David H Truong1,2, Roger Bedimo3,4, Matthew Malone5,6, Dane K Wukich2, Orhan K Oz7, Amanda L Killeen8, Lawrence A Lavery2,8. 1. Surgical Service, Podiatry Section, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA. 2. Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 3. Medical Service, Infectious Disease Section, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA. 4. Department of Infectious Disease, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 5. Infectious Disease and Microbiology, School of Medicine, Western Sydney University, Campbelltown, Australia. 6. South West Sydney Limb Preservation and Wound Research Academic Unit, South Western Sydney Local Health District, Sydney, Australia. 7. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 8. Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Abstract
Background: The aim of this study was to evaluate clinical outcomes in the published literature on medical and surgical management of diabetic foot osteomyelitis (DFO). Methods: A PubMed and Google Scholar search of articles relating to DFO was performed over the dates of January 1931 to January 2020. Articles that involved Charcot arthropathy, case reports, small case series, review articles, commentaries, nonhuman studies, and non-English articles were excluded. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to rate the bias of each study. A meta-analysis was performed using random-effects and inverse variance methods. The search yielded 1192 articles. After review and the removal of articles that did not meet inclusion criteria, 28 articles remained. Eighteen articles were related to the medical management of DFO and 13 articles were related to surgical management. Three articles looked at a combination of medical and surgical management and were included in both groups. Heterogeneity was evaluated using Cochran Q, I 2, τ2, and τ. Results: The average success rate was 68.2% (range, 17.0%-97.3%) for medical treatment and 85.7% (range, 65.0%-98.8%) for surgical and medical treatment. There were significant inconsistencies in accounting for peripheral arterial disease and peripheral neuropathy. There was significant heterogeneity in outcomes between studies. However, there was a high rate of successful treatment and a wide range between patients with medical treatment and combined surgical and medical treatment. Conclusions: Additional properly designed prospective studies with gold-standard references for diagnosing osteomyelitis are needed to help determine whether medical management of DFO can be successful without surgical intervention. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2022.
Background: The aim of this study was to evaluate clinical outcomes in the published literature on medical and surgical management of diabetic foot osteomyelitis (DFO). Methods: A PubMed and Google Scholar search of articles relating to DFO was performed over the dates of January 1931 to January 2020. Articles that involved Charcot arthropathy, case reports, small case series, review articles, commentaries, nonhuman studies, and non-English articles were excluded. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to rate the bias of each study. A meta-analysis was performed using random-effects and inverse variance methods. The search yielded 1192 articles. After review and the removal of articles that did not meet inclusion criteria, 28 articles remained. Eighteen articles were related to the medical management of DFO and 13 articles were related to surgical management. Three articles looked at a combination of medical and surgical management and were included in both groups. Heterogeneity was evaluated using Cochran Q, I 2, τ2, and τ. Results: The average success rate was 68.2% (range, 17.0%-97.3%) for medical treatment and 85.7% (range, 65.0%-98.8%) for surgical and medical treatment. There were significant inconsistencies in accounting for peripheral arterial disease and peripheral neuropathy. There was significant heterogeneity in outcomes between studies. However, there was a high rate of successful treatment and a wide range between patients with medical treatment and combined surgical and medical treatment. Conclusions: Additional properly designed prospective studies with gold-standard references for diagnosing osteomyelitis are needed to help determine whether medical management of DFO can be successful without surgical intervention. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2022.
Authors: E Senneville; Y Yazdanpanah; M Cazaubiel; M Cordonnier; M Valette; E Beltrand; A Khazarjian; L Maulin; S Alfandari; M Caillaux; L Dubreuil; Y Mouton Journal: J Antimicrob Chemother Date: 2001-12 Impact factor: 5.790
Authors: J Aragón-Sánchez; J L Lázaro-Martínez; C Hernández-Herrero; N Campillo-Vilorio; Y Quintana-Marrero; E García-Morales; M J Hernández-Herrero Journal: Diabet Med Date: 2012-06 Impact factor: 4.359
Authors: F J Aragón-Sánchez; J J Cabrera-Galván; Y Quintana-Marrero; M J Hernández-Herrero; J L Lázaro-Martínez; E García-Morales; J V Beneit-Montesinos; D G Armstrong Journal: Diabetologia Date: 2008-08-22 Impact factor: 10.122