Fungal Infection in Patients With Diabetic Foot Osteomyelitis

2019 ◽  
Author(s):  
Keyword(s):  
Fungal Infection ◽  
Diabetic Foot ◽  
Diabetic Foot Osteomyelitis

scholarly journals 318. Deferring Amputation in Diabetic Foot Osteomyelitis: Doing more Harm than Good?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S231-S232
Author(s):  
Shiwei Zhou ◽  
Brian M Schmidt ◽  
Oryan Henig ◽  
Keith S Kaye
Keyword(s):  
Diabetic Foot ◽  
Medical Management ◽  
Wound Care ◽  
Cohort Analysis ◽  
Severity Of Illness ◽  
Complete Healing ◽  
Knee Amputation ◽  
Management Group ◽  
One Year ◽  
Diabetic Foot Osteomyelitis

Abstract Background Diabetic foot osteomyelitis (DFO) is a leading cause of below knee amputation (BKA). Even when medical treatment is deemed unlikely to succeed, patients with DFO are often resistant to amputation. Methods An observational cohort analysis was done on patients with DFO at Michigan Medicine who were evaluated by podiatry and recommended BKA from Oct 2015 - Jun 2019. Primary outcome was mortality after BKA recommendation. Secondary outcomes were healing of affected limb, rate of BKA or above knee amputation (AKA) and total antibiotic days in the 6 months following. All intravenous antibiotics and oral courses of linezolid and fluoroquinolones were captured. Results Of 44 patients with DFO, 18 chose BKA, 26 chose medical management with wound care. Mean age of the cohort was 61, 68% male, 80% white with a median Charlson Comorbidity Index of 6 (IQR 4,7). The two groups were similar with regards to demographics and comorbid conditions. Those who chose medical management did so because their infection was non-life-threatening and they desired to avoid amputation. One-year mortality was greater in patients who were medically managed compared to those who had BKA (23.1% vs 0%, OR 11.7, 95% CI 0.6–222.9). Considering only the 33 patients who were followed for at least 2 years, 2-year mortality was also greater in the medically managed group compared to the BKA group (38.5% vs 5.6%, OR 10.6, 95% CI 1.2–92.7, Figure 1). Fewer patients in the medical management group had complete healing of their wound/stump compared to the BKA group (46.2% vs 88.9%, OR 9.3, 95% CI 1.8–49.1). In the medically managed group, 18 (69%) patients went on to require BKA or AKA at a median of 76.5 days compared to 2 (11%) in the BKA group who required AKA at 1 and 11 days following recommendation. Median antibiotic days were significantly greater in the medically managed group compared to the BKA group (55 IQR 42,78 vs 17 IQR 10,37, p=0.0017). Conclusion In this cohort of DFO patients where BKA was recommended, medical management was associated with increased mortality, poor healing of the affected limb, and excess antibiotic exposure compared to BKA. These findings are particularly notable as case mix and severity of illness were similar between the two groups. This study can be used to inform providers and patients in cases where BKA is recommended. Disclosures All Authors: No reported disclosures

scholarly journals Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

2008 ◽  
Vol 24 (S1) ◽  
pp. S145-S161 ◽  
Author(s):  
A. R. Berendt ◽  
E. J. G. Peters ◽  
K. Bakker ◽  
J. M. Embil ◽  
M. Eneroth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diabetic Foot ◽  
Progress Report ◽  
Diabetic Foot Osteomyelitis

scholarly journals Complications associated with the approach to metatarsal head resection in diabetic foot osteomyelitis

2018 ◽  
Vol 16 (2) ◽  
pp. 467-472 ◽  
Author(s):  
Aroa Tardáguila‐García ◽  
Irene Sanz‐Corbalán ◽  
Raúl J. Molines‐Barroso ◽  
Francisco J. Álvaro‐Afonso ◽  
Yolanda García‐Álvarez ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Metatarsal Head ◽  
Diabetic Foot Osteomyelitis
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