Original Research
The Effect of Residual Osteomyelitis at the Resection Margin in Patients with Surgically Treated Diabetic Foot Infection

https://doi.org/10.1053/j.jfas.2010.12.009Get rights and content

Abstract

The appropriate antibiotic treatment of surgically resected diabetic foot osteomyelitis is controversial. We conducted a retrospective cohort study to evaluate the prognostic impact of residual osteomyelitis at the surgical margin of surgically resected diabetic foot osteomyelitis, and to assess the effectiveness of postoperative antibiotic therapy for residual osteomyelitis after surgical resection of infected bone. Of the 111 patients included in the study, 39 (35.14%) had pathologically confirmed margins positive for residual osteomyelitis. The median total duration of antibiotic treatment was 19 (range 10–134) days in patients with positive margins, whereas it was 14 (range 2–63) days in those with negative margins (P = .01). No statistically significant difference (P = .695) was found in the primary outcome of definite failure, defined as pathologically or microbiologically confirmed infection relapse at the proximal amputation site, between 3 (7.69%) of 39 patients with positive margins and 4 (5.56%) of 47 patients with negative margins. A statistically significant difference (P = .001) in the secondary outcome, definite treatment failure, or the need for more proximal amputation was found between 17 (43.59%) of 39 patients with positive margins and 11 (15.28%) of 72 patients with negative margins. Residual osteomyelitis at the pathologic margin was associated with a higher rate of treatment failure, despite the longer duration of antibiotic therapy.

Section snippets

Study Design and Outcome Measures

This was a single-center (Gundersen Lutheran Medical Center, La Crosse, WI), retrospective cohort investigation of patients with diabetes mellitus and histologically confirmed osteomyelitis of the foot that was treated with antibiotics and surgical resection of infected bone. Surgical and medical treatment decisions were made at the discretion of the treating clinicians. In general, physician providers treated patients in a multidisciplinary fashion from departments including Internal Medicine,

Results

A total of 262 pathology reports from 241 patients were reviewed for inclusion in the study. Twenty-one patients (8.71%) had a second episode of osteomyelitis at a separate site, but only the initial episode of diabetic foot osteomyelitis was included in this study. One hundred thirty patients were excluded from the study, as follows: 108 patients had osteomyelitis in an area other than the foot, 9 patients did not have diabetes mellitus, 9 patients did not have sufficient pathologic

Discussion

Complete surgical excision of infected bone is considered the treatment of choice for osteomyelitis; however, short of amputation, complete excision is sometimes impossible in diabetic foot osteomyelitis. Recent guidelines suggest that antibiotic therapy route and duration in patients with diabetic foot osteomyelitis should be chosen based on the extent of surgical debridement performed and the presence of residual infected bone and tissue (1). Conceptually, this strategy is appealing, and our

References (8)

There are more references available in the full text version of this article.

Cited by (0)

Financial Disclosure: None reported.

Conflict of Interest: None reported.

View full text