title: Risk factors for developing osteomyelitis in patients with diabetic foot wounds.
abstract: OBJECTIVE
  Osteomyelitis worsens the prognosis in the diabetic foot, but predisposing factors remain largely undefined. In a prospectively followed cohort we assessed risk factors for developing osteomyelitis.
  
  
  METHODS
  We enrolled consecutive persons with diabetes who presented to a managed-care diabetes disease management program. The patients underwent standardized assessments. We monitored for all foot complications, defined infections by criteria consistent with International Working Group guidelines, and defined osteomyelitis as a positive culture from a bone specimen.
  
  
  RESULTS
  1666 persons were enrolled, 50% male, mean age 69 years. Over a mean of 27.2 months of follow-up, 151 patients developed foot infections, 30 (19.9%) of which involved bone. Independent risk factors for osteomyelitis were: wounds that extended to bone or joint (relative risk [RR]=23.1), previous history of a wound prior to enrollment (RR=2.2), and recurrent or multiple wounds during the study period (RR=1.9).
  
  
  CONCLUSIONS
  In this study population, managed in a specialized diabetic foot care center, the results suggest that independent risk factors for developing osteomyelitis are deep, recurrent and multiple wounds. These results may help clinicians target their efforts at diagnosing foot osteomyelitis to the highest risk patients.
authors.affiliation: Department of Surgery, Scott and White Hospital, Texas A&M University Health Science Center College of Medicine, Temple, TX, USA. llavery@swmail.sw.org
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: Edgar J G
authors.initials: EJ
authors.lastname: Peters
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wendel
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Murdoch
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000150:complications* / Q000601:surgery; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D006278:Medicare; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014481:United States; D014505:Urban Population; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult