In the Diabetic Foot Unit of the Clinical School of Podiatry; Faculty of Nursing, Physiotherapy, and Podiatry; Universidad Complutense de Madrid, Spain; Aroa Tardáguila-García, DPM, PhD; Irene Sanz-Corbalán, DPM, PhD; Esther García-Morales, DPM, PhD; Yolanda García-Álvarez, DPM, PhD; Raúl J. Molines-Barroso, DPM, PhD; and José Luis Lázaro-Martínez, DPM, PhD, are Podiatrists. The authors have disclosed no financial relationships related to this article. Submitted September 10, 2020; accepted in revised form October 28, 2020.
Adv Skin Wound Care. 2021 Apr 1;34(4):204-208. doi: 10.1097/01.ASW.0000734376.32571.20.
To compare the diagnostic accuracy of bone culture (microbiology) and biopsy (histology) in patients with acute or chronic diabetic foot osteomyelitis (DFO).
This cross-sectional study involved patients for whom providers had a clinical suspicion of DFO. Two bone samples were taken: one for microbiologic testing and another for histologic testing. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio were calculated for bone culture results in relation to the probability of DFO diagnosis.
Fifty-two patients were included; 69% had positive bone culture results, and 90.4% had positive histology results (P = .013), and of those 90.4%, 25.5% had acute and 74.5% had chronic DFO. The sensitivity of the microbiologic bone culture result was 0.70, the specificity was 0.40, the positive predictive value was 0.92, and the negative predictive value was 0.13.
Histology provides more accurate diagnosis of DFO than microbiology, especially for patients with chronic DFO. These patients could be underdiagnosed because of false-negative results provided by bone culture. Providers should perform both tests to confirm the presence of DFO.
比较急性或慢性糖尿病足骨髓炎（DFO）患者的骨培养（微生物学）和活检（组织学）的诊断准确性。
本横断面研究纳入了临床疑似患有 DFO 的患者。采集了两份骨样本：一份用于微生物学检测，另一份用于组织学检测。计算了骨培养结果与 DFO 诊断概率相关的灵敏度、特异性、阳性预测值、阴性预测值和似然比。
共纳入 52 例患者；69%的患者骨培养结果阳性，90.4%的患者组织学结果阳性（P =.013），其中 90.4%的患者为急性 DFO，74.5%为慢性 DFO。微生物学骨培养结果的灵敏度为 0.70，特异性为 0.40，阳性预测值为 0.92，阴性预测值为 0.13。
组织学比微生物学能更准确地诊断 DFO，尤其是对慢性 DFO 患者。由于骨培养的假阴性结果，这些患者可能被误诊。医生应同时进行这两项检测以确认 DFO 的存在。
