Limited forefoot amputation in diabetic patients with osteomyelitis is frequently required. We retrospectively reviewed diabetic patients with osteomyelitis, an unhealed ulcer and blood pressure in the toe of > 45 mmHg who underwent limited amputation of the foot with primary wound closure. Between 2006 and 2012, 74 consecutive patients with a mean age of 67 years (29 to 93), and a median follow-up of 31 months, were included. All the wounds healed primarily at a median of 37 days (13 to 210; mean 48). At a median of 6 months (1.5 to 18; mean 353 days), 23 patients (31%) suffered a further ulceration. Of these, 12 patients (16% of the total) required a further amputation. We conclude that primary wound closure following limited amputation of the foot in patients with diabetes is a safe and effective technique when associated with appropriate antibiotic treatment.

Endospores have the ability to withstand extreme temperature, desiccation, ultraviolet radiation and chemicals which make them a threat to the food and healthcare industry. Green tea polyphenols (GTP), contain anti-microbial and anti-spore properties but not stable. In this study, two modified lipophilic green tea polyphenols, epigallocatechin-3-gallate-sterate (EGCG-S) and crude lipophilic green tea polyphenols (LTP), were used to compare their anti-spore effect with EGCG and crude GTP. Purified endospores from Bacillus cereus (B. cereus), B. megaterium and B. subtilis were treated with 1% or 5% of four tea polyphenols. Log reduction showed colony forming units (CFU) reduced significantly in all treated samples, ranging from 1.27 to 4.31 with no survivals (CFU = 0) in four samples (P < 0.05). Average percentage of inhibition for these polyphenols treatment ranged from 91.68% to 100%. The EGCG-S and LTP have equal or better anti-spore activities compared with EGCG and GTP.EGCG-S and LTP were further used to carry out time course study on B. cereus.The results indicated that 15 min of treatment of 1% and 5% LTP and EGCG-S are able to inhibit 98.7% to 100% of germination. Transmission and scanning electron microscopy studies showed that EGCG-S caused surface disruption and damaged spores structural integrity. EGCG-S and LTP are stable anti-spore agents may aid in preventing food and beverage spoilage caused by sporeforming bacteria as well as preventing contamination in the medical industry.

OBJECTIVES: Although a growing body of evidence suggests that early transition to oral antimicrobial therapy is equally efficacious to prolonged intravenous antibiotics for treatment of acute pediatric osteomyelitis, little is known about the pediatric trends in peripherally inserted central catheter (PICC) placements. Using a national database, we examined incidence rates of pediatric hospitalizations for acute osteomyelitis in the United States from 2007 through 2016, as well as the trends in PICC placement, length of stay (LOS), and cost associated with these hospitalizations.METHODS: This was a retrospective, serial cross-sectional study of the National Inpatient Sample database from 2007 through 2016. Patients #18 years of age with acute osteomyelitis were identified by using appropriate diagnostic codes. Outcomes measured included PICC placement rate, LOS, and inflation-adjusted hospitalization costs. Weighted analysis was reported, and a hierarchical regression model was used to analyze predictors. RESULTS:The annual incidence of acute osteomyelitis increased from 1.0 to 1.8 per 100 000 children from 2007 to 08 to 2015 to 16 (P < .0001), whereas PICC placement rates decreased from 58.8% to 5.9% (P < .0001). Overall, changes in LOS and inflation-adjusted hospital costs were not statistically significant. PICC placements and sepsis were important predictors of increased LOS and hospital costs.CONCLUSIONS: Although PICC placement rates for acute osteomyelitis significantly decreased in the face of increased incidence of acute osteomyelitis in children, LOS and hospital costs for all hospitalizations remained stable. However, patients receiving PICC placements had longer LOS. Further studies are needed to explore the long-term outcomes of reduced PICC use.