Metaoy Sara, Rusu Iulia, Pillai Anand
University of Manchester, Manchester, UK.
Wythenshawe Hospital Manchester, Manchester, UK.
Clin Diabetes Endocrinol. 2024 Dec 16;10(1):51. doi: 10.1186/s40842-024-00200-w.
The management of diabetic foot osteomyelitis (DFO) is complex. The targeted use of adjuvant local antibiotics, in the form of biocomposite bone void filler, in DFO, can enhance patient outcomes while minimising the adverse effects associated with systemic antibiotic therapy and its shortcomings.
We reviewed a series of 105 consecutive patients who underwent surgical management for diabetic foot osteomyelitis. In the NLAB group, (no adjuvant local antibiotic use), 49 patients, received the current standard of care treatment with no use of adjunctive local antibiotic therapy. In group LAB, (adjuvant use of local antibiotics), 56 patients received additional adjuvant local antibiotic therapy. Patient outcomes were compared between both groups.
Infection healing was demonstrated in 10 (20.41%) patients from group NLAB and 41 (73.21%) from group LAB (p < 0.0001). Persistence of infection with no evidence of wound healing, 6 months from surgery, was observed in 15 (30.61%) patients in group NLAB. Among the LAB group, only 4 (7.14%) patients demonstrated infection persistence (p = 0.00183). Reinfection was observed in 24 of 49 patients in group NLAB (49%) and in only 11 out of 56 patients in group LAB (20%) (p = 0.001466). 7 (6.67%) patients required major amputation with 6 (12.24%) belonging to group NLAB. Only 1 (1.78%) patient in group LAB underwent major amputation. A higher 5-year mortality rate was noted within patients in group NLAB, 27 (55.1%). The mortality rate in group LAB was (12.5%).
The adjuvant use of antibiotic loaded bio-composite bone void filler locally was associated with increased infection clearance rates regarding diabetic foot osteomyelitis when compared with the standard care of treatment while achieving lower rates of infection persistence and recurrence. It also has the potential to reduce amputation and mortality rates with further research.
糖尿病足骨髓炎（DFO）的治疗较为复杂。以生物复合骨缺损填充剂形式靶向使用辅助性局部抗生素治疗DFO，可改善患者预后，同时将全身抗生素治疗相关的不良反应及其缺点降至最低。
我们回顾了105例连续接受糖尿病足骨髓炎手术治疗的患者。在NLAB组（未使用辅助性局部抗生素）中，49例患者接受了当前的标准治疗，未使用辅助性局部抗生素治疗。在LAB组（使用辅助性局部抗生素）中，56例患者接受了额外的辅助性局部抗生素治疗。比较两组患者的预后情况。
NLAB组10例（20.41%）患者感染愈合，LAB组41例（73.21%）患者感染愈合（p＜0.0001）。NLAB组15例（30.61%）患者术后6个月感染持续存在且无伤口愈合迹象。LAB组中，只有4例（7.14%）患者感染持续存在（p = 0.00183）。NLAB组49例患者中有24例（49%）发生再感染，LAB组56例患者中只有11例（20%）发生再感染（p = 0.001466）。7例（6.67%）患者需要进行大截肢，其中6例（12.24%）属于NLAB组。LAB组只有1例（1.78%）患者接受了大截肢。NLAB组患者的5年死亡率较高，为27例（55.1%）。LAB组的死亡率为（12.5%）。
与标准治疗相比，局部使用含抗生素的生物复合骨缺损填充剂作为辅助治疗糖尿病足骨髓炎，可提高感染清除率，同时降低感染持续和复发率。进一步研究还有望降低截肢率和死亡率。
