Diabetic Food Study Group- Portugal-

Aim: The purpose of this study was to evaluate the characteristics and clinical course of patients with
diabetic foot osteomyelitis.

Method: A retrospective observational study was performed. Patients reviewed were observed for the first time in a multidisciplinary outpatient diabetic foot clinic between January and December 2014.

We included those with probable osteomyelitis (obtained from clinical and radiological criteria). The following data were obtained: gender, age, diabetes duration, presence of arterial disease, microbiological isolations and use of antibiotics. Adverse outcome was defined as death or amputation.

Results/Discussion: We included 56 patients; the majority of them were male (67.9%). Median age was 64 years (min. 32, max. 93) and mean duration of diabetes was 18.1 years (+- 10.0). Peripheral artery disease was present in 71.4% (n=40). In 67.9% (n=38) of the patients cure was achieved with medical treatment only; of these, more than one antibiotic course was, necessary in 57.9% (n=22).

Amputation was performed in 30.4% (n=17) of the patients [28.6% (n=16) were submitted to minor amputation and 1.8% (n=1) to major amputation]. One patient died during hospital admission from diabetic foot infection. No correlation was found between the adverse outcome and peripheral artery disease.

Nine patients (16%) had infection with multi-resistant bacteria (methicilin-resistant Staphylococcus aureus or quinolone-resistant Pseudomonas aeruginosa); no extended-spectrum beta- lactamase-producing bacteria were isolated.

Conclusion: Although a considerable percentage of patients need amputation in the course of diabetic foot osteomyelitis, medical treatment, which sometimes requires more than one antibiotic course, was effective in treating 67.9% of patients. In our series, the presence of peripheral artery disease was not correlated with the outcome. More studies are needed to define which factors can be predictive of amputation.