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Diabetologia. 2008 Jun;51(6):962-7. doi: 10.1007/s00125-008-0976-1. Epub 2008 Apr 3.

Primarily non-surgical management of osteomyelitis of the foot in diabetes.

Author information

1
Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, Nottingham University Hospitals Trust, City Hospital Campus, Nottingham NG5 1PB, UK. fgame@futu.co.uk

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.

PMID:
18385975
DOI:
10.1007/s00125-008-0976-1
[Indexed for MEDLINE]

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