Surgical Diabetic Foot Infections: Is Osteomyelitis Associated With a Worse Prognosis?

Abstract

It has been reported that patients with diabetes and foot ulcers complicated with osteomyelitis (OM) have a worse prognosis than those complicated with soft tissue infections (STI). Our study aimed to determine whether OM is associated with a worse prognosis in cases of moderate and severe diabetic foot infections requiring surgery. A retrospective series consisted of 150 patients who underwent surgery for diabetic foot infections. We studied the differences between OM versus STI. Furthermore, diabetic foot infections were reclassified into four groups: moderate STI (M-STI), moderate OM (M-OM), severe STI (S-STI), and severe OM (S-OM). The variables associated with prognosis were limb loss, length of hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing (both the initial ulcer and the postoperative wound). No differences in limb salvage, hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing were found when comparing OM with STI. Patients with M-O had a higher rate of recurrences after initial treatment and a longer time to healing when comparing with M-STI. We didn’t find any differences between severe infections with or without OM. In conclusion, we have found in our surgical series of diabetic foot infections that OM is not associated with worse prognosis when comparing with STI regarding limb loss rate, length of hospital stays, duration of antibiotic treatment, recurrence of the infection, and time to healing. The results of the present series should further be confirmed by other authors.

Clinical, microbiological and inflammatory markers of severe diabetic foot infections

“…23 The mean WBC count was 15.61 ± 4.74 cells/mm 3 in cases of severe infection 8 and higher values have been reported in other series. 10 More research is needed to study whether a WBC count >12,000 cells/mm 3 should be used to diagnose severe DFI. ESR is an inflammatory biomarker associated with severe infections, 24 with longer hospital stay 25 and with amputations in some series.…”

“…Regarding clinical signs, the odds of developing a severe DFI was 7.82 times higher in patients who presented with gangrene 8 . Necrosis has repeatedly been associated with a poor prognosis in cases of DFI 9,10 . Finally, the impact of microbiology on the severity and outcomes of DFI is poorly understood.…”

“…8 Necrosis has repeatedly been associated with a poor prognosis in cases of DFI. 9,10 Finally, the impact of microbiology on the severity and outcomes of DFI is poorly understood. The isolation of Gram-negative bacteria from tissue culture has been associated with more severe infections.…”

Treating Diabetic Foot Osteomyelitis: A Practical State-of-the-Art Update

“…DFI cases were not clearly separated by the presence or absence of osteomyelitis, but only 22% of ulcers healed without surgery, and 72% had minor (60%) or major (12%) amputations [66]. A retrospective 2021 study from Costa Rica that reviewed 150 patients who underwent surgery for DFI compared those with DFO to those with only soft tissue infection [67]. Surprisingly, they found no significant differences in length of hospital stay, duration of antibiotic treatment, time to healing, limb salvage or recurrence of infection [67].…”

“…A retrospective 2021 study from Costa Rica that reviewed 150 patients who underwent surgery for DFI compared those with DFO to those with only soft tissue infection [67]. Surprisingly, they found no significant differences in length of hospital stay, duration of antibiotic treatment, time to healing, limb salvage or recurrence of infection [67].…”