Osteomyelitis in the feet of diabetic patients. Long-term results, prognostic factors, and the role of antimicrobial and surgical therapy

Am J Med. 1987 Oct;83(4):653-60. doi: 10.1016/0002-9343(87)90894-1.

Abstract

Fifty-one diabetic patients with osteomyelitis of the foot were studied to determine potential prognostic factors and the role of antimicrobial therapy. Most of the patients were elderly, with diminished pulses, a sensory neuropathy, and a polymicrobial infection. Twenty-seven patients had a good outcome, defined as clinical resolution at the time of the last follow-up examination, without the need for amputation. The mean duration of follow-up for these patients was 19 months. Fifteen patients had a below-knee amputation, and nine had a toe amputation. The absence of necrosis and/or gangrene, the presence of swelling, and the use of antimicrobial therapy active against the isolated pathogens for at least four weeks intravenously, or combined intravenously and orally for 10 weeks, predicted a good outcome. Diabetic foot osteomyelitis, in the absence of extensive necrosis or gangrene, usually responds to antimicrobial therapy without the need for an ablative surgical procedure.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Amputation
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Infections / etiology*
  • Bacterial Infections / therapy
  • Diabetes Complications*
  • Drug Combinations / therapeutic use
  • Foot Diseases / etiology*
  • Foot Diseases / therapy
  • Humans
  • Middle Aged
  • Osteomyelitis / etiology*
  • Osteomyelitis / therapy
  • Prognosis
  • Sulfamethoxazole / therapeutic use
  • Time Factors
  • Trimethoprim / therapeutic use
  • Trimethoprim, Sulfamethoxazole Drug Combination

Substances

  • Anti-Bacterial Agents
  • Drug Combinations
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Trimethoprim
  • Sulfamethoxazole