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Abstract
Purpose
The question of surgical versus non-surgical treatment for diabetic foot osteomyelitis remains subject to debate. The aims of this study were to analyse the outcome of conservative treatment (antibiotic treatment and conservative surgery) for diabetic foot osteomyelitis and identify the predictive factors of remission in conservative treatment of diabetic foot osteomyelitis.
Materials and Methods
Seventy-seven patients with diabetic foot osteomyelitis who initially received conservative treatment from January 2004 to July 2013 were identified, and their medical records were reviewed. Diabetic foot osteomyelitis was defined by imaging studies or histological evidence. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 12 months after the end of treatment. The demographic, clinical, and therapeutic factors were analysed.
Results
The mean age of the patients was 62.7±12.2 years, and 47 patients (61.0%) were male. The median diabetes duration was 15.7±11.2 years and mean HbA1c was 8.7%±2.4%. Forty-eight patients (62.3%) healed with conservative treatment (antibiotic treatment and conservative surgery). Twenty-five patients (32.5%) underwent amputation. In the multivariate analysis, concomitant peripheral artery disease and inadequate antibiotic therapy were associated with failure of conservative treatment.
Conclusion
Antibiotics alone, or with conservative surgery, were successful in treatment of diabetic foot osteomyelitis in 62.3% of the patients. Concomitant peripheral artery disease and inadequate antimicrobial therapy were risk factors for remission in conservatively treated diabetic foot osteomyelitis.
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References
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Table 1.
Baseline Characteristics of Study Subjects
Table 2.
Bacteria Isolated from Wound and Bone Cultures
Table 3.
Clinical Characteristics Associated with Remission of Conservative Treatment in Patients with Diabetic Foot Osteomyelitis
| Characteristic | Failure (n=29) | Remission (n=48) | p-value* |
|---|---|---|---|
| Age (yr) | 61.2±12.1 | 63.6±12.3 | 0.422 |
| Sex (male/female) | 14/15 | 33/15 | 0.094 |
| HbA1c (%) | 8.5±2.32 | 8.4±3.0 | 0.884 |
| Diabetic duration (yr) | 15.1±16.7 | 18.9±19.2 | 0.389 |
| Diabetes with end organ damage | 17 (58.6) | 31 (64.6) | 0.617 |
| Insulin user | 18 (62.0) | 27 (56.2) | 0.138 |
| Underlying disease | |||
| Myocardial infarction | 1 (3.4) | 5 (10.4) | 0.400 |
| Congestive heart failure | 3 (10.3) | 7 (14.6) | 0.734 |
| Peripheral arterial disease | 21 (72.4) | 16 (33.3) | 0.001 |
| Cerebrovascular disease | 3 (10.3) | 8 (16.7) | 0.520 |
| Dementia | 0 (0) | 1 (2.1) | <1.000 |
| Connective tissue disease | 0 (0) | 1 (2.1) | <1.000 |
| Ulcer disease | 0 (0) | 1 (2.1) | <1.000 |
| Mild liver disease | 0 (0) | 1 (2.1) | <1.000 |
| Any tumor | 1 (3.4) | 4 (8.3) | 0.645 |
| Moderate to severe renal disease | 15 (52) | 13 (28.8) | 0.049 |
| Moderate to severe liver disease | 1 (3.4) | 1 (2.1) | <1.000 |
| Metastatic solid tumor | 0 (0) | 1 (2.1) | <1.000 |
| Adjunctive therapy | |||
| Percutaneous transluminal angioplasty | 6 (20.1) | 2 (4.1) | 0.047 |
| Irrigation and debridement | 25 (86.1) | 37 (76.2) | 0.327 |
| Vacuum application | 12 (41.3) | 16 (33.3) | 0.207 |
| Identified pathogen | 17 (68) | 39 (75) | 0.795 |
| Staphylococcus aureus infection | 7 (24.1) | 9 (18.8) | 0.560 |
| Duration of antibiotics therapy (wk) | 7.5±4.2 | 8.9±4.22 | 0.190 |
| Inadequate antibiotic therapy | 4 (13.8) | 44 (91.3) | <0.001 |
| Infectious diseases department consultation | 22 (75.9) | 38 (79.2) | 0.784 |
Table 4.
Multivariate Analysis with Independent Predictors of Remission of Conservative Treatment in Patients with Diabetic Foot Osteomyelitis
| Predictor | Failure (n=29) | Remission (n=48) | Total (n=77) | p-value* | p-value† | Odds ratio |
|---|---|---|---|---|---|---|
| Underlying disease | ||||||
| Peripheral arterial disease | 21 (72.4) | 16 (33.3) | 37 (48) | 0.001 | 0.006 | 0.229 |
| Moderate to severe renal disease | 15 (52) | 13 (28.8) | 28 (32.4) | 0.049 | 0.260 | 0.229 |
| Adjunctive therapy | ||||||
| Percutaneous transluminal angioplasty | 6 (24) | 2 (3.8) | 8 (10.3) | 0.047 | 0.889 | 1.18 |
| Inadequate antibiotic therapy | 13 (52) | 16 (30.7) | 29 (37.6) | <0.001 | <0.001 | 71.42 |
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