title: [Diabetic foot osteomyelitis: is conservative treatment possible?].
abstract: BACKGROUND
  The aim of the present study is to determine the proportion of foot ulcers, complicated by osteomyelitis in diabetic patients, that heal without amputation. Furthermore, an attempt is made to analyze the main clinical and microbiological characteristics of episodes, and to identify potential predictive factors leading to the failure of conservative treatment.
  
  
  METHODS
  A prospective observational study was carried out between 2007 and 2009 on diabetic patients with a foot lesion and attending a diabetic foot clinic. A percutaneous bone biopsy was required to be included in the study.
  
  
  RESULTS
  A total of 81 episodes of diabetic foot osteomyelitis in 64 patients were evaluated. Staphylococcus aureus (28/81) and coagulase negative Staphylococcus (22/81) were the most frequent organisms isolated. Among the gramnegative group (34/81), non-fermenting gram negative bacteria were the most prevalent organisms isolated (14/81). Conservative treatment was successful in 73% of episodes. After a logistic regression analysis using the most significant prognostic variables, only lesion size greater than 2cm independently predicted failure of conservative treatment. Culture guided antibiotic treatment was associated with a better prognosis.
  
  
  CONCLUSIONS
  Conservative treatment, including culture-guided antibiotics, is successful without amputation in a large proportion of diabetic patients with diabetic foot osteomyelitis. Considering empiric therapy directed at non-fermenting gramnegative bacteria could be advisable in some cases, because they are frequently isolated in our setting.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España. Electronic address: qjordano@mutuaterrassa.es.
authors.forename: Queralt
authors.initials: Q
authors.lastname: Jordano-Montañez
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: Montse
authors.initials: M
authors.lastname: Muñiz-Tatay
authors.affiliation: Servicio de Endocrinología, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Viadé-Julià
authors.affiliation: Fundación Mútua de Terrassa para la Docencia y la Investigación Biomédica y Social, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: Angeles
authors.initials: A
authors.lastname: Jaen-Manzanera
authors.affiliation: Servicio de Cirugía Vascular, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: Josep
authors.initials: J
authors.lastname: Royo-Serrando
authors.affiliation: Servicio de Microbiología, Caltab.
authors.forename: Eva
authors.initials: E
authors.lastname: Cuchí-Burgos
authors.affiliation: Servicio de Endocrinología, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Anglada-Barceló
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra-Iserte
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D017719:Diabetic Foot / Q000150:complications* / Q000628:therapy; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Diabetes; Foot; Osteomielitis; Osteomyelitis; Pie