Title :

Two-step sequential approach for concomitant skin and soft tissue infection and osteomyelitis complicating the diabetic foot

Author(s) :

Berthol, Naima [Auteur]
Centre Hospitalier Gustave Dron [Tourcoing]
Robineau, Olivier [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Boucher, Anne [Auteur]
Centre Hospitalier de Tourcoing
Blondiaux, Nicolas [Auteur]
Centre Hospitalier Gustave Dron [Tourcoing]
Beltrand, Eric [Auteur]
Centre Hospitalier Gustave Dron [Tourcoing]
Valette, Michel [Auteur]
Centre Hospitalier Gustave Dron [Tourcoing]
Cazaubiel, Marie [Auteur]
Centre Hospitalier de Tourcoing
Nguyen, Sophie [Auteur]
Centre Hospitalier Gustave Dron [Tourcoing]
Senneville, Eric [Auteur]
221576|||Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS] (VALID)

Journal title :

Diabetes Care

Abbreviated title :

Diabetes Care

Volume number :

40

Pages :

E170-E171

Publisher :

American Diabetes Association

Publication date :

2017-12-01

ISSN :

0149-5992

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Current guidelines (1,2) do not provide data on the treatment of patients presenting with concomitant soft tissue infection and osteomyelitis of the diabetic foot (DF-STI/DFO). We have developed a two-step sequential ...
Show more >Current guidelines (1,2) do not provide data on the treatment of patients presenting with concomitant soft tissue infection and osteomyelitis of the diabetic foot (DF-STI/DFO). We have developed a two-step sequential approach (TSA) consisting chronologically of 1) an empirical antibiotic therapy for diabetic foot soft tissue infection (DF-STI) secondarily adapted to the culture results of a tissue sample taken by curettage from the periphery of the ulcer (step 1), 2) an antibiotic-free period of at least 2 weeks, and 3) a bone biopsy obtained percutaneously or intraoperatively in case of, respectively, medical or surgical approach of diabetic foot osteomyelitis (DFO) (step 2) chosen according to Lipsky’s recommendations (3). In the present monocentric retrospective 2006–2015 study, 38 adult patients out of a total of 297 patients followed for DFO (12.8%) had concomitant DF-STI and DFO not requiring urgent surgery and were treated with TSA. DFO was determined by clinical elements (bone exposed through the ulcer, positive probe to bone test) and imaging data on plain X-rays, bone scans, or MRI. Antibiotics administered for DFO were chosen among those with a high bone-to-blood ratio associated with sustained activity against biofilm bacteria and good oral availability, such as rifampin and fluoroquinolone combinations for, respectively, gram-positive cocci and gram-negative bacilli osteomyelitis (4,5). Remission of DFO was defined as the absence of recurrence of both DF-STI and DFO at the initial infected site or contiguous to it, complete healing of the foot ulcer, and no need for additional surgery during the post–end of treatment follow-up. Approval by the local ethics committee was obtained (no. 2017/1). The patients’ main characteristics are reported in Table 1. All patients had peripheral neuropathy, and six of them (15.8%) who were found at admission to have associated ischemia of the foot on the basis of clinical findings confirmed by angiography underwent with success either endoarterial stent placement or arterial revascularization.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T16:49:13Z
2024-12-18T08:38:29Z