Venkatesan P, Lawn S, Macfarlane R M, Fletcher E M, Finch R G, Jeffcoate W J
Department of Microbiology, City Hospital, Nottingham, UK.
Diabet Med. 1997 Jun;14(6):487-90. doi: 10.1002/(SICI)1096-9136(199706)14:6<487::AID-DIA373>3.0.CO;2-Q.
Experience of conservative management of osteomyelitis in a specialized, multidisciplinary, diabetic foot clinic was reviewed. The records of all patients attending the clinic over a 10-year period were examined retrospectively, and 22 patients with overt osteomyelitis were identified. Median age was 66 (31-87) years. In 12 cases the bone infection was a complication of a pre-existing ulcer; the most prevalent organism cultured from swabs was Staphylococcus aureus. The main site of infection was the first toe. The total duration of antibiotic treatment was 12 weeks (median, range 5-72), and clindamycin was the most commonly used oral agent. Four patients did not respond to initial conservative therapy and proceeded to amputation, while 1 patient responded clinically but had a recurrence of osteomyelitis at the same site 6 years later. In the remaining 17 patients resolution of osteomyelitis was achieved with conservative management over a median period of follow-up of 27 (range 5-73) months. The success of conservative therapy with prolonged courses of oral antibiotics challenges conventional advice that excision of infected bone is essential in the management of osteomyelitis affecting the foot in diabetes.
回顾了在一家专业的多学科糖尿病足诊所对骨髓炎进行保守治疗的经验。对该诊所10年间所有就诊患者的记录进行了回顾性检查，确定了22例显性骨髓炎患者。中位年龄为66岁（31 - 87岁）。12例患者的骨感染是先前存在的溃疡的并发症；从拭子培养出的最常见病原体是金黄色葡萄球菌。感染的主要部位是第一趾。抗生素治疗的总时长为12周（中位值，范围5 - 72周），克林霉素是最常用的口服药物。4例患者对初始保守治疗无反应并接受了截肢手术，1例患者临床症状有改善，但6年后同一部位骨髓炎复发。其余17例患者在中位随访期27个月（范围5 - 73个月）内通过保守治疗实现了骨髓炎的缓解。长期口服抗生素进行保守治疗的成功挑战了传统观念，即对于糖尿病患者足部骨髓炎的治疗，切除感染骨至关重要。
