Application and Clinical Effectiveness of Antibiotic-Loaded Bone Cement to Promote Soft Tissue Granulation in the Treatment of Neuropathic Diabetic Foot Ulcers Complicated by Osteomyelitis: A Randomized Controlled Trial

Abstract

This study explored the clinical effectiveness of antibiotic-loaded bone cement on primary treatment of diabetic foot infection. This is a randomized controlled study, including thirty-six patients with diabetic foot ulcer complicated by osteomyelitis who had undergone treatment between May 2018 and December 2019. Patients were randomly divided into control group (group A) and study group (group B). Patients in the intervention group received antibiotic-loaded bone cement repair as primary treatment, while patients in the control group received conventional vacuum sealing draining treatment. Clinical endpoints were assessed and compared between the two groups, including wound healing time, wound bacterial conversion, NRS pain score, number of wound dressing changes, and average hospitalization time. All patients were followed up for a period of 12 months after discharge. Results show that compared with the control group, patients in the study group had significant difference in the number of patients for baseline pathogens eradication, short NRS pain score, hospital length of stay and cost, wound surface reduction, healing time, low rate of complications, and infection recurrence. Based on the findings, we conclude that antibiotic-loaded bone cement can be used for treatment of wound in patient with diabetic foot infection. It can help to control wound infections, shorten hospital length of stay, reduce medical cost, and relieve both doctors’ and patients’ burden. The application of antibiotic-loaded bone cement is suitable for diabetic wound with soft tissue infection or osteomyelitis.

Antibiotic‐loaded bone substitutes therapy in the management of the moderate to severe diabetic foot infection: A meta‐analysis

“…However, no additional articles that satisfied the inclusion criteria were discovered in these searches. After selection, seven studies were included for quantitative synthesis 30–36 …”

“…These studies seem to show that topical antibiotics can safely and effectively treat residual infections in stumps, as opposed to systemic antibiotics alone. In the included studies, Krause et al 32 and Martin et al 34 reported no antibiotic‐related adverse reactions, and Mendame et al 35 reported a difference in the incidence rate of complication between the two groups ( P < 0.05), but did not specify the type of complication. We hope to pay more attention to the antibiotics application manner, dose, timing, and drug‐related adverse reactions.…”

A meta‐analysis of the effectiveness of antibacterial bone cement in the treatment of diabetic foot skin wound infections

“…Thirteen papers, published between 2016 and 2023, from a total of 1237 linked research that met the inclusion criteria were chosen for the research 6,7,17–27 . The results of these results are provided in Table 2.…”

“…In the research that was utilized for the meta-analysis, 895 IDFWs persons were in the utilized researchers' starting point, 449 of them were utilizing ABC and 446 were control. 6,7,[17][18][19][20][21][22][23][24][25][26][27] ABC had significantly lower wound healing time, and time to BC of the wound compared to…”

Application of antibiotic bone cement in the treatment of infected diabetic foot ulcers in type 2 diabetes

“…Generally, it is worth noting that few studies have demonstrated the advantages of antibiotic bone cement in clinical treatment of infected DFU. Three similar studies such as Liu et al [ 5 ], Ehya et al [ 28 ] and Melamed et al [ 6 ] have found the adjunctive antibiotic bone cement to improve the outcomes in surgically treated diabetic foot osteomyelitis or infected diabetic foot ulcer. Liu et al reported that the healing duration was 13.1 ± 3.7 weeks in the PMMA group and 26.4 ± 7.8 weeks in the control group.…”