Complications during the treatment of diabetic foot osteomyelitis. (January 2018)

• Record Type: Journal Article
• Authors: van Asten, Suzanne A.V.; Mithani, Moez; Peters, Edgar J.G.; La Fontaine, Javier; Kim, Paul J.; Lavery, Lawrence A.
• Is Part Of: Diabetes research and clinical practice. Volume 135(2018)
• Page Start: 58
• Page End: 64
• Publication Date: 2018-01
• Subjects: Diabetic foot -- Osteomyelitis -- Acute kidney injury -- Bacterial resistance -- Antibiotics; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.06.002
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Patients with diabetic foot osteomyelitis are at risk for acute kidney injuries. Antibiotic exposure does not seem to be the explanation for the kidney injuries. Acute kidney injuries are associated with poor clinical outcomes. The rates of resistant organisms in diabetic foot osteomyelitis appear to be low. Abstract: Aim: To identify complications of medical treatment in patients with diabetic foot osteomyelitis (DFO). Methods: We reviewed 143 records of consecutive patients admitted with DFO, confirmed by bone histopathology or culture. Complications monitored included acute kidney injuries (AKI), development of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), gastrointestinal complications, and venous catheter related complications during a 12 months follow-up period. Results: Forty-seven AKI episodes were reported during follow-up; half occurred during the first hospitalization with involvement of antimicrobial therapy in 14 events (29.8%). Patients with AKI were more likely to have recurrent ulcerations (69.2% vs. 45.2%, p = 0.02), recurrent infections (38.5% vs. 17.3%, p = 0.01), and recurrent hospitalizations (43.6% vs. 28.8%, p = 0.02) during follow-up. Only 14 MRSA isolates were found in bone samples at baseline (9.8%). Resistant strains of MRSA and VRE were identified in twenty-one patients (14.7%) during follow-up. Patients re-hospitalized for infection were more likely to have resistant bacterial strains (52.6% vs. 25.8%, p = 0.02). Conclusions: In this study, the rates of VRE and MRSA in bone biopsies of patients with DFO were lower than in previous reports. Acute kidney injury occurred frequently in our patient population but might not be associated with antibiotic exposure.