title: Primarily non-surgical management of osteomyelitis of the foot in diabetes.
abstract: OBJECTIVE
  We examined the use of surgery and assessed the response to non-surgical management of osteomyelitis of the foot in diabetic patients.
  
  
  METHODS
  We reviewed the records of all patients presenting to a single specialist centre with osteomyelitis complicating a diabetic foot ulcer over a 5 year period. Details were extracted on antibiotic choice and treatment duration, hospital admission, incidence of minor and major amputation, and 12 month outcomes.
  
  
  RESULTS
  There were 147 patients, with mean age 64.7 years (66% men). Of these, 26 (18%) were admitted to hospital at the time of presentation and managed with intravenous antibiotics; the remainder were managed with oral antibiotics as outpatients. Surgery was undertaken because of life- or limb-threatening infection, or failure to respond, in 34 (23%) patients (minor amputation 28, major amputation six patients). The remaining 113 were managed non-surgically. Remission was induced in 66 (58.4% of 113), while 35 (31%) had a relapse. Of those experiencing relapse, 27 (77%) achieved apparent arrest of the infection with a further course of antibiotics; six underwent minor and two underwent major amputation. Of all 113 whose infection was initially managed without surgery, apparent remission was achieved with antibiotics alone in 93 (82.3%).
  
  
  CONCLUSIONS
  As these observations were made in an unselected case series, they give more insight into the respective roles of surgical and non-surgical management. The results confirm that although urgent surgery is indicated in some patients, non-surgical management of those without limb-threatening infection is associated with a high rate of apparent remission.
authors.affiliation: Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, Nottingham University Hospitals Trust, City Hospital Campus, Nottingham NG5 1PB, UK. fgame@futu.co.uk
authors.forename: F L
authors.initials: FL
authors.lastname: Game
authors.forename: W J
authors.initials: WJ
authors.lastname: Jeffcoate
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010045:Outpatients
chemical_list: D000900:Anti-Bacterial Agents