Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study.
OBJECTIVE
The purpose of this article was to identify criteria predictive of remission in nonsurgical treatment of diabetic foot osteomyelitis.


METHODS
Diabetic patients who were initially treated without orthopedic surgery for osteomyelitis of the toe or metatarsal head of a nonischemic foot between June 2002 and June 2003 in nine French diabetic foot centers were identified, and their medical records were reviewed. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 1 year after the end of treatment. A total of 24 demographic, clinical, and therapeutic variables including bone versus swab culture-based antibiotic therapy were analyzed.


RESULTS
Fifty consecutive patients aged 62.2 +/- 11.1 years (mean +/- SD) with diabetes duration of 16 +/- 10.9 years were included. The mean duration of antibiotic treatment was 11.5 +/- 4.21 weeks. Bone biopsy was routinely available in four of the nine centers. Overall patient management was similar in the different centers except for the use of rifampin, which was recorded more frequently in patients from centers in which a bone biopsy was available. At the end of a 12.8-month posttreatment mean follow-up, 32 patients (64%) were in remission. Bone culture-based antibiotic therapy was the only variable associated with remission, as determined by both univariate (18 of 32 [56.3%] vs. 4 of 18 [22.2%], P = 0.02) and multivariate analyses (odds ratio 4.78 [95% CI 1.0-22.7], P = 0.04).


CONCLUSIONS
Bone culture-based antibiotic therapy is a factor predictive of success in diabetic patients treated nonsurgically for osteomyelitis of the foot.
Senneville
Eric
E
Diabetic Foot Clinic, Dron Hospital, Tourcoing, France. esenneville@ch-tourcoing.fr
Lombart
Audrey
A
Beltrand
Eric
E
Valette
Michel
M
Legout
Laurence
L
Cazaubiel
Marie
M
Yazdanpanah
Yazdan
Y
Fontaine
Pierre
P
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017719:Diabetic Foot / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D016106:Methicillin Resistance; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D018579:Patient Selection; D011859:Radiography; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents