Routine bacterial culture of proximal bone specimens during minor amputation in patients with diabetes‐related foot infections has little clinical utility in predicting re‐operation or ulcer healing
Background Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections of diabetes‐related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residu...
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| Published in | Journal of foot and ankle research Vol. 15; no. 1; pp. 64 - n/a |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
20.08.2022
BioMed Central Ltd Wiley |
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| Abstract | Background
Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections of diabetes‐related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra‐operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens.
Methods
Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra‐operative bone samples available. Patient outcomes were monitored up to 6 months post‐amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi‐Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable.
Results
A moderate‐high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13–0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21–0.94], P = 0.03) were independent risk factors for non‐healing.
Conclusion
There was a moderate‐high degree of concordance between superficial wound swab results and intra‐operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. |
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| AbstractList | Trans-phalangeal and trans-metatarsal amputation, collectively termed 'minor amputations' are important procedures for managing infections of diabetes-related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra-operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens.BACKGROUNDTrans-phalangeal and trans-metatarsal amputation, collectively termed 'minor amputations' are important procedures for managing infections of diabetes-related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra-operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens.Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra-operative bone samples available. Patient outcomes were monitored up to 6 months post-amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi-Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable.METHODSData was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra-operative bone samples available. Patient outcomes were monitored up to 6 months post-amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi-Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable.A moderate-high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13-0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21-0.94], P = 0.03) were independent risk factors for non-healing.RESULTSA moderate-high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13-0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21-0.94], P = 0.03) were independent risk factors for non-healing.There was a moderate-high degree of concordance between superficial wound swab results and intra-operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU.CONCLUSIONThere was a moderate-high degree of concordance between superficial wound swab results and intra-operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. Abstract Background Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections of diabetes‐related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra‐operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens. Methods Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra‐operative bone samples available. Patient outcomes were monitored up to 6 months post‐amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi‐Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable. Results A moderate‐high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13–0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21–0.94], P = 0.03) were independent risk factors for non‐healing. Conclusion There was a moderate‐high degree of concordance between superficial wound swab results and intra‐operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. Trans-phalangeal and trans-metatarsal amputation, collectively termed 'minor amputations' are important procedures for managing infections of diabetes-related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra-operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens. Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra-operative bone samples available. Patient outcomes were monitored up to 6 months post-amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi-Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable. A moderate-high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13-0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21-0.94], P = 0.03) were independent risk factors for non-healing. There was a moderate-high degree of concordance between superficial wound swab results and intra-operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. Background Trans-phalangeal and trans-metatarsal amputation, collectively termed 'minor amputations' are important procedures for managing infections of diabetes-related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra-operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens. Methods Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra-operative bone samples available. Patient outcomes were monitored up to 6 months post-amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi-Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable. Results A moderate-high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13-0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21-0.94], P = 0.03) were independent risk factors for non-healing. Conclusion There was a moderate-high degree of concordance between superficial wound swab results and intra-operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. Keywords: Diabetes, Foot, Diabetes-related foot ulcer, Osteomyelitis, Minor amputation, Bone, Swab Trans-phalangeal and trans-metatarsal amputation, collectively termed 'minor amputations' are important procedures for managing infections of diabetes-related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra-operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens. Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra-operative bone samples available. Patient outcomes were monitored up to 6 months post-amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi-Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable. A moderate-high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13-0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21-0.94], P = 0.03) were independent risk factors for non-healing. There was a moderate-high degree of concordance between superficial wound swab results and intra-operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. Background Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections of diabetes‐related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra‐operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens. Methods Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra‐operative bone samples available. Patient outcomes were monitored up to 6 months post‐amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi‐Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable. Results A moderate‐high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13–0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21–0.94], P = 0.03) were independent risk factors for non‐healing. Conclusion There was a moderate‐high degree of concordance between superficial wound swab results and intra‐operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. Background Trans-phalangeal and trans-metatarsal amputation, collectively termed ‘minor amputations’ are important procedures for managing infections of diabetes-related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra-operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens. Methods Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra-operative bone samples available. Patient outcomes were monitored up to 6 months post-amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi-Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable. Results A moderate-high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13–0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21–0.94], P = 0.03) were independent risk factors for non-healing. Conclusion There was a moderate-high degree of concordance between superficial wound swab results and intra-operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. Abstract Background Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections of diabetes‐related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra‐operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens. Methods Data was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra‐operative bone samples available. Patient outcomes were monitored up to 6 months post‐amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi‐Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable. Results A moderate‐high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13–0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21–0.94], P = 0.03) were independent risk factors for non‐healing. Conclusion There was a moderate‐high degree of concordance between superficial wound swab results and intra‐operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU. |
| Audience | Academic |
| Author | Ritter, Jens Carsten Hamilton, Emma J. Voon, Kimberly Hiew, Jonathan Vo, Uyen G. Hand, Robert Manning, Laurens |
| Author_xml | – sequence: 1 givenname: Kimberly surname: Voon fullname: Voon, Kimberly organization: Fiona Stanley Hospital – sequence: 2 givenname: Uyen G. surname: Vo fullname: Vo, Uyen G. organization: Fiona Stanley Hospital – sequence: 3 givenname: Robert surname: Hand fullname: Hand, Robert organization: Fiona Stanley Hospital – sequence: 4 givenname: Jonathan surname: Hiew fullname: Hiew, Jonathan organization: Fiona Stanley Hospital – sequence: 5 givenname: Jens Carsten surname: Ritter fullname: Ritter, Jens Carsten organization: Fiona Stanley Hospital – sequence: 6 givenname: Emma J. surname: Hamilton fullname: Hamilton, Emma J. organization: Fiona Stanley Hospital – sequence: 7 givenname: Laurens orcidid: 0000-0003-4334-5351 surname: Manning fullname: Manning, Laurens email: laurens.manning@uwa.edu.au organization: Fiona Stanley Hospital |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35987828$$D View this record in MEDLINE/PubMed |
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| Keywords | Osteomyelitis Minor amputation Swab Diabetes-related foot ulcer Bone Diabetes Foot |
| Language | English |
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| PublicationTitle | Journal of foot and ankle research |
| PublicationTitleAlternate | J Foot Ankle Res |
| PublicationYear | 2022 |
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| References_xml | – volume: 110 start-page: 147 issue: 2 year: 2015 end-page: 157 article-title: High burden of diabetic foot infections in the top end of Australia: an emerging health crisis (DEFINE study) publication-title: Diabetes Res Clin Pract – volume: 18 start-page: 822 issue: 10 year: 2001 end-page: 827 article-title: Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb‐threatening diabetic foot infection publication-title: Diabet Med – volume: 42 start-page: 57 issue: 1 year: 2006 end-page: 62 article-title: Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures publication-title: Clin Infect Dis – volume: 100 start-page: 1448 issue: 17 year: 2018 end-page: 1454 article-title: Culture of bone biopsy specimens overestimates rate of residual osteomyelitis after toe or forefoot amputation publication-title: J Bone Joint Surg Am – volume: 54 start-page: 132 issue: 12 year: 2012 end-page: 173 article-title: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections publication-title: Clin Infect Dis – volume: 5 start-page: 436 issue: 6 year: 2005 end-page: 440 article-title: 2005: The International Diabetes Federation focuses on the diabetic foot publication-title: Curr Diab Rep – volume: 4 start-page: 128 year: 2013 article-title: Beta‐lactamase induction and cell wall metabolism in Gram‐negative bacteria publication-title: Front Microbiol – volume: 36 start-page: 1 issue: e3280 year: 2019 end-page: 24 article-title: Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update) publication-title: Diabetes Metab Res Rev – volume: 32 start-page: 254 year: 2016 end-page: 260 article-title: Pitfalls in diagnosing diabetic foot infections publication-title: Diabetes Metab Res Rev – year: 2021 – volume: 55 start-page: 1148 issue: 6 year: 2016 end-page: 1157 article-title: Complete fifth ray amputation with peroneal tendon transfer to the cuboid: a review of consecutive cases Involving lateral column neuropathic foot ulceration and osteomyelitis publication-title: J Foot Ankle Surg – volume: 8 start-page: e019437 issue: 1 year: 2018 article-title: CODIFI (Concordance in Diabetic Foot Ulcer Infection): a cross‐sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England publication-title: BMJ Open – volume: 51 start-page: 749 issue: 6 year: 2012 end-page: 752 article-title: Rate of Residual Osteomyelitis after Partial Foot Amputation in Diabetic Patients: A Standardized Method for Evaluating Bone Margins with Intraoperative Culture publication-title: J Foot Ankle Surg – volume: 20 start-page: 90 year: 2020 end-page: 95 article-title: Diabetic foot ulcer classifications: A critical review publication-title: Diabetes Metab Res Rev – volume: 20 start-page: 90 issue: Suppl 1 year: 2004 end-page: 95 article-title: Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies publication-title: Diabetes Metab Res Rev – volume: 21 start-page: 705 issue: 7 year: 2004 end-page: 709 article-title: Swab cultures accurately identify bacterial pathogens in diabetic foot wounds not involving bone publication-title: Diabet Med – start-page: 229 year: 2015 end-page: 51 – year: 2012 – volume: 17 start-page: 88 year: 2021 end-page: 93 article-title: The Current Burden of Diabetic Foot Disease publication-title: J Clin Orthop Trauma – ident: e_1_2_12_9_1 doi: 10.1136/bmjopen‐2017‐019437 – ident: e_1_2_12_2_1 doi: 10.1007/s11892‐005‐0051‐y – volume: 36 start-page: 1 issue: 3280 year: 2019 ident: e_1_2_12_6_1 article-title: Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update) publication-title: Diabetes Metab Res Rev contributor: fullname: Lipsky BA – ident: 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Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections of... Trans-phalangeal and trans-metatarsal amputation, collectively termed 'minor amputations' are important procedures for managing infections of diabetes-related... Abstract Background Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections... Background Trans-phalangeal and trans-metatarsal amputation, collectively termed 'minor amputations' are important procedures for managing infections of... Background Trans-phalangeal and trans-metatarsal amputation, collectively termed ‘minor amputations’ are important procedures for managing infections of... Abstract Background Trans‐phalangeal and trans‐metatarsal amputation, collectively termed ‘minor amputations' are important procedures for managing infections... |
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| SubjectTerms | Amputation Amputation, Surgical - adverse effects Amputation, Surgical - methods Angioplasty Antibiotics Australia Bone Clinical medicine Comparative analysis Diabetes Diabetes Mellitus Diabetes‐related foot ulcer Diabetic foot Diabetic Foot - complications Diabetics Discordance Foot Foot diseases Foot Ulcer - complications Health aspects Humans Infection Infection control Infections Infectious diseases Kidney diseases Laboratories Leg ulcers Medical research Medicine, Experimental Metatarsus Microbiology Minor amputation Osteomyelitis Patients Retrospective Studies Risk factors Surgeons Surgery Swab Ulcer - complications Ulcers Variables Wounds |
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| Title | Routine bacterial culture of proximal bone specimens during minor amputation in patients with diabetes‐related foot infections has little clinical utility in predicting re‐operation or ulcer healing |
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