title: Successful limb-sparing treatment strategy for diabetic foot osteomyelitis.
abstract: BACKGROUND
  Diabetic foot osteomyelitis is common and causes substantial morbidity, including major amputations, yet the optimal treatment approach is unclear. We evaluated an approach to limb salvage that combines early surgical debridement or limited amputation with antimicrobial therapy.
  
  
  METHODS
  We conducted a retrospective cohort study of patients treated between May 1, 2005, and May 31, 2007. The primary end point was cure, defined as not requiring further treatment for osteomyelitis of the affected limb. The secondary end point was limb salvage, defined as not requiring a below-the-knee amputation or a more proximal amputation.
  
  
  RESULTS
  Fifty patients with diabetic foot osteomyelitis met the study criteria. Initial surgical management included local amputation in 43 patients (86%) and debridement without amputation in seven (14%). Most infections (n = 30; 60%) were polymicrobial, and Staphylococcus aureus was the most common pathogen (n = 23; 46%). Parenteral antibiotics were used in 45 patients (90%). Patients who had pathologic evidence of osteomyelitis at the surgical margin received therapy for a median of 43 days (interquartile range [IQR], 36-56 days), whereas those without evidence of residual osteomyelitis received therapy for a median of 19 days (IQR, 13-40 days). Overall, 32 patients (64%) were considered cured after a median follow-up of 26 months (IQR, 12-38 months). Fifteen of 18 patients (83%) who failed initial therapy were treated again with limb-sparing surgery. Limb salvage was achieved in 47 patients (94%), with only three patients (6%) requiring below-the-knee amputation.
  
  
  CONCLUSIONS
  In patients with diabetic foot osteomyelitis, surgical debridement or limited amputation plus antimicrobial therapy is effective at achieving clinical cure and limb salvage.
authors: Department of Medicine, Division of Infectious Diseases, Denver Health Medical Center, CO, USA. alisonbeieler@gmail.com
authors: Alison M
authors: AM
authors: Beieler
authors: Timothy C
authors: TC
authors: Jenkins
authors: Connie S
authors: CS
authors: Price
authors: Carla C
authors: CC
authors: Saveli
authors: Merribeth
authors: M
authors: Bruntz
authors: Robert W
authors: RW
authors: Belknap
mesh_terms: D000671:Amputation, Surgical; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003646:Debridement; D017719:Diabetic Foot / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents