Osteomyelitis in patients with diabetes presents significant clinical challenges, often leading to prolonged treatments and complex surgical decisions. A recent study by our long-time toemigo Lavery et al. (2024) published in The International Wound Journal delves into whether complete resection of infected bone improves outcomes in these patients.
The study analyzed data from 171 diabetic patients who underwent surgical treatment for osteomyelitis, dividing them into two groups: those with no residual osteomyelitis (NRO) after surgery and those with residual osteomyelitis (RO). Surprisingly, the study found that while patients in the NRO group experienced shorter durations of antibiotic therapy both during and after hospitalization, the overall 12-month outcomes—such as wound healing, re-infection, and hospitalization rates—did not significantly differ between the two groups.
Key findings included:
• Shorter antibiotic courses: Patients with complete resection (NRO) had significantly shorter durations of antibiotic treatment (21 days vs. 37 days during hospitalization and 42 days vs. 50 days during follow-up).
• Higher amputation rates: Patients in the NRO group had higher rates of amputation during the initial hospitalization.
• Similar long-term outcomes: Both groups exhibited similar rates of wound healing, re-infection, and hospitalization over the 12-month follow-up period.
This study challenges the assumption that complete resection necessarily leads to better long-term outcomes. The findings suggest that surgical decisions should consider patient preferences and the balance between resection and other therapeutic strategies, as long-term results may not be substantially impacted by complete resection alone.
Citation:
Lavery LA, Tarricone AN, Reyes MC, et al. “Does complete resection of infected bone improve clinical outcomes in patients with diabetic foot osteomyelitis?” Int Wound J. 2024;21:e70072. DOI: 10.1111/iwj.70072.
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