scholarly journals Surgical techniques for Bone Biopsy in Diabetic Foot Infection, and association between results and treatment duration

2020 ◽  
Vol 5 (4) ◽  
pp. 198-204
Author(s):  
Eric Senneville ◽  
Donatienne Joulie ◽  
Nicolas Blondiaux ◽  
Olivier Robineau
Keyword(s):  
Diabetic Foot ◽  
Treatment Duration ◽  
Bone Biopsy ◽  
Imaging Techniques ◽  
Surgical Techniques ◽  
Antimicrobial Treatment ◽  
Diabetic Foot Infection ◽  
Patient’S Outcome ◽  
The Impact ◽  
Bone Margin

Abstract. Surgery is an important part of the management of patients diagnosed with DFO. It consists in some selected patients, to remove all or part of the infected bone(s) or even to amputate all or part of the foot. Despite the use of sophisticated imaging techniques, it is however difficult to remove all the infected tissue while respecting the principles of an economical surgery. Bone biopsy performed at the margins of the resection permits to identify residual osteomyelitis and to adjust the post-surgical antibiotic treatment. Some recent studies have reported the way to perform bone margin biopsies and have assessed the impact of the bone results on the patient's outcome. However, the real impact of a residual osteomyelitis on the risk of recurrent DFO is still debated and questions regarding the interpretation of the results remain to be solved. Similarly, the consequences in terms of choice and duration of the antimicrobial treatment to use in case of positive bone margin are not clearly established.

scholarly journals How Do Preoperative Antibiotics Affect Culture Yield in Diabetic Foot Infections?

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Heather Young ◽  
Whitney Miller ◽  
Randy Burnham ◽  
Susan Heard ◽  
Chrystal Berg ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Negative Results ◽  
Diabetic Foot Infections ◽  
Preoperative Antibiotics ◽  
The Impact ◽  
Culture Negative ◽  
Culture Yield

abstractThe impact of preoperative antibiotics on culture of diabetic foot infection samples has not been studied. We found that increasing exposure to preoperative antibiotics was associated with less frequent growth of streptococci and anaerobes and more culture-negative results. In contrast, the yield of Staphylococcus aureus and Gram-negative bacilli was unaffected.

The Impact of Hospitalization for Diabetic Foot Infection on Health-Related Quality of Life: Utilizing PROMIS

2021 ◽  
Author(s):  
Matthew J. Johnson ◽  
Dane K. Wukich ◽  
Paul A. Nakonezny ◽  
Lawrence A. Lavery ◽  
Javier La Fontaine ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Health Related Quality ◽  
Diabetic Foot Infection ◽  
Related Quality ◽  
Health Related ◽  
The Impact

scholarly journals Time-to-Report of the Bone Culture and Microbiologic Adequacy of Empiric Antibiotics in Patient’s with Diabetic Foot Osteomyelitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S94-S95
Author(s):  
Hyun Kyung Kim ◽  
Olga Vasylyeva
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Anaerobic Bacteria ◽  
Accurate Method ◽  
Bone Culture ◽  
Culture Result ◽  
Gram Positive ◽  
Diabetic Foot Infection ◽  
Superficial Wound ◽  
Diabetic Foot Osteomyelitis

Abstract Background Bone cultures in diabetic foot infection is the most accurate method to identify causative pathogen, while there is only 30% concordance between superficial wound swab and bone biopsy cultures. Diabetic foot infection is commonly polymicrobial, therefore report on the bone biopsy culture may come with several updates before it is finalized. Our study is aimed to describe how often additional pathogens were identified after patients’ discharge on antibiotics therapy for diabetic foot osteomyelitis, and evaluate microbiological appropriateness of antibiotic regimen upon discharge based on the final result of the bone culture. Methods Medical records of the patients 18 years old or older, who had inpatient bone biopsy, deep tissue debridement or amputation for diabetic foot infection, were reviewed from January 2014 through Dec 2015 in Rochester Regional Health System. Antibiotic regimens for the patients discharged before final culture result were evaluated for microbiological appropriateness by two reviewers trained in infectious diseases. Results In total, 198 procedures were screened, 158 procedures met inclusion criteria, out of which 74 patients with 80 procedures (51%) were discharged before the final culture result was available. Average time from procedure to the final culture report was 6 days, and from discharge to the final culture was 3.7 days. In most of the cases (70%, 56 out of 80) the patients were discharged on empiric regimen discordant with final culture result. Predominant organisms were Gram-positive bacteria 74%, with Gram negatives 24%, and yeast 2%. Most infections were polymicrobial (81%), mixed with anaerobic bacteria in 37%. The most frequent isolates were Staphylococcus aureus (15%), Corynebacterium (14%), anaerobic Gram-positive cocci (12%), and Staphylococcus epidermidis (8%). All negative Gram stains (31%, 25 out of 80) had positive growth on culture. Conclusion Half of the patients with diabetic foot osteomyelitis, who underwent bone biopsy, were discharged before final culture results were available. Most of them were discharged on empiric regimen discordant with final culture. This data suggests that careful outpatient follow-up on the final culture would likely result in modification of antibiotics therapy to target newly reported pathogen. Disclosures All authors: No reported disclosures.

scholarly journals The analysis for time of referral to a medical center among patients with diabetic foot infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cheng-Wei Lin ◽  
Hui-Mei Yang ◽  
Shih-Yuan Hung ◽  
I-Wen Chen ◽  
Yu-Yao Huang
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Poor Prognosis ◽  
Medical Center ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Diabetic Foot Infection ◽  
The Impact

Abstract Background Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. Methods This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. Results One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028). Conclusions The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. Trial registration Not applicable.

scholarly journals Culturomics Approach to Identify Diabetic Foot Infection Bacteria

2021 ◽  
Vol 22 (17) ◽  
pp. 9574
Author(s):  
Michał Złoch ◽  
Ewelina Maślak ◽  
Wojciech Kupczyk ◽  
Marek Jackowski ◽  
Paweł Pomastowski ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Culture Media ◽  
Bacterial Species ◽  
Microbial Composition ◽  
Diabetic Foot Infection ◽  
Flight Mass Spectrometry ◽  
Diabetic Foot Infections ◽  
Corynebacterium Striatum ◽  
Vancomycin Resistant ◽  
The Impact

The main goal of the study was to evaluate the usefulness of the culturomics approach in the reflection of diabetic foot infections (DFIs) microbial compositions in Poland. Superficial swab samples of 16 diabetic foot infection patients (Provincial Polyclinical Hospital in Toruń, Poland) were subjected to culturing using 10 different types of media followed by the identification via the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and Biotyper platform. Identified 204 bacterial isolates representing 18 different species—mostly Enterococcus faecalis (63%) and Staphylococcus aureus (44%). Most of the infections (81%) demonstrated a polymicrobial character. Great differences in the species coverage, the number of isolated Gram-positive and Gram-negative bacteria, and the efficiency of the microbial composition reflection between the investigated media were revealed. The use of commonly recommended blood agar allowed to reveal only 53% of the entire microbial composition of the diabetic foot infection samples, which considerably improved when the chromagar orientation and vancomycin-resistant enterococi agar were applied. In general, efficiency increased in the following order: selective < universal < enriched < differential media. Performed analysis also revealed the impact of the culture media composition on the molecular profiles of some bacterial species, such as Corynebacterium striatum, Proteus mirabilis or Morganella morganii that contributed to the differences in the identification quality. Our results indicated that the culturomics approach can significantly improve the accuracy of the reflection of the diabetic foot infections microbial compositions as long as an appropriate media set is selected. The chromagar orientation and vancomycin-resistant enterococi agar media which were used for the first time to study diabetic foot infection microbial profiles demonstrate the highest utility in the culturomics approach and should be included in further studies directed to find a faster and more reliable diabetic foot infection diagnostic tool.

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

The Impact of Plate Imaging Techniques on Flexographic Printed Conductive Traces

2012 ◽  
Vol 56 (4) ◽  
pp. 1-8 ◽  
Author(s):  
Bruce E. Kahn ◽  
Liam H. O’Hara ◽  
Chip Tonkin ◽  
Howard E. Nelson ◽  
William J. Ray ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
The Impact

scholarly journals Boosting Immunity against Multiple Myeloma

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1221
Author(s):  
Raquel Lopes ◽  
Bruna Velosa Ferreira ◽  
Joana Caetano ◽  
Filipa Barahona ◽  
Emilie Arnault Carneiro ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Residual Disease ◽  
Proteasome Inhibitors ◽  
Treatment Strategies ◽  
Complete Response ◽  
Drug Conjugates ◽  
Incurable Disease ◽  
Car T ◽  
Patient’S Outcome ◽  
The Impact

Despite the improvement of patient’s outcome obtained by the current use of immunomodulatory drugs, proteasome inhibitors or anti-CD38 monoclonal antibodies, multiple myeloma (MM) remains an incurable disease. More recently, the testing in clinical trials of novel drugs such as anti-BCMA CAR-T cells, antibody–drug conjugates or bispecific antibodies broadened the possibility of improving patients’ survival. However, thus far, these treatment strategies have not been able to steadily eliminate all malignant cells, and the aim has been to induce a long-term complete response with minimal residual disease (MRD)-negative status. In this sense, approaches that target not only myeloma cells but also the surrounding microenvironment are promising strategies to achieve a sustained MRD negativity with prolonged survival. This review provides an overview of current and future strategies used for immunomodulation of MM focusing on the impact on bone marrow (BM) immunome.

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