Some compelling work from our SALSAmigos at University of Manchester as well as Riyadh and Adelaide via Dr. Malone.
Diabetes Metab Res Rev. 2013 May 7. doi: 10.1002/dmrr.2425. [Epub ahead of print]
Podiatry Department, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia; Department of Surgery, Podiatric Surgery Unit, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
Osteomyelitis is a major complication in patients with diabetic foot ulceration. Accurate pathogenic identification of organisms can aid the clinician to a specific antibiotic therapy thereby preventing the need for amputation.
All diabetic patients with bone biopsy- confirmed osteomyelitis were included into the study: biopsies were performed either during surgical removal of infected bone, or percutaneously under guided fluoroscopy through non-infected tissue. The depth and extent of the ulcer was assessed using a sterile blunt metal probe. Deep wound cultures were taken from the wound base after sharp debridement.
Of 66 cases of suspected Osteomyelitis in 102 joints, 34 patients had both bone biopsies and deep wound cultures over the study period. Thirty two of 34 (94%), had a history of preceding foot ulceration, and in 25 of the cases a positive probe to bone test was recorded. In a high proportion of patients, at least one similar organism was isolated from both the deep wound culture and bone biopsy procedures (n = 25, 73.5% of cases; p < 0.001). When organisms were isolated from both wound cultures and bone biopsies, the identical strain was identified in both procedures in a significant proportion of cases (n = 14, 56% of cases; p < 0.001.
Deep wound cultures correlate well with osseous cultures and provide a sensitive method in assessing and targeting likely pathogens that cause osseous infections. This will help aid the clinician in guiding antibiotic therapy in centers where bone biopsies may not be readily available. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.