Jordano-Montañez Queralt, Muñiz-Tatay Montse, Viadé-Julià Jordi, Jaen-Manzanera Angeles, Royo-Serrando Josep, Cuchí-Burgos Eva, Anglada-Barceló Jordi, de la Sierra-Iserte Alejandro
Servicio de Medicina Interna, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
Servicio de Medicina Interna, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
Enferm Infecc Microbiol Clin. 2014 Nov;32(9):555-9. doi: 10.1016/j.eimc.2014.03.012. Epub 2014 Jun 7.
The aim of the present study is to determine the proportion of foot ulcers, complicated by osteomyelitis in diabetic patients, that heal without amputation. Furthermore, an attempt is made to analyze the main clinical and microbiological characteristics of episodes, and to identify potential predictive factors leading to the failure of conservative treatment.
A prospective observational study was carried out between 2007 and 2009 on diabetic patients with a foot lesion and attending a diabetic foot clinic. A percutaneous bone biopsy was required to be included in the study.
A total of 81 episodes of diabetic foot osteomyelitis in 64 patients were evaluated. Staphylococcus aureus (28/81) and coagulase negative Staphylococcus (22/81) were the most frequent organisms isolated. Among the gramnegative group (34/81), non-fermenting gram negative bacteria were the most prevalent organisms isolated (14/81). Conservative treatment was successful in 73% of episodes. After a logistic regression analysis using the most significant prognostic variables, only lesion size greater than 2cm independently predicted failure of conservative treatment. Culture guided antibiotic treatment was associated with a better prognosis.
Conservative treatment, including culture-guided antibiotics, is successful without amputation in a large proportion of diabetic patients with diabetic foot osteomyelitis. Considering empiric therapy directed at non-fermenting gramnegative bacteria could be advisable in some cases, because they are frequently isolated in our setting.
本研究旨在确定糖尿病患者并发骨髓炎的足部溃疡在未进行截肢的情况下愈合的比例。此外，还试图分析这些病例的主要临床和微生物学特征，并确定导致保守治疗失败的潜在预测因素。
2007年至2009年期间，对患有足部病变并就诊于糖尿病足诊所的糖尿病患者进行了一项前瞻性观察研究。纳入研究需要进行经皮骨活检。
共评估了64例患者的81例糖尿病足骨髓炎病例。分离出的最常见微生物是金黄色葡萄球菌（28/81）和凝固酶阴性葡萄球菌（22/81）。在革兰氏阴性菌组（34/81）中，非发酵革兰氏阴性菌是分离出的最普遍微生物（14/81）。73%的病例保守治疗成功。在使用最显著的预后变量进行逻辑回归分析后，只有病变大小大于2cm独立预测保守治疗失败。培养指导的抗生素治疗与更好的预后相关。
对于大多数患有糖尿病足骨髓炎的糖尿病患者，包括培养指导的抗生素治疗在内的保守治疗在不进行截肢的情况下是成功的。考虑到在某些情况下，针对非发酵革兰氏阴性菌的经验性治疗可能是可取的，因为在我们的研究环境中它们经常被分离出来。
