Infection Relapse and Time-to-Healing After Conservative Surgery for Non-Acute Presentations of Diabetes-Related Forefoot Osteomyelitis: Does Site Matter?

Diabetes-related foot osteomyelitis (DFO) can present as an acute condition with soft tissue involvement or as a non-acute form characterized by long-standing ulcers without immediate limb-threatening features. This study evaluates infection relapse and healing times after conservative surgery in non-acute DFO, with a focus on osteomyelitis localization. A retrospective cohort of 60 patients treated for forefoot DFO without soft tissue involvement or necrosis was analyzed.

Conservative surgery for forefoot osteomyelitis may increase reulceration-free survival compared to minor amputation in diabetes-related foot disease.

This study suggests that conservative surgery may improve reulceration-free survival in patients with diabetes-related forefoot osteomyelitis, compared to minor amputation. By excluding patients with prior surgeries, the analysis more accurately reflects the benefits of conservative surgery. These findings highlight the importance of preserving foot structure to maintain biomechanics and reduce reulceration risk.

Two-Step Conservative Surgery for Complicated Forms of Diabetes-Related Foot Osteomyelitis.

Diabetes-related foot osteomyelitis (DFO) is a common yet complex condition, often complicated by concurrent soft tissue infections (STIs). This study evaluates the efficacy of a two-step conservative surgical approach, hypothesizing that it offers comparable outcomes to a one-step procedure. Conducted on a cohort of 93 patients with DFO, the study categorized cases into two types: OM1 (osteomyelitis without STI) and OM2 (osteomyelitis with STI).

Outpatient Foot-Sparing Surgery Is Safe in Selected Patients with Diabetic Foot Infections.

Objective: To determine if outpatient foot-sparing surgery for patients with diabetic foot infections (DFIs) is associated with a higher rate of treatment failure or longer healing time.

Methods: In this prospective observational study, the authors consecutively recruited a cohort of 200 patients with moderate and severe DFIs from the Diabetic Foot Unit of Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José de Costa Rica, Costa Rica from October 15, 2020 to December 15, 2021. They compared outpatients with those admitted.

Risk Factors Associated with Failure of Toe Amputation in Diabetic Foot Infections.

We aim to identify the factors associated with the failure of amputation of one to three toes (index toe amputation) in patients with diabetes and foot infection. We conducted a retrospective cohort of 175 patients with diabetes who were hospitalized for moderate to severe foot infection and underwent amputation of one to three toes. A Poisson regression model was used to determine the prevalence ratio (PR) as a measure of association.

Differences in Foot Infections Secondary to Puncture Wounds or Chronic Ulcers in Diabetes.

We hypothesized that foot infections secondary to a puncture wounds (PWs) have a worse prognosis concerning infection-related mortality, recurrence of the infection, and healing than those secondary to a chronic ulcer. We conducted a prospective study consisting of 200 patients with moderate-to-severe diabetic foot infections. The cohort consisted of 155 men (77.

Interventions in the management of diabetes-related foot infections: A systematic review.

The optimal approaches to managing diabetic foot infections remain a challenge for clinicians. Despite an exponential rise in publications investigating different treatment strategies, the various agents studied generally produce comparable results, and high-quality data are scarce. In this systematic review, we searched the medical literature using the PubMed and Embase databases for published studies on the treatment of diabetic foot infections from 30 June 2018 to 30 June 2022.

IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the management and prevention of diabetes-related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline.

IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the management and prevention of diabetes-related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline.

Diagnosis of infection in the foot of patients with diabetes: A systematic review.

Background: Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potential mortality and present formidable challenges in surgical and antimicrobial treatment.

Methods: In June 2022, we searched the literature using PubMed and EMBASE for published studies on the diagnosis of diabetic foot infection (DFI). On the basis of pre-determined criteria, we reviewed prospective controlled, as well as non-controlled, studies in English.

Extracellular to Intracellular Water Ratio Determined by Bioimpedance is Associated with Mortality in Patients Admitted for Diabetic Foot Ulcers.

An increased extracellular water/intracellular water (ECW/ICW) ratio determined by bioimpedance has been related to mortality in patients undergoing hemodialysis. We aimed to evaluate the impact of body water distribution in patients with diabetes-related foot ulcers. Seventy-six patients were evaluated with bioimpedance, handgrip strength, and laboratory examinations.

Residual osteomyelitis at the resection margin after conservative surgery is not associated with the recurrence of diabetic foot infection and may successfully be treated without postoperative antibiotic therapy.

Aims: We hypothesize that microbiology- and pathology-confirmed positive bone margins after the resection of diabetes-related foot osteomyelitis are associated with worse outcomes.

Methods: We conducted a prospective study consisting of a cohort of 93 patients with diabetes-related foot osteomyelitis (histopathology confirmed) who underwent bone resection and where an additional bone biopsy was taken at the resection margin. The primary outcome was the recurrence of the infection.

Systemic Immune-Inflammation Index in Diabetic Foot Infections and Osteomyelitis.

The systemic immune-inflammation index (SII) was significantly higher in patients with severe infections, those with necrosis, and in those requiring admission, postoperative antibiotics, and any amputation. However, SII was significantly lower in patients with osteomyelitis compared to those with soft tissue infections. The correlation coefficients (rho) between SII and other inflammatory markers were as follows: WBC (Moderate correlation, 0.

Mean Platelet Volume-to-Lymphocyte Ratio Is a Biomarker of 1-Year Mortality in Patients With Diabetic Foot Infections.

We aimed to evaluate the value of 2 peripheral blood cell ratios, the mean platelet volume-to-lymphocyte ratio (MPVLR) and the neutrophil-to-lymphocyte ratio (NLR) as prognostic biomarkers of mortality in patients with diabetic foot infections (DFIs). We conducted a prospective observational study consisting of a cohort of 200 patients with moderate to severe DFIs consecutively recruited from our Diabetic Foot Unit, Hospital San Juan de Dios, San José de Costa Rica, Costa Rica from October 15, 2020, to December 15, 2021. We studied the variables associated with one-year all-cause mortality using a multivariate backward Cox's regression model.

Clinical Features, Inflammatory Markers, and Limb Salvage in Older Adults with Diabetes-Related Foot Infections.

Little information exists about diabetic foot infections (DFIs) in older patients. We hypothesize that older patients with DFIs have different clinical features and worse outcomes than younger patients. We conducted a prospective observational study consisting of a cohort of patients with diabetes and moderate to severe DFIs.

Surgery without postoperative antibiotic treatment in diabetic foot osteomyelitis is not associated with recurrence or limb loss.

Not using antibiotics after surgical treatment of diabetic foot osteomyelitis was not associated with failure of the surgery, recurrences, or limb loss. Antibiotics were given in doubtful complicated cases such as severe infections, cases with necrosis, foul-smelling lesions and patients requiring revascularization.

Prospective Validation of the Value of Adding Osteomyelitis to Moderate and Severe Categories of Diabetic Foot Infections.

We aimed to validate the value of adding osteomyelitis (OM) to moderate and severe categories of diabetic foot infections (DFIs) classification. We conducted a prospective study of a cohort of 200 patients with moderate and severe infections. Variables associated with prognosis were need for any amputation, major amputation, need for hospitalization, length of hospitalization, length of antibiotic therapy, reinfection rate and infection-related mortality.

Severe diabetic foot infections without systemic inflammatory response syndrome: Prospective validation of a new category.

We aimed to validate the prognostic value of subclassifying moderate diabetic foot infections into two categories: moderate and moderate/severe. We conducted a prospective study of a cohort of 200 patients with moderate and severe infections. Moderate infections were subclassified after applying a previously published score.

Controversial Issues Regarding Positive Bone Margins in Surgery for Diabetic Foot Osteomyelitis: A Pilot Study.

Obtaining clean margins in patients who undergo surgical treatment for diabetic foot osteomyelitis (DFO) is recommended. We hypothesize that the rate of recurrence of the infection is not associated with positive margins, even when using a short-term duration of postoperative antibiotic treatment. We conducted a retrospective pilot study of patients who underwent surgery for DFO confirmed by histopathological analysis of the resected bone from August 1, 2020, to December 1, 2020.

Handgrip Strength But Not Malnutrition According to Global Leadership Initiative on Malnutrition Criteria Is a Risk Factor for Mortality in Hospitalized Patients with Ischemic Diabetic Foot Ulcers.

This study aimed to test the hypothesis that patients with malnutrition and impaired muscle function determined by hand grip strength (HGS) will have adverse outcomes. We conducted a prospective observational study of 77 patients admitted for ischemic diabetic foot ulcers (IDFU). Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose malnutrition.

Clinical, microbiological and inflammatory markers of severe diabetic foot infections.

Aims: In addition to systemic inflammatory response syndrome (SIRS), various clinical signs, microbiological findings and inflammatory markers could be associated with severe diabetic foot infections (DFI).

Methods: This study included a retrospective cohort of 245 patients with DFI treated at San Juan de Dios Hospital in San José de Costa Rica. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), CRP/albumin ratio, peripheral blood leucocyte ratios and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system were evaluated.

Does Metabolic Control Have Any Influence on the Clinical Presentation and Short-Term Outcomes of Diabetic Foot Infections?

We hypothesized that patients with poor glycemic control undergoing treatment for diabetic foot infections (DFIs) would have a poorer prognosis than those with better metabolic control assessed by glycated hemoglobin (HbA1c). We analyzed a retrospective cohort of 245 patients with moderate and severe DFIs. HbA1c values were dichotomized (<7% or ≥7% and ≤75th percentile (P75) and >P75) to analyze patient outcomes regarding metabolic control.