Evaluating Predictive Value of Surgical Resected Proximal Bone Margins in Diabetic Foot Osteomyelitis With Clinical Outcomes at 1 Year.

Autor: Weng B; Division of Infectious Diseases, Department of Internal Medicine, Riverside University Health System, Moreno Valley, California, USA.; Department of Internal Medicine, University of California, Riverside, California, USA., Oskooilar Y; Department of Internal Medicine, University of California, Riverside, California, USA., Zakhary B; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California, USA., Chiu CA; Department of Pharmacy, Riverside University Health System, Moreno Valley, California, USA., Wu P; Division of Infectious Diseases, Department of Internal Medicine, Riverside University Health System, Moreno Valley, California, USA.; Department of Internal Medicine, University of California, Riverside, California, USA., Mulligan N; Department of Pharmacy, Riverside University Health System, Moreno Valley, California, USA., Sutjita M; Division of Infectious Diseases, Department of Internal Medicine, Riverside University Health System, Moreno Valley, California, USA.; Department of Internal Medicine, University of California, Riverside, California, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2022 Dec 26; Vol. 10 (1), pp. ofac689. Date of Electronic Publication: 2022 Dec 26 (Print Publication: 2023).
DOI: 10.1093/ofid/ofac689
Abstrakt: Background: Osteomyelitis of the diabetic foot remains a significant complication that may result in the need for amputation. Proximal surgical margin histopathology after limb-sparing amputation could be used to guide antimicrobial duration and prognostic management but remains debatable. Here we evaluate if negative proximal bone margins predict outcomes of diabetic foot osteomyelitis at 1 year.
Methods: A retrospective study assessed adults with diabetes undergoing limb-sparing foot amputations from September 2016 to September 2019. Patients required histopathology confirmation of osteomyelitis, proximal margin histopathology report, and documented electronic medical record follow-up through 12 months. The primary outcome evaluated if no further amputation at the same site was required in the following 12 months.
Results: Of 92 patients, 57 (61.9%) had pathology-confirmed negative margins for osteomyelitis. Patients with negative margins required less frequent subsequent amputations at the same site within 12 months compared to positive margins (86.0% vs 65.7%; P = .003). Antibiotic duration was shorter in patients with negative margins (mean, 18 vs 30 days; P = .001). Negative-margin patients also noted lower rates of readmission at 12 months (26.3% vs 51.4%; P = .015) for site-specific complications. S taphylococcus aureus was more predominant in patients with positive versus negative margins (57.1% vs 29.8%; P = .017).
Conclusions: Negative proximal bone margin by histopathology was associated with lower frequency of further amputations at the index surgical site within 12 months. This group also received shorter courses of antibiotic therapy. It was also associated with lower rates of readmission at 12 months for surgical-site complications. Proximal margin histopathology results potentially can be integrated to guide antimicrobial duration and decrease the frequency of further amputation at the original site.
Competing Interests: Potential conflicts of interest. All authors: No reported conflicts.
(© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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