Utility of Culturing Marginal Bone in Patients Undergoing Lower Limb Amputation for Infection

Shiraev, Timothy; Lipsky, Benjamin A.; Kwok, Trevor M. Y.; Robinson, David

doi:10.1053/j.jfas.2018.12.012

Cited by 11 publications

(12 citation statements)

References 13 publications

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“…If we confirm our pilot findings, the clinical implications, especially for improved antibiotic stewardship of in the field of DFO [60] might be substantial. Until further results are present, we agree with recommendations of up to six weeks of antibiotic therapy when residual infected bone is suspected or proven [25,[61][62][63][64][65][66].…”

Section: Duration Of Antibiotic Therapysupporting

confidence: 73%

“…After a complete surgical resection of all infected and necrotic bone, many experts only warrant a short very duration of antimicrobial therapy (2-5 days) to finish with a remaining soft tissue infection [18,59,60]. However, surgeons frequently doubt about the clinical absence of residual bone infection in the proximal amputation stump [63][64][65]. The IWGDF recommends sampling the marginal, remaining bone for evidence of residual infection; and advocates a up to 6 weeks of a consecutive, targeted antimicrobial therapy if the residual bone samples return with positive microbiological results [33].…”

Section: Duration Of Antibiotic Therapy After Surgical Resection Of Dfomentioning

confidence: 99%

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Diabetic Foot Osteomyelitis: Frequent Pathogens and Conservative Antibiotic Therapy

Vogel¹,

Huber²,

Uçkay³

2021

Infections and Sepsis Development

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Chronic diabetic foot osteomyelitis (DFO) is a frequent complication in adult polyneuropathy patients with long-standing diabetes mellitus. Regarding the conservative therapy, there are several crucial steps in adequate diagnosing and approaches. The management should be performed in a multidisciplinary approach following the findings of recent research, general principles of antibiotic therapy for bone; and according to (inter-)national guidance. In this chapter we emphasize the overview on the state-of-the-art management regarding the diagnosis and antibiotic therapy in DFO. In contrast, in this general narrative review and clinical recommendation, we skip the surgical, vascular and psychological aspects.

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Section: Duration Of Antibiotic Therapysupporting

confidence: 73%

Section: Duration Of Antibiotic Therapy After Surgical Resection Of Dfomentioning

confidence: 99%

Diabetic Foot Osteomyelitis: Frequent Pathogens and Conservative Antibiotic Therapy

Vogel¹,

Huber²,

Uçkay³

2021

Infections and Sepsis Development

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“…A DFO-k esetén IWGDF nem javasol 6 hétnél hosszabb terápiát, ha a beteg állapota nem javul az első pár hetet követően, akkor megfontolandó a csontbiopszia vétele mikrobiológiai tenyésztéshez, sebészeti terápia bevezetése vagy egy alternatív antibiotikum-terápiára váltás [5,34,48]. Ha egy DFO-s beteg esetén a nekrotikus csontszövetet teljes egészében eltávolították, a legtöbb irányelv egyetért, hogy csupán 2-5 napos antibiotikum-terápia szükséges [72]. Fontos kiemelni azonban, hogy néhány vizsgálatban azt figyelték meg, hogy a betegek több mint 30%-ában reziduális osteomyelitis alakul ki a külsőleg egészségesnek tűnő csontszövetben; ezért az IWGDF ajánlása, hogy az ép csontszövet marginális részéből készüljön biopszia mikrobiológiai tenyésztés céljából [5].…”

Section: Ajánlások a Terápia Időtartamára Az Adagolás Módjáraunclassified

Non-surgical therapy of diabetic foot infections based on recent guidelines and published data

Urbán

García-Lorenzana

2020

Bulletin of Medical Sciences

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Chronic, non-communicable diseases are affecting the lives of more and more people worldwide; due to obesity and inadequate eating habits, the proportion of diabetics is on an increasing trend globally. The development of a number of macro- and microangiopathic pathologies associated with the onset of diabetes affects the life expectancy of patients. Diabetic foot infection (DFI) is one of the most serious long-term complications of diabetes and may be considered an intersection of infectious and non-infectious diseases; these infections can significantly reduce the quality of life of affected patients. The purpose of this review was to summarize the latest recommendations for conservative (non-surgical) therapy for DFIs and diabetic foot osteomyelitis (DFO).

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“…The gold standard for laboratory diagnosis includes microbiological and histological examinations; the latter is, however, carried out infrequently in practice. 3,4 The optimal management of DFO is still a matter of debate and there is no universally accepted strategy. The International Working Group for Diabetic Foot (IWGDF) guidelines on foot infections recommends surgical intervention in cases of DFO accompanied by spreading soft tissue infection, progressive bone destruction on X-ray or bone protruding through the ulcer.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Evidence supporting the idea that culture from proximal (remnant) bone specimens is of any clinical benefit has to date been restricted only to small studies. 4,7,8 The best method of obtaining remnant bone samples at the time of amputation is unclear, but usually involves taking a small piece of bone from the remnant bone after the wound has been cleaned with saline and using sterile instruments. Typically, the surgeon estimates the margin between infected and uninfected bone and excises back until he/she thinks they have reached the healthy bone.…”

Section: Introductionmentioning

confidence: 99%

The role of remnant bone microbiological cultures in managing diabetic foot osteomyelitis

et al. 2021

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Aim: Effective treatment of diabetic foot osteomyelitis can reduce the risk of major amputations. Our primary aim was to compare the yield in cultures from the proximal and distal segments of bone excised intraoperatively and the impact on antibiotic choice and duration.Methods: Patients with a confirmed diagnosis of osteomyelitis on bone culture results, where both proximal and distal bone segment samples had been collected, were retrospectively reviewed. Microbiological data were examined to identify true pathogens and studied against antimicrobial choice and duration of prescribing.Results: A total of 47 forefoot amputation cases were studied. In 89% of cases, definite or likely pathogens were isolated from the deep tissues cultured. Definite pathogens (Staphylococcus aureus, Group B streptococcus, Group G streptococcus and Streptococcus anginosus) were identified in 32% of cases; in 73% of these, definite pathogens were grown in both the proximal and distal bone segments.Conclusion: Sampling of remnant bone culture can help in reducing the duration of antibiotic treatment in patients (27% of cases in our series) as it is challenging to correctly estimate intraoperatively whether clear surgical margins have been adequately achieved when resecting infected bone.

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Utility of Culturing Marginal Bone in Patients Undergoing Lower Limb Amputation for Infection

Cited by 11 publications

References 13 publications

Diabetic Foot Osteomyelitis: Frequent Pathogens and Conservative Antibiotic Therapy

Diabetic Foot Osteomyelitis: Frequent Pathogens and Conservative Antibiotic Therapy

Non-surgical therapy of diabetic foot infections based on recent guidelines and published data

The role of remnant bone microbiological cultures in managing diabetic foot osteomyelitis

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