Trends in Oral Antibiotic Treatment in Patients Hospitalized with Diabetic Foot Osteomyelitis: A Single-Centre Experience.

BACKGROUND

The Oral Versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial demonstrated the efficacy of highly bioavailable oral antibiotic therapy for the treatment of osteoarticular infections. However, there continues to be significant variability in practice. This study aimed to assess changes in oral antibiotic use in the treatment of diabetic foot osteomyelitis (DFO) at a large academic hospital.

METHODS

We conducted a retrospective cohort study of adult patients admitted to Sunnybrook Health Sciences Centre from January 1, 2016, to December 31, 2022, with a diagnosis of DFO. The primary outcome was the proportion of patients who received definitive oral antibiotic treatment during two timeframes (Pre-OVIVA publication: January 1, 2016, through February 28, 2019, and post-OVIVA publication: March 1, 2019, to December 31, 2022). Patients were excluded if they had another indication for long-term intravenous antibiotics, if they did not receive antibiotic treatment for osteomyelitis, or if they underwent amputation without the need for postoperative antibiotics.

RESULTS

A total of 145 patients were included in the analysis. (65 patients pre-OVIVA and 80 patients post-OVIVA). The majority of patients had a history of peripheral arterial disease (59%) and gangrene (66%) present on hospital admission. Use of definitive oral antibiotic therapy increased from 10.8% in the pre-OVIVA period to 21.2% in the post-OVIVA period ( = 0.14).

CONCLUSIONS

There was a trend toward increased definitive oral antibiotic therapy for DFO, but overall use remained low. Further studies are needed to explore the factors influencing the selection of oral antibiotic therapy in this population.