title: The value of inflammatory markers to diagnose and monitor diabetic foot osteomyelitis.
abstract: In this study, we assessed the effectiveness of inflammatory markers to diagnose and monitor the treatment of osteomyelitis in the diabetic foot. We evaluated 35 consecutive patients admitted to our hospital with infected foot ulcers. Patients were divided in two groups based on the results of bone culture and histopathology: osteomyelitis and no osteomyelitis. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor alpha (TNFα), monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein-1 alpha (MIP1α) were measured at baseline after 3 and 6 weeks of standard therapy. PCT levels in the osteomyelitis group were significantly higher at baseline than in the group with no osteomyelitis (P = 0·049). There were no significant differences between the two groups in the levels of the other markers. CRP, ESR, PCT and IL-6 levels significantly declined in the group with osteomyelitis after starting therapy, while MCP-1 increased (P = 0·002). TNFα and MIP1α levels were below range in 80 out of 97 samples and therefore not reported. Our results suggest that PCT might be useful to distinguish osteomyelitis in infected foot ulcers. CRP, ESR, PCT and IL-6 are valuable when monitoring the effect of therapy.
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.|Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Suzanne Av
authors.initials: SA
authors.lastname: Van Asten
authors.affiliation: Department of Orthopaedics, Sanford Health, Sioux Falls, SD, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Nichols
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: La Fontaine
authors.affiliation: Department of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Kavita
authors.initials: K
authors.lastname: Bhavan
authors.affiliation: Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Edgar Jg
authors.initials: EJ
authors.lastname: Peters
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015331:Cohort Studies; D017719:Diabetic Foot / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D002116:Calcitonin
keywords: Biomarkers; Diabetic foot infection; Erythrocyte sedimentation rate; Osteomyelitis; Procalcitonin