Oral antimicrobial therapy for diabetic foot osteomyelitis.
BACKGROUND
Osteomyelitis in the foot of a diabetic individual is a common complication of peripheral neuropathy, peripheral vascular disease, and infection. Operative facilities and home intravenous antibiotic therapy programs may not be available in remote or rural communities. Limited data are available regarding the treatment results of oral antimicrobial therapy, with or without limited office debridement for diabetic foot osteomyelitis.


METHODS
This retrospective medical record review of 325 consecutive diabetic patients who were evaluated at a multidisciplinary foot clinic identified 94 (29%) patients with 117 episodes of osteomyelitis. The most common group of organisms isolated were aerobic gram-positive cocci, and the single most frequent organism was Staphylococcus aureus. A mean of 1.6 +/- 0.8 (range 1 to 4) pathogens were recovered per episode of osteomyelitis. Therapy was guided by culture results. There were 93 episodes of osteomyelitis (79 patients) that were treated with a mean of 3 +/- 1 oral antimicrobial agents (with or without an initial short course of intravenous antimicrobial agents) and had adequate followup to evaluate outcome of treatment; office treatment included bone debridement in 26 (28%) and toe amputation in nine (10%) of the 93 episodes (79 patients).


RESULTS
Of the 93 episodes treated with oral antimicrobial agents (with or without an initial short course of intravenous antimicrobial agents), 75 (80.5%) episodes were put into remission. Mean duration of oral antimicrobial therapy was 40 +/- 30 weeks. Mean relapse-free followup duration was 50 +/- 50 weeks.


CONCLUSIONS
Diabetic foot osteomyelitis was effectively managed with oral antimicrobial therapy with or without limited office debridement in most patients. This regimen may be especially useful in communities where infectious disease specialists and operative resources are limited.
Embil
John M
JM
Department of Medcicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada. jembil@hsc.mb.ca
Rose
Greg
G
Trepman
Elly
E
Math
Mary Cheang M
MC
Duerksen
Frank
F
Simonsen
J Neil
JN
Nicolle
Lindsay E
LE
D000284:Administration, Oral; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003646:Debridement; D017719:Diabetic Foot / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005529:Foot Bones / Q000382:microbiology* / Q000601:surgery; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008682:Metatarsal Bones / Q000382:microbiology / Q000601:surgery; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors; D050277:Toe Phalanges / Q000382:microbiology / Q000601:surgery; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004338:Drug Combinations