Osteomyelitis and Its Main Determinants in Patients With Diabetic Foot Ulcer: A Cross-Sectional Study

Diabetic foot ulcers (DFUs) represent a significant and prevalent complication of diabetes, imposing substantial psychological, financial, and healthcare burdens globally. Osteomyelitis, the most common complication of DFUs, is a primary cause of lower limb amputations in diabetic patients. This cross-sectional study aimed to evaluate the epidemiological and clinical aspects of patients with diabetic foot osteomyelitis (DFOM) resulting from DFU infection.

Hospital records with a diagnosis of diabetic foot wound infection were reviewed during a period of 8 months (April-December 2021). Osteomyelitis was diagnosed using magnetic resonance imaging criteria. Patients were categorized into two groups of with and without osteomyelitis, and compared accordingly for predisposing risk factors and also clinical outcome.

Among 252 cases of DFU infection, 23.8% were confirmed to have DFOM. Multivariate logistic regression analysis identified lower age (p = 0.02; OR = 0.86; 95%CI: 0.75-0.98), lower BMI (p = 0.01; OR = 0.57; 95%CI: 0.382-0.86), higher income level (p < 0.001; OR = 8.62; 95%CI: 2.42-30.74), higher HbA1c level (p < 0.001; OR = 19.072; 95%CI: 7.61-47.78), and the location of the wound on the heel and leg as predictive factors for the occurrence of DFOM. Regarding the clinical outcomes, osteomyelitis was significantly associated with longer length of hospitalization (19.02 ± 2.58 vs. 14.53 ± 2.74 days), delayed wound healing (above 6 months: 40.0 vs. 8.8%), lower limb salvage (68.3 vs. 99.0%), higher rate of wound dehiscence (33.3 vs. 10.4%), and higher rate of wound recurrence (30.0 vs. 0.5%). The mortality rate was also higher in the osteomyelitis group (13.3 vs. 0%).

Approximately 23.8% of patients with DFU may develop osteomyelitis, which can be predicted by lower age, lower BMI, higher income level, higher HbA1c level, and the location of the wound. Early identification and appropriate management of these risk factors may help prevent osteomyelitis development in DFU patients.