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.
背景:糖尿病足感染尤其是骨髓炎是糖尿病患者截肢的主要危险因素。骨活检联合微生物检查是骨髓炎诊断的金标准, 可提供致病病原体及其对抗生素的敏感性信息。这使我们可以用窄谱抗生素靶向这些病原体, 减少抗菌素耐药性的出现。经皮透视引导下的骨活检可安全、准确地定位患骨。 方法:在一家三级医疗机构, 我们9年内进行了170例经皮骨活检。我们回顾了这些患者的医疗记录, 包括患者的人口统计数据、影像以及活检微生物学和病理学结果。 结果:在阳性骨样本中, 71.3%为革兰氏阳性细菌。金黄色葡萄球菌是最常见的分离病原体来自阳性骨培养, 几乎三分之一显示甲氧西林耐药。肠球菌是最常见的病原菌多种微生物样本。肠杆菌科细菌是最常见的革兰氏阴性病原体在多种微生物样本中更常见。 结论:经皮影像引导骨活检是一种低风险的微创程序, 可以提供关于致病微生物的有价值信息, 用窄谱抗生素靶向这些病原体。.
Keywords: diabetic foot; diabetic foot ulcer; foot osteomyelitis; percutaneous bone biopsy; 糖尿病足; 经皮骨活检; 足溃疡; 骨髓炎.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.