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Diabetic foot osteomyetitis: a progress report on diagnosis and a systematic review of treatment

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Author

  • A R Berendt
  • E J G Peters
  • K Bakker
  • J M Embil
  • Magnus Eneroth
  • R J Hinchliffe
  • W J Jeffcoate
  • B A Lipsky
  • E Senneville
  • J Teh
  • G D Valk
Show all

Summary, in English

The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006. The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations. The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae. We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited and further research is, urgently needed.

Publishing year

2008

Language

English

Pages

145-161

Publication/Series

Diabetes/Metabolism Research & Reviews

Volume

24

Issue

S1

Document type

Journal article review

Publisher

John Wiley & Sons Inc.

Topic

  • Endocrinology and Diabetes

Keywords

  • diagnosis
  • surgery
  • antibiotics
  • osteomyelitis
  • diabetes
  • diabetic foot
  • systematic review

Status

Published

ISBN/ISSN/Other

  • ISSN: 1520-7552