title: Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study.
abstract: 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.
authors.affiliation: Diabetic Foot Clinic, Dron Hospital, Tourcoing, France. esenneville@ch-tourcoing.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Senneville
authors.forename: Audrey
authors.initials: A
authors.lastname: Lombart
authors.forename: Eric
authors.initials: E
authors.lastname: Beltrand
authors.forename: Michel
authors.initials: M
authors.lastname: Valette
authors.forename: Laurence
authors.initials: L
authors.lastname: Legout
authors.forename: Marie
authors.initials: M
authors.lastname: Cazaubiel
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: Pierre
authors.initials: P
authors.lastname: Fontaine
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents