TY - JOUR
T1 - Complications during the treatment of diabetic foot osteomyelitis
AU - van Asten, Suzanne A.V.
AU - Mithani, Moez
AU - Peters, Edgar J.G.
AU - La Fontaine, Javier
AU - Kim, Paul J.
AU - Lavery, Lawrence A.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Aim To identify complications of medical treatment in patients with diabetic foot osteomyelitis (DFO). Methods We reviewed 143 records of consecutive patients admitted with DFO, confirmed by bone histopathology or culture. Complications monitored included acute kidney injuries (AKI), development of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), gastrointestinal complications, and venous catheter related complications during a 12 months follow-up period. Results Forty-seven AKI episodes were reported during follow-up; half occurred during the first hospitalization with involvement of antimicrobial therapy in 14 events (29.8%). Patients with AKI were more likely to have recurrent ulcerations (69.2% vs. 45.2%, p = 0.02), recurrent infections (38.5% vs. 17.3%, p = 0.01), and recurrent hospitalizations (43.6% vs. 28.8%, p = 0.02) during follow-up. Only 14 MRSA isolates were found in bone samples at baseline (9.8%). Resistant strains of MRSA and VRE were identified in twenty-one patients (14.7%) during follow-up. Patients re-hospitalized for infection were more likely to have resistant bacterial strains (52.6% vs. 25.8%, p = 0.02). Conclusions In this study, the rates of VRE and MRSA in bone biopsies of patients with DFO were lower than in previous reports. Acute kidney injury occurred frequently in our patient population but might not be associated with antibiotic exposure.
AB - Aim To identify complications of medical treatment in patients with diabetic foot osteomyelitis (DFO). Methods We reviewed 143 records of consecutive patients admitted with DFO, confirmed by bone histopathology or culture. Complications monitored included acute kidney injuries (AKI), development of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), gastrointestinal complications, and venous catheter related complications during a 12 months follow-up period. Results Forty-seven AKI episodes were reported during follow-up; half occurred during the first hospitalization with involvement of antimicrobial therapy in 14 events (29.8%). Patients with AKI were more likely to have recurrent ulcerations (69.2% vs. 45.2%, p = 0.02), recurrent infections (38.5% vs. 17.3%, p = 0.01), and recurrent hospitalizations (43.6% vs. 28.8%, p = 0.02) during follow-up. Only 14 MRSA isolates were found in bone samples at baseline (9.8%). Resistant strains of MRSA and VRE were identified in twenty-one patients (14.7%) during follow-up. Patients re-hospitalized for infection were more likely to have resistant bacterial strains (52.6% vs. 25.8%, p = 0.02). Conclusions In this study, the rates of VRE and MRSA in bone biopsies of patients with DFO were lower than in previous reports. Acute kidney injury occurred frequently in our patient population but might not be associated with antibiotic exposure.
KW - Acute kidney injury
KW - Antibiotics
KW - Bacterial resistance
KW - Diabetic foot
KW - Osteomyelitis
UR - http://www.scopus.com/inward/record.url?scp=85035044742&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.diabres.2017.06.002
DO - https://doi.org/10.1016/j.diabres.2017.06.002
M3 - Article
C2 - 28951333
SN - 0168-8227
VL - 135
SP - 58
EP - 64
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -