title: Methicillin-Resistant Staphylococcus aureus in Foot Osteomyelitis.
abstract: BACKGROUND
  Conflicting studies exist regarding the impact of methicillin-resistant Staphylococcus aureus (MRSA) on increased time to wound healing, future need for surgical procedures, and likelihood of treatment failure in patients with diabetic foot osteomyelitis. The purpose of this study is to determine the overall significance of MRSA in predicting treatment failure in bone infections of the foot and to determine an appropriate pre-operative and empiric post-operative antibiotic regimen.
  
  
  METHODS
  Patients presenting with an initial episode of "probable" or "definite" foot osteomyelitis were included for review and analysis if the following criteria were met: (1) Osteomyelitis occurred in the foot (i.e., distal to the malleoli of the ankle); episodes occurring above the ankle were excluded. (2) Patients received either no antibiotics or only oral antibiotics for long-term treatment; episodes managed with long-term parenteral antibiotics were excluded. (3) The infection was managed initially with medical therapy or conservative surgical therapy; episodes managed with major (above-ankle) amputation as the initial treatment were excluded. The primary objective of this study was to assess whether episodes of foot osteomyelitis associated with MRSA resulted in treatment failure more frequently than not.
  
  
  RESULTS
  Of 178 episodes included in the study, 50 (28.1%) episodes had treatment failure. Median time-to-treatment failure was 60 days (range 7-598 days). In 28.1% (9/32 episodes) in which treatment failure occurred and 39.0% (41/105) episodes in which no treatment failure occurred, MRSA was present. The presence of MRSA was not significantly associated with treatment failure (p = 0.99).
  
  
  CONCLUSIONS
  The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.
authors.affiliation: 1 Department of Pharmacy, Michael E. DeBakey Veterans Affairs Medical Center . Houston, Texas.
authors.forename: Chester N
authors.initials: CN
authors.lastname: Ashong
authors.affiliation: 1 Department of Pharmacy, Michael E. DeBakey Veterans Affairs Medical Center . Houston, Texas.
authors.forename: Shazia A
authors.initials: SA
authors.lastname: Raheem
authors.affiliation: 1 Department of Pharmacy, Michael E. DeBakey Veterans Affairs Medical Center . Houston, Texas.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Hunter
authors.affiliation: 2 Department of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center . Houston, Texas.
authors.forename: Cezarina
authors.initials: C
authors.lastname: Mindru
authors.affiliation: 3 Division of Vascular and Endovascular Surgery, Michael E. DeBakey Department of Surgery Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center , Houston, Texas.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
mesh_terms: D000368:Aged; D017719:Diabetic Foot / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology
keywords: MRSA; MSSA; diabetes; osteomyelitis; staphylococcal infections