Role of bone biopsy specimen culture in the management of diabetic foot osteomyelitis.
BACKGROUND
There has been increasing evidence in favor of conservative management of diabetic foot osteomyelitis which requires targeted antibiotic therapy to the causative pathogen. But the method of reliable microbiological isolation is controversial.


OBJECTIVE
To study the concordance of superficial swab culture with bone biopsy specimen culture in patients with diabetic foot osteomyelitis.


METHODS
A prospective study was conducted from July 2008 to July 2010. All consecutive patients with suspected diabetic foot osteomyelitis were included in the study. Superficial swab and Percutaneous bone biopsy specimens were obtained for culture. The culture results in these two groups were compared for concordance.


RESULTS
A total of 144 patients were included in the study. 134 cases of bone biopsy specimen and 140 cases of superficial swab showed positive culture results. Mean number of isolate per sample was similar. Staphylococcus aureus was the commonest organism grown in both cultures. The bone pathogen was identified in the corresponding swab culture in only 55 cases (38.2%). Staphylococcus aureus had the highest concordance percentage of 46.5% which was not statistically significant.


CONCLUSIONS
Superficial swab culture may not be accurate in identifying all the organisms causing diabetic foot osteomyelitis. Bone biopsy specimen taken simultaneously would increase the accuracy of detecting the bacterial isolate.
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. elamurugan_tp@yahoo.co.in
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Elamurugan
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Jagdish
Vikram
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Kate
Subhash
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Chandra Parija
D001706:Biopsy; D001842:Bone and Bones / Q000473:pathology*; D017719:Diabetic Foot / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008828:Microbiological Techniques; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*