title: Are granulocyte colony-stimulating factors beneficial in treating diabetic foot infections?: A meta-analysis.
abstract: OBJECTIVE
  To assess the value of granulocyte colony-stimulating factor (G-CSF) as adjunctive therapy for diabetic foot infections.
  
  
  METHODS
  We systematically searched the medical literature (including Medline, Embase, LookSmart, and the Cochrane Library) for prospective randomized studies that used G-CSF as an adjunct to standard treatment for diabetic foot infections. Using a conventional meta-analysis, we pooled the relative risks (RRs) for outcomes of interest, including resolution of infection, wound healing, duration of antibiotic therapy, and need for various surgical interventions, using a fixed-effects model.
  
  
  RESULTS
  Five randomized trials, with a total of 167 patients, met our inclusion criteria. The methodological quality of the studies was satisfactory. The investigators administered various G-CSF preparations parenterally for between 3 and 21 days. The meta-analysis revealed that adding G-CSF did not significantly affect the resolution of infection or the healing of the wounds but was associated with a significantly reduced likelihood of lower extremity surgical interventions (RR 0.38 [95% CI 0.20-0.69], number of patients who needed to be treated: 4.5), including amputation (0.41 [0.17-0.95], number of patients who needed to be treated: 8.6). There was no evidence of heterogeneity among the studies or of publication bias, suggesting that these conclusions are reasonably generalizable and robust.
  
  
  CONCLUSIONS
  Adjunctive G-CSF treatment does not appear to hasten the clinical resolution of diabetic foot infection or ulceration but is associated with a reduced rate of amputation and other surgical procedures. The small number of patients who needed to be treated to gain these benefits suggests that using G-CSF should be considered, especially in patients with limb-threatening infections.
authors.affiliation: University of Washington, School of Medicine, Director, General Internal Medicine Clinic, VA Puget Sound Health Care System (S-111-GIMC), 1660 South Columbian Way, Seattle, WA 98108-1597, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Cruciani
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
authors.forename: Carlo
authors.initials: C
authors.lastname: Mengoli
authors.forename: Fausto
authors.initials: F
authors.lastname: de Lalla
mesh_terms: D000671:Amputation, Surgical; D001424:Bacterial Infections / Q000188:drug therapy*; D017719:Diabetic Foot / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D023821:Limb Salvage; D016032:Randomized Controlled Trials as Topic
chemical_list: D016179:Granulocyte Colony-Stimulating Factor