Hui Ding ◽  
Wei-Wei Miao ◽  
Hong-Lin Chen
Keyword(s):  
Sensitivity Analysis ◽  
Wound Healing ◽  
Cigarette Smoking ◽  
Cohort Studies ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Meta Analysis ◽  
Negative Effect ◽  
Retrospective Cohort Studies ◽  
Leave One Out

The role of smoking for wound healing in patients with diabetic foot has been unclear. This meta-analysis examined the relationship between cigarette smoking and diabetic foot wound healing. Observational studies for the association between smoking and diabetic foot wound healing of patients were systematically searched through PubMed and Wanfang Data, published up to June 2018. Healing rates of wounds were recognized as outcomes. Meta-analysis models were chosen by heterogeneity. A total of 3388 eligible studies were identified, of which 18 met all our inclusion criteria. In the smoking group, healing rate had an average of 62.1%, ranging from 20.0% to 89.6%; in the nonsmoking group, healing rate had an average of 71.5%, ranging from 40.2% to 93.8%. A significant association was found between smoking and the healing of diabetic foot wounds ( z = 3.08; P = .002), with an odds ratio (OR) of 0.70 (95% CI = 0.56-0.88), based on a random-effects model. Meta-regression analyses indicated that the heterogeneity did not come from publication year ( t = −0.50, P = .622) or overall healing rate ( t = 0.16, P = .872). The leave-one-out sensitivity analysis was robust; sensitivity analysis for pooled estimate of adjusted ORs had an OR of 0.20 (95% CI = 0.07-0.56; z = 3.08; P = .002). Subgroup analysis had an OR of 0.62 (95% CI = 0.41-0.95; z = 2.21; P = .027) in retrospective cohort studies and had an OR of 0.75 (95% CI = 0.57-0.99; z = 2.02; P = .043) in prospective cohort studies. Our meta-analysis indicated that smoking had an overall negative effect on the wound healing of diabetic foot individuals. This study provides evidence for the harm of smoking to diabetic foot and may help reduce the medical and economic burden on poor healing of diabetic foot.

Blood cultures after bone biopsy in diabetic foot osteomyelitis

2017 ◽  
Vol 89 (1) ◽  
pp. 78-79 ◽  
Author(s):  
Paule Letertre-Gibert ◽  
Françoise Desbiez ◽  
Magali Vidal ◽  
Natacha Mrozek ◽  
Pereira Bruno ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Blood Cultures ◽  
Diabetic Foot Osteomyelitis

scholarly journals Are surrogate markers for diabetic foot osteomyelitis remission reliable?

2020 ◽  
Author(s):  
Peter A Crisologo ◽  
Matthew Malone ◽  
Javier La Fontaine ◽  
Orhan Oz ◽  
Kavita Bhavan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Surrogate Marker ◽  
Surrogate Markers ◽  
Bone Culture ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Index Site ◽  
Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

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