Retrospective analysis of diabetic foot osteomyelitis management and outcome at a tertiary care hospital in the UK.

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Retrospective analysis of diabetic foot osteomyelitis management and outcome at a tertiary care hospital in the UK.

PLoS One. 2019;14(5):e0216701

Authors: Arias M, Hassan-Reshat S, Newsholme W

Abstract
OBJECTIVES: This study aimed to analyse retrospectively management and outcomes of the diabetic foot osteomyelitis (DFOM) multi-disciplinary team at St Thomas' Hospital, London.
METHODS: Patients admitted during 2015 with diagnosis of DFOM were included. Data were obtained from medical and microbiology records.
RESULTS: 275 patients were admitted for DF infection in 2015: 45.1% had OM (75% males). 40% were newly diagnosed with DF ulcer (DFU). 81% patients had X-ray and 28% had MRI. Bone infection was confirmed by MC&S in 53% cases. 930 microbiological isolates were obtained: 63% were Gram-positive microorganisms [S.aureus and MRSA (~40%), CoNS (20%), and E.faecalis (8%)]. All MRSA were vancomycin and linezolid sensitive. 23.2% isolates were vancomycin-resistant enterococci. 24% isolates were Gram-negative organisms: P.aeruginosa (42%), E.coli (13%), and E.cloacae (12%). Meropenem resistance was low; 5.4% P.aeruginosa, 87.5% A.baumanii. 76% patients received co-amoxiclav; 41% received ≥3 antibiotics; 17% received >3 months antibiotics. Hospital mean-length of stay was 26.1 days. Ulcer time-to-heal was >6 months in 25% patients. 22% ulcers healed without surgery, 60% healed after minor amputation, 12% patients had major amputation.
CONCLUSION: Despite current MDT approach, many patients progress to amputation. DF-OM still represents a challenging clinical condition, requiring further study to develop better management guidelines.

PMID: 31095593 [PubMed - in process]