title: Staphylococcus aureus-Related Diabetic Osteomyelitis: Medical or Surgical Management? A French and Spanish Retrospective Cohort.
abstract: Staphylococcus aureus is the main cause of diabetic foot osteomyelitis (DFO) and can be treated medically or by surgery. We investigated the outcome of consecutive patients with a diagnosis of S aureus DFO retrospectively in 4 hospitals according to the type of management, medical (including debridement at bedside) or surgical. The outcome was classified as either favorable or failure (relapse, impaired wound healing, or amputation). Seventy-four patients with S aureus DFO, including 26 with methicillin-resistant S aureus, were included with a mean duration of follow-up of 21 ± 1 months. As part of the initial treatment, 47% underwent bone surgery followed with a short course of antibiotic. Others were treated with antibiotic therapy alone with bedside debridement. The outcome was favorable for 84% of these patients, with similar rates in the surgical and medical groups (80% vs 87%, P > .05). Patients in the medical group were less frequently hospitalized (49% vs 94%, P < .001) and had a shorter length of hospital stay (17 ± 3 vs 50 ± 12 days, P = .004). Patients in the surgery group received a shorter course of antibiotic therapy (10 ± 2 vs 11 ± 1 weeks, P = .001) with fewer side effects (9% vs 33%, P = .01). The type of management was not associated with subsequent new episode of noncontiguous DFO, which developed in 32% of cases. In conclusion, except significant differences in duration of hospitalization and antibiotic therapy, medical and surgical management of S aureus DFO had similar outcomes with a cure rate >80%.
authors.affiliation: Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France olesens@chu-clermontferrand.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesens
authors.affiliation: Service d'endocrinologie Hôpital Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Desbiez
authors.affiliation: Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Theïs
authors.affiliation: University of Lyon Claude Bernard, Lyon, France Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Tristant
authors.initials: T
authors.lastname: Ferry
authors.affiliation: Centre hospitalier d'Annecy, Metz-Tessy, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Bensalem
authors.affiliation: Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Laurichesse
authors.affiliation: University of Lyon Claude Bernard, Lyon, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Tauveron
authors.affiliation: Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Beytout
authors.affiliation: La Paloma Hospital, Las Palmas de Gran Canaria, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Aragón Sánchez
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement; D003657:Decision Making; D017719:Diabetic Foot / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D010019:Osteomyelitis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Staphylococcus aureus; amputation; diabetic foot; osteomyelitis