Utility of Culturing Marginal Bone in Patients Undergoing Lower Limb Amputation for Infection.

Area of Science:

• Orthopedics
• Infectious Diseases
• Surgical Pathology

Background:

• Clinical guidelines recommend culturing bone margins after osteomyelitis resection, despite limited supporting evidence.
• The impact of marginal bone culturing on antibiotic management and subsequent surgical procedures is not well-defined.

Purpose of the Study:

• To determine if culturing marginal bone after infected bone resection influences antibiotic therapy or necessitates further surgical intervention.
• To evaluate the association between marginal bone culture results and clinical decision-making in patients with foot osteomyelitis.

Main Methods:

• A retrospective review of 132 patients undergoing amputation for foot infection between January 2014 and May 2015.
• Data collected included patient demographics, diabetes status, amputation level, marginal bone culture results, antibiotic use, and subsequent surgeries.

Main Results:

• Marginal bone was cultured in 43.9% of patients, with 86.2% yielding positive results.
• Patients with positive bone cultures were significantly more likely to undergo further surgical intervention (20.0% vs 6.1%, p=0.047).
• Diabetes status did not significantly affect the likelihood of marginal bone culturing or further surgery.

Conclusions:

• While clinicians appear to use marginal bone culture findings in decision-making, the procedural benefit requires further investigation.
• Positive bone cultures correlated with increased surgical intervention, but the rationale and efficacy of this additional surgery remain uncertain.