Is fluoroscopy‐guided percutaneous bone biopsy of diabetic foot with suspected osteomyelitis worthwhile? A retrospective study

Abstract

Background Diabetic foot infection, particularly osteomyelitis, is a major risk factor of amputation in persons with diabetes. Bone biopsy with microbial examination is considered the gold standard of diagnosis of osteomyelitis, providing information about the offending pathogens as well as their antibiotics susceptibility. This allows targeting of these pathogens with narrow spectrum antibiotics, potentially reducing emergence of antimicrobial resistance. Percutaneous fluoroscopy guided bone biopsy allows accurate and safe targeting of the affected bone. Methods In a single tertiary medical institution and over 9 year period, we performed 170 percutaneous bone biopsies. We retrosepctively reviewed the medical record of these patients including patients' demographics, imaging and biopsy microbiology and pathollogic results. Results Microbiological cultures of 80 samples (47.1%) were positive with 53.8% of the positive culture showed monomicrobial growth and the remaining were polymicrobial. Of the positive bone samples 71.3% grew Gram‐positive bacteria. Staphylococcus aureus was the most frequently isolated pathogen from positive bone cultures with almost one third showing methicillin resistence. Enterococcus species were the most frequently isolated pathogens from polymicrobial samples. Enterobacteriaceae species were the most common Gram‐negative pathogens and were more common in polymicrobial samples. Conclusions Percutaneous image‐guided bone biopsy is a low‐risk, minimally invasive procedure that can provide valuable information about microbial pathogens and therefore enable targeting these pathogens with narrow spectrum antibiotics.

Brazilian Society of Angiology and Vascular Surgery 2023 guidelines on the diabetic foot

“…145,146 Thus, in most cases material should be collected aseptically, surgically, or percutaneously due to the reliable results. 147 Acute infections of lesser severity that have not undergone previous treatment can be considered for empirical treatment without culture collection, although culture collection should be performed or repeated when the clinical course is unfavorable or when the ulcer is subject to surgical debridement (recommendation class IIa, level of evidence C). 11,13 imaging exams Due to its easy access and low cost, radiography should be the initial imaging modality for patients with a DFU and suspected osteomyelitis (recommendation class I, level of evidence B).…”

“…Quando obtidas de tecidos profundos com crescimento de patógeno único, podem sugerir etiologia da infecção óssea associada, porém há que se considerar que estudos demonstram correlação da cultura de tecidos moles e óssea em menos de 50% dos casos, chegando em algumas casuísticas até 17,4% 145 , 146 . Por esse motivo, na maioria dos casos é sugerida a coleta de material de forma asséptica, via cirúrgica ou via percutânea, a qual também apresenta resultados fidedignos 147 . Infecções agudas de menor gravidade e sem tratamento anterior podem ser consideradas para tratamento empírico sem coleta de culturas, porém sugere-se realização ou repetição da mesma em face de qualquer evolução desfavorável ou quando a úlcera for submetida a desbridamento cirúrgico (classe de recomendação IIa, nível de evidência C) 11 , 13 .…”