Primarily non-surgical management of osteomyelitis of the foot in diabetes

• Published in: Diabetologia Vol. 51; no. 6; pp. 962 - 967
• Main Authors: Game, F. L, Jeffcoate, W. J
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.06.2008; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Anti-Bacterial Agents - therapeutic use; Antibiotics; Associated diseases and complications; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Debridement; Denervation; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diabetic foot; Diabetic Foot - drug therapy; Diabetic Foot - surgery; Diabetic Foot - therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Foot diseases; Gangrene; Hospitals; Human bacterial diseases; Human Physiology; Humans; infection; Infectious diseases; Internal Medicine; Leg ulcers; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; osteomyelitis; Osteomyelitis - drug therapy; Osteomyelitis - surgery; Osteomyelitis - therapy; Outpatients; Remission (Medicine); Sepsis; Staphylococcus infections; Surgery; Ulcer; X-rays; Infection; Osteomyelitis; Antibiotics; Amputation; Diabetic foot; Gangrene; Ulcer; Diabetes; Endocrinopathy; Skin disease; Nervous system diseases; Diabetic Foot; Diabetes mellitus; Diseases of the osteoarticular system; Antibiotic; Osteitis; Disease of the foot
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-008-0976-1

Aims/hypothesis We examined the use of surgery and assessed the response to non-surgical management of osteomyelitis of the foot in diabetic patients. Methods We reviewed the records of all patients presenting to a single specialist centre with osteomyelitis complicating a diabetic foot ulcer over a 5 year period. Details were extracted on antibiotic choice and treatment duration, hospital admission, incidence of minor and major amputation, and 12 month outcomes. Results There were 147 patients, with mean age 64.7 years (66% men). Of these, 26 (18%) were admitted to hospital at the time of presentation and managed with intravenous antibiotics; the remainder were managed with oral antibiotics as outpatients. Surgery was undertaken because of life- or limb-threatening infection, or failure to respond, in 34 (23%) patients (minor amputation 28, major amputation six patients). The remaining 113 were managed non-surgically. Remission was induced in 66 (58.4% of 113), while 35 (31%) had a relapse. Of those experiencing relapse, 27 (77%) achieved apparent arrest of the infection with a further course of antibiotics; six underwent minor and two underwent major amputation. Of all 113 whose infection was initially managed without surgery, apparent remission was achieved with antibiotics alone in 93 (82.3%). Conclusions/interpretation As these observations were made in an unselected case series, they give more insight into the respective roles of surgical and non-surgical management. The results confirm that although urgent surgery is indicated in some patients, non-surgical management of those without limb-threatening infection is associated with a high rate of apparent remission.