Conservative management of osteomyelitis in the feet of diabetic patients

TLDR

The study reviews experience of conservative management of osteomyelitis in a specialized diabetic foot clinic. The authors retrospectively reviewed 10 years of clinic records, identifying 22 diabetic patients (median age 66) mainly with first‑toe infection, who received a median 12‑week course of oral antibiotics, most often clindamycin. Conservative therapy succeeded in 17 of 22 patients (77 %) over a median 27‑month follow‑up, while four required amputation and one had a late recurrence, showing that prolonged oral antibiotics can be effective for foot osteomyelitis in diabetes.

Abstract

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.