[Emergence of monomicrobial methicillin-resistant Staphylococcus aureus infections in diabetic foot osteomyelitis (retrospective study of 48 cases)].
OBJECTIVE
Describe the clinical appearance, microorganisms involved, and prognosis of diabetic foot osteomyelitis.


METHODS
Retrospective study of 48 patients seen in 2004 for presumed osteomyelitis (exposed bone or suggestive radiographic or clinical picture). Specimens for culture came from swabs of wound discharge, needle aspiration and bone biopsy.


RESULTS
Forty-eight patients with diabetes and contiguous osteomyelitis of the foot were followed for a year. The principal microorganisms isolated were Staphylococcus aureus (58%) and Gram-negative bacilli (29%); 58% of the infections were monomicrobial, 31% of the microorganisms multidrug-resistant, and 85% of the patients were hospitalized, for a median duration of 30 days. Healing occurred in 40 patients, although 15 required amputation first, and 18 had a new infection at a different site (11 involving osteomyelitis) in the year after antibiotic treatment ended.


CONCLUSIONS
Diabetic foot osteomyelitis is a serious disease in view of its site and the microorganisms involved, which are often multidrug-resistant. There is a clear predominance of S. aureus. Medical treatment has an increasingly important role in its management and requires that samples be properly collected for bacteriological testing. The prognosis for these infections, which remains grim in view of the amputation rate and the high risk of new infection, could be improved by reinforcing prevention measures.
Couret
Gaëlle
G
Service des maladies infectieuses et tropicales, Hôtel-Dieu, CHU, Clermont-Ferrand (63); Service d'endocrinologie, Hôpital Gabriel Montpied, CHU, Clermont-Ferrand (63).
Desbiez
Françoise
F
Thieblot
Philippe
P
Tauveron
Igor
I
Bonnet
Richard
R
Beytout
Jean
J
Laurichesse
Henri
H
Lesens
Olivier
O
D000671:Amputation, Surgical; D002118:Calcium / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000382:microbiology; D017719:Diabetic Foot / Q000382:microbiology* / Q000601:surgery; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology* / Q000601:surgery; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects*; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D002118:Calcium