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OUTCOME OF DIABETIC FOOT OSTEOMYELITIS TREATED NON-SURGICALLY: A RETROSPECTIVE COHORT STUDY

¹Diabetic Foot Clinic, Dron Hospital, Tourcoing
²Department of Orthopedic Surgery, Dron Hospital, Tourcoing
³ Department of Diabetology, CHRU of Lille, France

esenneville{at}ch-tourcoing.fr

ABSTRACT

Objective: To identify criteria predictive of remission in non-surgical treatment of diabetic foot osteomyelitis.

Research Design And Methods: Diabetic patients were identified who were initially treated without orthopedic surgery for osteomyelitis of the toe or metatarsal head of a non-ischemic foot, between June 2002 and June 2003 in 9 French diabetic foot centers, and their medical records were reviewed. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least one year after the end of treatment. A total of 24 demographic, clinical and therapeutic variables including bone versus swab-culture-based antibiotic therapy were analyzed.

Results: Fifty consecutive patients with a mean age of 62.2 ± 11.1 years and mean diabetes duration of 16 ± 10.9 years were included. The mean duration of antibiotic treatment was 11.5 ± 4.21 weeks. Bone biopsy was routinely available in 4 of the 9 centers. Overall patient management was similar in the different centers except for the use of rifampin, which was recorded more frequently in patients from centers where bone biopsy was available. At the end of a 12.8 month post-treatment mean follow-up, 32 patients (64%) were in remission. Bone-culture-based antibiotic therapy was the only variable associated with remission, as determined by both univariate [18/32 (56.3%) vs. 4/18 (22.2%), P=0.02] and multivariate analysis (OR 4.78, 95% IC 1.0-22.7, P=0.04).

Conclusions: Bone-culture-based antibiotic therapy is a factor predictive of success in diabetic patients treated non-surgically for osteomyelitis of the foot.

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