Percutaneous Bone Biopsy for Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis
Marcos C Schechter1, Mohammed K Ali2, Benjamin B Risk3
1Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA.
Open Forum Infectious Diseases
|November 2, 2020
Summary
Percutaneous bone biopsy (PBB) for diabetic foot osteomyelitis (DFO) shows a high rate of positive cultures (84%). However, data on PBB safety and its impact on patient outcomes or antibiotic treatment remain limited.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Diabetology
Background:
- Diabetic foot osteomyelitis (DFO) is a major cause of non-traumatic lower extremity amputations worldwide.
- Percutaneous bone biopsy (PBB) is recommended for microbiological diagnosis of DFO.
- The diagnostic yield, safety, and clinical impact of PBB in DFO are not well-established.
Purpose of the Study:
- To determine the frequency of culture-positive percutaneous bone biopsies (PBBs) in patients with diabetic foot osteomyelitis (DFO).
- To review available data on PBB-related adverse events and their impact on DFO outcomes and antibiotic management.
Main Methods:
- A systematic literature search was conducted across PubMed, EMBASE, and Cochrane Trials databases up to December 31, 2019.
- A random-effects meta-analysis was used to calculate the pooled proportion of culture-positive PBBs.
- Data on adverse events, DFO outcomes, and antibiotic adjustments were extracted and analyzed where available.
Main Results:
- The meta-analysis included 11 studies with 780 patients and 837 PBBs.
- The pooled proportion of PBBs yielding a positive culture was 84% (95% CI, 73%-91%).
- Significant heterogeneity existed between studies, with limited reporting on adverse events, clinical outcomes, or antibiotic management.
Conclusions:
- Percutaneous bone biopsy (PBB) demonstrates a high diagnostic yield for microbiological confirmation in DFO.
- There is a critical need for more research on the safety and clinical effectiveness of PBB in managing DFO.
- Further investigation is particularly important in low- and middle-income countries where data are scarce.
