Rate of Residual Osteomyelitis after Partial Foot Amputation in Diabetic Patients: A Standardized Method for Evaluating Bone Margins with Intraoperative Culture

Atway, Said; Nerone, Vincent S.; Springer, Kevin D.; Woodruff, Darren M.

doi:10.1053/j.jfas.2012.06.017

Cited by 77 publications

(64 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We hypothesize that such false-positive results are due to contamination from adjacent infected soft tissue. The rate of residual osteomyelitis in patients who have undergone toe amputation appears to be much lower than postulated by studies that relied on culture of bone biopsy specimens alone 16,20 . We recommend that both histological analysis and culture of bone biopsied from the resection margin be used to diagnose residual osteomyelitis after toe amputation.…”

Section: Discussionmentioning

confidence: 64%

“…Furthermore, Kowalski et al 14 found positive cultures to be twice as frequent as positive histological findings in their study of specimens from the resected bone (Table IV); however, they did not discuss this observation. Atway et al 16 analyzed biopsy specimens from the resected bone margin after amputation but performed only cultures; they did not carry out histological analysis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Culture of Bone Biopsy Specimens Overestimates Rate of Residual Osteomyelitis After Toe or Forefoot Amputation

Mijuskovic

Kuehl

Widmer

et al. 2018

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background:Guidelines recommend both histological analysis and culture for definite diagnosis of osteomyelitis. It is not clear if histological and culture criteria can be used interchangeably in the clinical scenario of toe amputation. We therefore prospectively compared the results of intraoperative culture and those of histological examination in this setting.Methods:Consecutive patients requiring toe or forefoot amputation at the University Hospital Basel during a 2-year period were included in the study. Biopsy specimens from the residual bone were cultured according to microbiological standards. Histological analysis was performed using standardized criteria for osteomyelitis. Clinical outcomes were assessed retrospectively via chart review.Results:Of 51 patients included in the study, 33 (65%) had a positive culture of residual bone and 14 (27%) showed histological signs of osteomyelitis. A negative histological result but a positive culture was found for 21 (41%) of the patients, suggesting that culture has a high false-positive rate if histological analysis is used as the reference to rule out osteomyelitis. The recommended criteria of both positive histological findings and positive culture were fulfilled by 12 (24%) of the 51 patients.Conclusions:Positive cultures of residual bone after forefoot or toe amputation overestimate the true rate of osteomyelitis as defined by histological analysis, presumably because of contamination from soft tissue at the time of surgery. Additional studies are needed to evaluate the indications for, and the duration of, antibiotic treatment according to these findings.Clinical Relevance:Our results cast doubt on the strategy of relying solely on culture of bone biopsy specimens when deciding whether antibiotic treatment for osteomyelitis is necessary after toe or forefoot amputation.

show abstract

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Culture of Bone Biopsy Specimens Overestimates Rate of Residual Osteomyelitis After Toe or Forefoot Amputation

Mijuskovic

Kuehl

Widmer

et al. 2018

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

“…Studies unanimously advocate the use of prophylactic antibiotics generally for 0‐48 hours and up to 5 days . Secondly, residual infection, with authors supporting culture of intraoperative bone samples from residual stumps, rather than from the removed bone . Kowalski et al demonstrated that amputated DFI patients with positive resection margins for residual osteomyelitis (histologically or microbiologically) revealed more treatment failures and re‐amputations than those without (44% vs 15%, despite a similar 2 week intravenous antibiotic therapy in both arms).…”

Section: Discussionmentioning

confidence: 99%

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

Rossel

Lebowitz

Gariani

et al. 2019

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

Summary Objective The appropriate duration of antibiotic therapy for diabetic foot infections (DFI) after surgical amputations in toto is debated. There are discrepancies worldwide. Methods Using a clinical pathway for adult DFI patients (retrospective cohort analysis), we conducted a cluster‐controlled Cox regression analysis. Minimum follow‐up was 2 months. Results We followed 482 amputated DFI episodes for a median of 2.1 years after the index episode. The DFIs predominately affected the forefoot (n = 433; 90%). We diagnosed osteomyelitis in 239 cases (239/482; 50%). In total, 47 cases (10%) were complicated by bacteremia, 86 (18%) by abscesses and 139 (29%) presented with cellulitis. Surgical amputation involved the toes (n = 155), midfoot (280) and hindfoot (47). Overall, 178 cases (37%) required revascularization. After amputation, the median duration of antibiotic administration was 7 days (interquartile range, 1‐16 days). In 109 cases (25%), antibiotics were discontinued immediately after surgery. Overall, clinical failure occurred in 90 DFIs (17%), due to the same pathogens in only 38 cases. In multivariate analysis, neither duration of total postsurgical antibiotic administration (HR 1.0, 95% CI 0.99‐1.01) nor immediate postoperative discontinuation altered failure rate (HR 0.9, 0.5‐1.5). Conclusion According to our clinical pathway, we found no benefit in continuing postsurgical antibiotic administration in routine amputation for DFI. In the absence of residual infection (ie, resection at clear margins), antibiotics should be discontinued.

show abstract

“…Atway et al (7) reported a positive margin culture in three out of 13 patients (23.1%) who had a toe disarticulation.…”

Section: Distal or Minor Amputations For The Diabetic Footmentioning

confidence: 99%

Distal amputations for the diabetic foot

Nather¹,

Wong

2013

Diabetic Foot & Ankle

View full text Add to dashboard Cite

Minor amputations in diabetic patients with foot complications have been well studied in the literature but controversy still remains as to what constitutes successful or non-successful limb salvage. In addition, there is a lack of consensus on the definition of a minor or distal amputation and a major or proximal amputation for the diabetic population. In this article, the authors review the existing literature to evaluate the efficacy of minor amputations in this selected group of patients in terms of diabetic limb salvage and also propose several definitions regarding diabetic foot amputations.

show abstract

Rate of Residual Osteomyelitis after Partial Foot Amputation in Diabetic Patients: A Standardized Method for Evaluating Bone Margins with Intraoperative Culture

Cited by 77 publications

References 13 publications

Culture of Bone Biopsy Specimens Overestimates Rate of Residual Osteomyelitis After Toe or Forefoot Amputation

Culture of Bone Biopsy Specimens Overestimates Rate of Residual Osteomyelitis After Toe or Forefoot Amputation

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

Distal amputations for the diabetic foot

Contact Info

Product

Resources

About