Jordan University of Science and Technology, Irbid, Jordan.
University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
J Diabetes. 2023 Apr;15(4):332-337. doi: 10.1111/1753-0407.13377. Epub 2023 Mar 10.
Diabetic foot infection, particularly osteomyelitis, is a major risk factor of amputation in persons with diabetes. Bone biopsy with microbial examination is considered the gold standard of diagnosis of osteomyelitis, providing information about the offending pathogens as well as their antibiotics susceptibility. This allows targeting of these pathogens with narrow spectrum antibiotics, potentially reducing emergence of antimicrobial resistance. Percutaneous fluoroscopy guided bone biopsy allows accurate and safe targeting of the affected bone.
In a single tertiary medical institution and over 9 year period, we performed 170 percutaneous bone biopsies. We retrosepctively reviewed the medical record of these patients including patients' demographics, imaging and biopsy microbiology and pathollogic results.
Microbiological cultures of 80 samples (47.1%) were positive with 53.8% of the positive culture showed monomicrobial growth and the remaining were polymicrobial. Of the positive bone samples 71.3% grew Gram-positive bacteria. Staphylococcus aureus was the most frequently isolated pathogen from positive bone cultures with almost one third showing methicillin resistence. Enterococcus species were the most frequently isolated pathogens from polymicrobial samples. Enterobacteriaceae species were the most common Gram-negative pathogens and were more common in polymicrobial samples.
Percutaneous image-guided bone biopsy is a low-risk, minimally invasive procedure that can provide valuable information about microbial pathogens and therefore enable targeting these pathogens with narrow spectrum antibiotics.
糖尿病足感染，尤其是骨髓炎，是糖尿病患者截肢的主要危险因素。骨活检结合微生物检查被认为是骨髓炎诊断的金标准，可提供有关致病病原体及其抗生素敏感性的信息。这可以使这些病原体能够靶向使用窄谱抗生素，从而潜在地减少抗菌药物耐药性的出现。经皮荧光镜引导下的骨活检可准确、安全地定位受影响的骨骼。
在一家三级医疗机构中，我们在 9 年的时间内进行了 170 例经皮骨活检。我们回顾性地审查了这些患者的病历，包括患者的人口统计学、影像学和活检微生物学及病理结果。
80 份样本（47.1%）的微生物培养呈阳性，其中 53.8%的阳性培养显示单微生物生长，其余为多微生物生长。在阳性骨样本中，71.3%为革兰氏阳性菌。金黄色葡萄球菌是从阳性骨培养物中最常分离出的病原体，其中近三分之一表现出耐甲氧西林。肠球菌属是从多微生物样本中最常分离出的病原体。肠杆菌科是最常见的革兰氏阴性病原体，在多微生物样本中更为常见。
经皮影像引导下的骨活检是一种低风险、微创的程序，可以提供有关微生物病原体的有价值信息，从而能够使这些病原体能够靶向使用窄谱抗生素。
