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A new study published in the April 2008 issue of Diabetes Care indicates that bone culture-based antibiotic therapy may predict success in diabetic patients treated nonsurgically for osteomyelitis of the foot. Between June 2002 and June 2003, diabetic patients who were initially treated without orthopedic surgery for osteomyelitis of the toe or metatarsal head of a nonischemic foot in 9 French diabetic foot centers were identified, and their medical records were reviewed. Fifty consecutive patients aged 62.2 +/- 11.1 years (mean +/- SD) with diabetes duration of 16 +/- 10.9 years were included in the study. The investigators defined remission as the absence of any sign of infection at the initial or contiguous site assessed at least 1 year after the end of treatment.


More than 20 demographic, clinical, and therapeutic variables including bone versus swab culture-based antibiotic therapy were analyzed, and the mean duration of antibiotic treatment was 11.5 +/- 4.21 weeks. Bone biopsy was routinely available in 4 of the 9 centers, and patient management was similar in the different centers. The one exception was the use of rifampin, which was recorded more frequently in patients from centers in which a bone biopsy was available. At the end of a 12.8-month posttreatment mean follow-up, 32 patients (64%) were in remission. The investigators concluded that bone culture-based antibiotic therapy was the only variable associated with remission, as determined by both univariate (18 of 32 [56.3%] vs 4 of 18 [22.2%]; P = .02) and multivariate analyses (odds ratio, 4.78 [95% CI, 1.0-22.7]; P = .04).


Source: Senneville E, Lombart A, Bertrand E, et al. Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study. Diabetes Care 2008;31:637-42.