Outcome of patients with diabetes with negative percutaneous bone biopsy performed for suspicion of osteomyelitis of the foot

Abstract

The results of the present study suggest that, of patients with diabetes with the suspicion of osteomylelitis and a negative percutaneous bone biopsy, only one out of four will develop osteomyelitis within 2 years of the biopsy.

Osteomyelitis in the diabetic foot

“…For diabetic foot OM, bone scans have a sensitivity of 80–90% but a specificity of less than 50% (25–27). The poor specificity relates to inability of the bone scan to distinguish OM from other inflammatory or traumatic conditions involving the bone, such as Charcot neuroarthropathy joint disease, bone metastasis, gout, fracture, or even recent surgery (28, 29).…”

“…WBC scans have a sensitivity of at least 80% and a specificity of at least 70% for diabetic foot OM (25–27). WBC scanning shows soft tissue infection and is not bone specific and therefore correlation with the results of a bone scan is useful with a sensitivity and specificity of 80–90% (30).…”

“…If surgery is not performed, bone cultures may be obtained via percutaneous biopsy through an area of uninvolved skin (39). The precision of this approach can be questioned and Senneville et al (27) found that after transcutaneous biopsies for culture, 1 in 4 ‘normal’ results were false negatives. Needle aspiration when compared to transcutaneous bone biopsy was shown to be unreliable with only 33% concordance with transcutaneous biopsy culture results (40).…”

Das diabetische Fußsyndrom

“…Positive mikrobiologische und negative histologische Befunde finden sich im gleichen Ausmaß wie negative mikrobiologische und positive histologische Ergebnisse. Eine Studie zeigt, dass keine Methode der anderen überlegen ist und eine mikrobiologische Testung mit Erregernachweis und Resistenzbestimmung von Knochensequestern bei Verdacht auf Osteomyelitis ausreichend ist [20].…”

Factors predictive of treatment failure in staphylococcal prosthetic vascular graft infections: a prospective observational cohort study: impact of rifampin

“…In addition, details on antimicrobial agents used, their route of administration and their duration were not mentioned in most published studies [7-12]. Antimicrobial agents with bactericidal properties and activities against biofilm, such as rifampin (RIF), were of interest in PVGI [13,14], as reported in treatment of prosthetic valve infective endocarditis [15-18] and prosthetic joint infection [19-22]. …”