508. Successful Limb-Sparing Treatment Strategy for Diabetic Foot Osteomyelitis
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Foot osteomyelitis (OM) is a significant source of morbidity in patients with diabetes mellitus. The optimal treatment of these patients is unknown. Previous reports have found that between 5% and 30% of patients require major surgery, such as below the knee amputation (BKA). Our local approach typically involves surgical debridement with or without amputation and prolonged intravenous (IV) antibiotic therapy. We describe patient outcomes at 12 months post-treatment.
Methods: Retrospective chart review of all patients treated for diabetic foot OM between May 2005 and May 2007.
Results: Over 2 years, 53 patients were treated with combined surgery and antibiotics. The median age was 51 years (range 35-66) with a mean hemoglobin A1c of 9.2%. Initial surgical management included: surgical debridement without amputation (8/53, 15%), toe amputation (21, 40%), ray amputation (8, 15%), transmetatarsal amputation (14, 26%), and BKA (2, 4%). The majority of these infections were polymicrobial (64%) with 28% involving MSSA, 19% MRSA, 40% anaerobes, 25% gram-negative organisms, and 17% enterococci. Nearly all patients (96%) received IV antibiotics. Among patients who underwent amputation, 11 (21%) had a surgical margin negative for OM on pathology, and the median duration of IV therapy was 19 days. Of the patients with evidence of residual OM at the surgical margin (34/53, 64%), the median duration of IV therapy was 40 days. Patients with indeterminate or no pathologic evaluation (8, 15%), received IV therapy for a median of 44 days. Fifteen (28%) patients had recurrent infection at the same site within 12 months. Among this group, 14 patients required minor amputation (below the ankle) and 1 patient underwent BKA.
Conclusion: Management of diabetic foot OM with combined surgery and IV antibiotic therapy was successful in 72% of patients after 1 year of follow up. Major amputation was avoided in 94% of all patients. Early surgery plus prolonged IV therapy appears to be an effective limb-sparing strategy.
Alison Beieler, PA-C1, Robert Belknap, MD2, Merribeth Bruntz, DPM3, Timothy Jenkins, MD3, Connie Price, MD4, Carla Saveli, MD1 and  A. M. Beieler, None..
R. W. Belknap, None..
C. C. Saveli, None..
T. C. Jenkins, None..
M. Bruntz, None..
C. S. Price, None., (1)Denver Health and Hospital, (2)Denver Health and Hospital, Denver, CO, (3)Denver Health Hospital, Denver, CO, (4)University of Colorado Health Sciences Center, Denver, CO