A recent study conducted by our colleagues from the Canary Islands, Aragon-Sanchez et al., investigated the association between residual osteomyelitis at the resection margin and the recurrence of diabetic foot infection. The researchers aimed to determine if positive bone margins, confirmed by microbiology and pathology, were linked to worse outcomes. The findings provide valuable insights into the treatment of osteomyelitis in diabetic patients.
The prospective study included 93 patients with diabetes-related foot osteomyelitis, all of whom underwent bone resection. Additional bone biopsies were taken at the resection margin. The primary outcome measured was the recurrence of the infection. The researchers found that pathology-confirmed positive margins were detected in 66.7% of cases, while microbiology-confirmed positive margins were detected in 80.6% of cases. However, there was no significant association between positive margins and the recurrence of the infection.
Out of the 93 patients, 19 experienced a recurrence of the infection (20.4%). Statistical analysis failed to establish a significant association between the recurrence and either pathology-confirmed positive margins (p=0.82) or microbiology-confirmed positive margins (p=0.34). The use of postoperative antibiotics also did not show a significant association with the recurrence (p=0.70). Healing time was similar between patients with positive and negative margins.
Furthermore, the study revealed that 55.7% of patients with pathology-confirmed positive margins were treated without postoperative antibiotics. Interestingly, there was no association between the use of postoperative antibiotics and the recurrence of the infection in this group (p=0.47).
The study by Aragon-Sanchez et al. from the Canary Islands demonstrates that the presence of positive margins after conservative surgery for diabetic foot osteomyelitis was not associated with an increased risk of infection recurrence. Moreover, the time to healing was comparable between patients with positive and negative margins. These findings suggest that residual osteomyelitis at the resection margin may not require postoperative antibiotic therapy in certain cases. The study highlights the potential for a more tailored and conservative approach to treating diabetic foot osteomyelitis.
Link to the study: Residual osteomyelitis at the resection margin after conservative surgery is not associated with the recurrence of diabetic foot infection and may successfully be treated without postoperative antibiotic therapy