Calcium sulphate as a drug delivery system in a deep diabetic foot infection.
Treating diabetic foot infection is costly, time consuming and challenging for the patient and clinician alike. It requires a multidisciplinary approach to provide a favourable outcome but all too often results in amputation. We present a patient with Type 2 diabetes who attended clinic with a limb threatening foot infection complicated by osteomyelitis and requiring emergency surgery and antibiotic administration. Our patient underwent surgery by means of an incision and drainage procedure with local antibiotic administration to augment systemic antibiotics. The wound was packed with calcium sulphate (Stimulan(®) Biocomposites Ltd.) impregnated with gentamicin and vancomycin to enable high antibiotic concentrations at the site of infection. The patient made a full recovery at four months requiring only minimal bone excision to maintain a functional foot. This case demonstrates an alternative route for antibiotic administration to overcome some of the limitations of systemic administration including penetration at the site of infection, systemic toxicity, prolonged hospital admission and cost. This route of administration is being increasingly used as an alternative to systemic antibiotics at our centre.
Department of Podiatric Surgery, Buxton Hospital, London Road, Buxton, Derbyshire SK17 9NJ, United Kingdom. Electronic address: robertmorley@nhs.net.
Robert
R
Morley
Department of Podiatric Surgery, Buxton Hospital, London Road, Buxton, Derbyshire SK17 9NJ, United Kingdom. Electronic address: AXYH30@dsl.pipex.com.
Felix
F
Lopez
Department of Podiatric Surgery, Buxton Hospital, London Road, Buxton, Derbyshire SK17 9NJ, United Kingdom. Electronic address: frankwebb@nhs.net.
Frank
F
Webb
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002133:Calcium Sulfate; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000188:drug therapy*; D016503:Drug Delivery Systems; D004359:Drug Therapy, Combination; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D002133:Calcium Sulfate
Antibiotics; Calcium sulphate; Diabetes; Foot infection; Osteomyelitis