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Unique Identifier 97355835
Authors: Venkatesan P. Lawn S. Macfarlane RM. Fletcher EM. Finch RG. Jeffcoate WJ.
Institution: Department of Microbiology, City Hospital, Nottingham, UK.
Title: Conservative management of osteomyelitis in the feet of diabetic patients.
Source: Diabetic Medicine. 14(6):487-90, 1997 Jun.
Abstract: Experience of conservative management of osteomyelitis in a specialized, multidisciplinary, diabetic foot clinic was reviewed. The records of all patients attending the clinic over a 10-year period were examined retrospectively, and 22 patients with overt osteomyelitis were identified. Median age was 66 (31-87) years. In 12 cases the bone infection was a complication of a pre-existing ulcer; the most prevalent organism cultured from swabs was Staphylococcus aureus. The main site of infection was the first toe. The total duration of antibiotic treatment was 12 weeks (median, range 5-72), and clindamycin was the most commonly used oral agent. Four patients did not respond to initial conservative therapy and proceeded to amputation, while 1 patient responded clinically but had a recurrence of osteomyelitis at the same site 6 years later. In the remaining 17 patients resolution of osteomyelitis was achieved with conservative management over a median period of follow-up of 27 (range 5-73) months. The success of conservative therapy with prolonged courses of oral antibiotics challenges conventional advice that excision of infected bone is essential in the management of osteomyelitis affecting the foot in diabetes.

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Unique Identifier 96354773
Authors: Croll SD. Nicholas GG. Osborne MA. Wasser TE. Jones S.
Institution: Department of Surgery, Lehigh Valley Hospital, Allentown, PA 18105, USA.
Title: Role of magnetic resonance imaging in the diagnosis of osteomyelitis in diabetic foot infections.
Source: Journal of Vascular Surgery. 24(2):266-70, 1996 Aug.
Abstract: PURPOSE: The role of magnetic resonance imaging (MRI) in the diagnosis of osteomyelitis in foot infections in diabetics was investigated. The accuracy, sensitivity, and specificity of MRI, plain radiography, and nuclear scanning were determined for diagnosing osteomyelitis, and a cost comparison was made. METHODS: Twenty-seven patients with diabetic foot infections were studied prospectively. All patients underwent MRI and plain radiography. Twenty-two patients had technetium bone scans, and 19 patients had Indium scans. Nineteen patients had all four tests performed. Patients with obvious gangrene or a fetid foot were excluded. RESULTS: The diagnosis of osteomyelitis was established by pathologic specimen (n = 18), bone culture (n = 3), or successful response to medical management (n = 6). Osteomyelitis was confirmed in nine of the pathologic specimens. The diagnostic sensitivity, specificity, and accuracy for MRI was 88%, 100%, and 95%, respectively, for plain radiography it was 22%, 94%, and 70%, respectively, for technetium bone scanning it was 50%, 50%, and 50%, respectively, and for Indium leukocyte scanning it was 33%, 69%, and 58%, respectively. The data were analyzed statistically with the two-tailed Fisher's exact test. MRI was the only test that was statistically significant (p < 0.01). CONCLUSIONS: MRI appeared to be the single best test for the diagnosis of osteomyelitis associated with diabetic foot infections. It had a better diagnostic accuracy than conventional modalities and appeared to be more cost-effective than the frequently used Indium scan.

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Unique Identifier 95343128
Authors: Morrison WB. Schweitzer ME. Wapner KL. Hecht PJ. Gannon FH. Behm WR.
Institution: Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Title: Osteomyelitis in feet of diabetics: clinical accuracy, surgical utility, and cost-effectiveness of MR imaging.
Source: Radiology. 196(2):557-64, 1995 Aug.
Abstract: PURPOSE: To evaluate sensitivity, specificity, clinical utility, and cost-effectiveness of magnetic resonance (MR) imaging in the diagnosis of osteomyelitis of the foot in diabetics. MATERIALS AND METHODS: MR studies of 62 feet (diabetics [n = 27], nondiabetics [n = 35]) in 59 patients were prospectively evaluated to detect the presence and extent of osteomyelitis. Biopsy (n = 41 feet) and clinical follow-up (n = 62 feet) were used to establish the diagnosis, select treatment, and determine outcome; sensitivity and specificity of MR imaging were calculated. A cost analysis was performed. RESULTS: Sensitivity and specificity of MR imaging in the diagnosis of osteomyelitis were 82% and 80%, respectively, in diabetics and 89% and 94%, respectively, in nondiabetics. There was no recurrent infection at the surgical margin in 13 feet in which the area of limited resection had been delineated at MR imaging. CONCLUSION: MR imaging shows good sensitivity and specificity for diagnosing osteomyelitis in diabetic feet, and it is competitively priced compared with other imaging modalities. Accurate delineation of extent allows limited surgical resection, making MR imaging clinically useful and cost-effective.

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Unique Identifier 95299446
Authors: Lavery LA. Sariaya M. Ashry H. Harkless LB.
Institution: Department of Orthopedics/Podiatry, University of Texas Health Science Center at San Antonio, USA.
Title: Microbiology of osteomyelitis in diabetic foot infections.
Source: Journal of Foot & Ankle Surgery. 34(1):61-4, 1995 Jan-Feb.
Abstract: The objective of this report is to describe the bacterial pathogens in diabetic patients with osteomyelitis due to neuropathic foot ulcerations. The authors reviewed the records of 36 diabetic patients with osteomyelitis of the foot due to neuropathic ulceration. Intraoperative deep soft tissue and bone specimens were obtained from each patient. The mean age of patients was 56.7 years, and the mean duration of diabetes was 14.9 years. Streptococcus species (61%) and Staphylococcus aureus (47%) were the most common organisms identified. Gram-negative aerobes were found in 18 cultures (50%). Only five patients' cultures (14%) were identified with anaerobic pathogens. The average number of pathogens per patient was 2.25. The most common bacterial pathogens in bone infections in diabetics were Streptococcus species and Staphylococcus aureus. Anaerobes were uncommon.

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Unique Identifier 95156731
Authors: Grayson ML. Gibbons GW. Balogh K. Levin E. Karchmer AW.
Institution: Department of Medicine, New England Deaconess Hospital, Boston, Mass 02215.
Title: Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients
Source: JAMA. 273(9):721-3, 1995 Mar 1. [see comments]
Abstract: OBJECTIVE--To assess a bedside technique for diagnosing osteomyelitis. DESIGN--We prospectively assessed infected pedal ulcers for detectable bone by probing with a sterile, blunt, stainless steel probe. We then examined the relationship between detection of bone and the presence or absence of osteomyelitis that was defined histopathologically and/or clinically. SETTING--A tertiary care center. PATIENTS--Seventy-five hospitalized diabetic patients with a total of 76 infected foot ulcers were studied. RESULTS--Osteomyelitis was diagnosed in 50 instances (66%) and was excluded in 26 instances. Bone was detected by probing in 33 of 50 ulcers with contiguous osteomyelitis; in contrast, bone was probed in only four of 26 ulcers without contiguous osteomyelitis (P < .001). Bone detected on probing was visible in only three instances. Palpating bone on probing the pedal ulcer had a sensitivity of 66% for osteomyelitis, a specificity of 85%, a positive predictive value of 89%, and a negative predictive value of 56%. CONCLUSIONS--Palpation of bone in the depths of infected pedal ulcers in patients with diabetes is strongly correlated with the presence of underlying osteomyelitis. If bone is palpated on probing, specialized roentgenographic and radionuclide tests to diagnose osteomyelitis are unnecessary. Probing for bone should be included in the initial assessment of all diabetic patients with infected pedal ulcers.

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Unique Identifier 94012347
Authors: Gentry LO.
Institution: Infectious Disease Section, St. Luke's Episcopal Hospital, Houston, TX 77030.
Title: Diagnosis and management of the diabetic foot ulcer. [Review] [31 refs]
Source: Journal of Antimicrobial Chemotherapy. 32 Suppl A:77-89, 1993 Jul.
Abstract: Infected leg ulcers in patients with diabetes mellitus are a common and potentially serious problem. Neuropathy and vascular disease associated with diabetes mellitus allow the possibility of significant microbial invasion. Infections in diabetic patients are usually polymicrobial reflecting the normal flora of the foot skin. Curettage of the base of foot ulcers and deep tissue cultures are the most reliable methods for identifying the true pathogens, which are aerobic Gram-negative bacilli, anaerobes, and Staphylococcus aureus. Empirical antibiotic therapy should be directed against these pathogens. Once culture and sensitivity results are available, therapy should be targeted specifically for the pathogens present to prevent long-term use of broad-spectrum antibiotics. Preventive care of the foot in patients with diabetes mellitus is extremely important and may reduce complications associated with infections of the foot. [References: 31]

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