Evaluation of diabetic foot osteomyelitis using probe to bone test and magnetic resonance imaging and their impact on surgical intervention

Zaiton, Fatma; Samir, Ayman; Elkamash, Tarek H.; Tawfik, Ahmad M.; Hadhoud, Khaled M.

doi:10.1016/j.ejrnm.2014.04.015

Cited by 12 publications

(17 citation statements)

References 31 publications

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“…References: Lam et al, Lavery et al, Mutluoglu et al, Zaiton et al, Fleischer et al, and Morales‐Lozano et al…”

Section: Resultsmentioning

confidence: 99%

“…On the basis of the pooled sensitivity and specificity, we calculated that the positive and negative likelihood ratios of the PTB test in diagnosing or excluding diabetic foot osteomyelitis would be 5.1 and 0.16, respectively. While three cohort studies [26][27][28] were eligible for inclusion in this systematic review, two others that we identified were not. 29,30 One of the excluded papers was a case-control study of 54 patients with diabetes seen in a tertiary-care hospital 30 that found that the PTB test had a sensitivity of 85% but a specificity of only 47% for diagnosing osteomyelitis (confirmed by histology).…”

Section: Clinical Findings |mentioning

confidence: 99%

“…References: Lam et al, 25 Lavery et al, 26 Mutluoglu et al, 27 Zaiton et al, 28 Fleischer et al, 29 References: Lauri et al, 34 Ertugrul et al, 35 Johnson et al, 36 Nawaz et al, 37 Newman et als, 38 Shagos et al, 39 Blume et al, 40 Treglia et al, 41 Rastogi et al, 42 Abdel Razek and Samir, 43 Aslangul et al, 44 and 9% of the cases. The authors established that the overall accuracy swabs in these settings was 73%.…”

Section: 4mentioning

confidence: 99%

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Diagnosis of infection in the foot in diabetes: a systematic review

Senneville

Lipsky

Abbas

et al. 2020

Diabetes Metabolism Res

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Background Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potentially mortality and present formidable challenges in surgical and antimicrobial treatment. Methods In June 2018, we searched the literature using PuEbMed and EMBASE for published studies on the diagnosis of diabetic foot infection. On the basis of predetermined criteria, we reviewed prospective controlled, as well as noncontrolled, studies in any language, seeking translations for those not in English. We then developed evidence statements on the basis of the included papers. Results From the 4242 records screened, we selected 35 papers that met our inclusion criteria. The quality of all but one of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot scheme correlates with the patient's likelihood of ulcer healing, of lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers are supportive, but not diagnostic, of soft tissue or bone infection. In patients with suspected diabetic foot osteomyelitis, both a positive probe‐to‐bone test and an elevated erythrocyte sedimentation rate are strongly associated with its presence. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Plain X‐ray remains the first‐line imaging examination when there is suspicion of diabetic foot osteomyelitis, but advanced imaging methods help in cases when either the diagnosis or the localization of infection is uncertain. Conclusion The results of this first reported systematic review on the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is a need for more prospective controlled studies of high quality.

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“…References: Lam et al, Lavery et al, Mutluoglu et al, Zaiton et al, Fleischer et al, and Morales‐Lozano et al…”

Section: Resultsmentioning

confidence: 99%

Section: Clinical Findings |mentioning

confidence: 99%

Section: 4mentioning

confidence: 99%

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Diagnosis of infection in the foot in diabetes: a systematic review

Senneville

Lipsky

Abbas

et al. 2020

Diabetes Metabolism Res

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“…It consists of introducing a sterile (metal) blunt into the wound searching for a hard and gritty contact in favour of the presence of damaged bone tissues. The diagnostic performance of the PTB test has been evaluated in numerous studies . A recent systematic review established a pooled sensitivity of the PTB test of 87% (95% CI, 75‐93%), specificity of 83% (CI, 65‐93%), positive predictive value (PPV) of 98% and negative predictive value (NPV) of 70%.…”

Section: Resultsmentioning

confidence: 93%

“…The diagnostic performance of the PTB test has been evaluated in numerous studies. [9][10][11][12][13][14] A recent systematic review 9 established a pooled sensitivity of the PTB test of 87% (95% CI, 75-93%), specificity of 83% (CI, 65-93%), positive predictive value (PPV) of 98% and negative predictive value (NPV) of 70%. As a general fact in these statistical assessments, the PPV of PTB-test was higher in populations of patients with a high prevalence of DFI while the NPV was higher in populations with a low prevalence of DFO.…”

Section: Clinical Findingsmentioning

confidence: 99%

Diagnosing diabetic foot osteomyelitis

Senneville

Lipsky

Asten

et al. 2020

Diabetes Metabolism Res

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Bone involvement during an infection of the diabetic foot represents a serious complication associated with a high risk of amputation, prolonged antibiotic treatment and hospitalization. Diabetic foot osteomyelitis (DFOs) require a multidisciplinary approach given the usual complexity of these situations. DFO should be suspected in most cases especially in the most severe forms of soft tissue diabetic foot infections (DFIs) where the prevalence of bone infection may be up to 60%. Suspicion is based on clinical signs in particular a positive probe‐to‐bone (PTB) test, elevated inflammatory biomarkers especially erythrocyte sedimentation rate and abnormal imaging assessment using plain X‐ray as a first‐line choice. The combination of PTB test with plain X‐ray has proven effective in the diagnosis of DFO. The confirmation (definite) diagnosis of DFO is based on the results of a bone sample examination obtained by either surgical or percutaneous biopsy. Sophisticated imaging examinations such as Magnetic Resonance Imaging (MRI) and nuclear imaging techniques are useful where doubt persists after first‐line imaging assessment. These techniques may also help localize the bone infection site and increase the diagnostic performance of percutaneous bone biopsy. The quality of the microbiological documentation of DFO is likely to improve the adequacy of the antimicrobial therapy especially when medical (ie, no surgical resection of the infected bone tissues) is considered. The use of new (molecular) techniques for the identification of the bone pathogens have not yet proven superiority on classic cultural techniques for the management of such patients.

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