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Complications during the treatment of diabetic foot osteomyelitis

Suzanne A V van Asten1, Moez Mithani2, Edgar J G Peters3

  • 1Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Internal Medicine, VU Medical Center, Amsterdam, The Netherlands.

Diabetes Research and Clinical Practice
|September 28, 2017
PubMed
Abstract

Insights

Diabetic foot osteomyelitis (DFO) patients frequently experienced acute kidney injury (AKI), which was linked to worse outcomes. Rates of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) were lower than previously reported.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Diabetology

Background:

  • Diabetic foot osteomyelitis (DFO) is a serious complication of diabetes, often requiring prolonged treatment.
  • Medical interventions for DFO can lead to various complications, impacting patient outcomes.
  • Understanding these complications is crucial for optimizing DFO management.

Purpose of the Study:

  • To identify and analyze complications arising from medical treatments in patients diagnosed with diabetic foot osteomyelitis (DFO).
  • To assess the incidence of acute kidney injury (AKI), antimicrobial-resistant infections (MRSA, VRE), and catheter-related issues in DFO patients.
  • To explore associations between complications and patient outcomes during a 12-month follow-up.

Main Methods:

  • A retrospective review of 143 patients with histopathology or culture-confirmed DFO.
  • Monitoring for acute kidney injuries (AKI), development of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).
  • Tracking gastrointestinal and venous catheter-related complications over a 12-month follow-up period.

Main Results:

  • Forty-seven episodes of AKI were recorded, with half occurring during initial hospitalization, 29.8% linked to antimicrobial therapy.
  • Patients experiencing AKI showed higher rates of recurrent ulcerations (69.2%), infections (38.5%), and hospitalizations (43.6%).
  • Baseline MRSA rates in bone were 9.8%; resistant strains (MRSA/VRE) were found in 14.7% during follow-up, more common in re-hospitalized patients (52.6%).

Conclusions:

  • DFO patients frequently developed AKI, associated with poorer outcomes, though not definitively linked to antibiotic exposure.
  • The incidence of MRSA and VRE in DFO bone biopsies was lower than previously documented.
  • Effective management of DFO requires vigilant monitoring for complications like AKI and resistant infections.
Keywords:
Acute kidney injuryAntibioticsBacterial resistanceDiabetic footOsteomyelitis

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