Author(s): Game FL, Jeffcoate WJ
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Abstract AIMS/HYPOTHESIS: We examined the use of surgery and assessed the response to non-surgical management of osteomyelitis of the foot in diabetic patients. METHODS: We reviewed the records of all patients presenting to a single specialist centre with osteomyelitis complicating a diabetic foot ulcer over a 5 year period. Details were extracted on antibiotic choice and treatment duration, hospital admission, incidence of minor and major amputation, and 12 month outcomes. RESULTS: There were 147 patients, with mean age 64.7 years (66\% men). Of these, 26 (18\%) were admitted to hospital at the time of presentation and managed with intravenous antibiotics; the remainder were managed with oral antibiotics as outpatients. Surgery was undertaken because of life- or limb-threatening infection, or failure to respond, in 34 (23\%) patients (minor amputation 28, major amputation six patients). The remaining 113 were managed non-surgically. Remission was induced in 66 (58.4\% of 113), while 35 (31\%) had a relapse. Of those experiencing relapse, 27 (77\%) achieved apparent arrest of the infection with a further course of antibiotics; six underwent minor and two underwent major amputation. Of all 113 whose infection was initially managed without surgery, apparent remission was achieved with antibiotics alone in 93 (82.3\%). CONCLUSIONS/INTERPRETATION: As these observations were made in an unselected case series, they give more insight into the respective roles of surgical and non-surgical management. The results confirm that although urgent surgery is indicated in some patients, non-surgical management of those without limb-threatening infection is associated with a high rate of apparent remission.
This article was published in Diabetologia
and referenced in Clinical Pharmacology & Biopharmaceutics