Adjuvant antibiotic loaded bio composite in the management of diabetic foot osteomyelitis — A multicentre study. (June 2019)

• Record Type: Journal Article
• Authors: Niazi, Noman Shakeel; Drampalos, Efstathios; Morrissey, Natasha; Jahangir, Noman; Wee, Alexander; Pillai, Anand
• Is Part Of: Foot. Volume 39(2019)
• Page Start: 22
• Page End: 27
• Publication Date: 2019-06
• Subjects: Diabetic foot -- Chronic osteomyelitis -- Antibiotic-loaded bio-composite -- Cerament G; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Foot Diseases -- Periodicals; Foot -- surgery -- Periodicals; Pied -- Maladies -- Périodiques; Pied -- Chirurgie -- Périodiques; Pied -- Lésions et blessures -- Périodiques; Foot -- Diseases; Foot -- Surgery; Periodicals; Electronic journals; Electronic journals; 617.585005
• DOI: 10.1016/j.foot.2019.01.005
• Languages: English
• ISSNs: 0958-2592

Abstract

Highlights: A retrospective review of patients with diabetic foot ulceration and osteomyelitis treated by debridement with adjuvant local antibiotic was performed It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Offers the advantage of local delivery of antibiotic for at least 30 days. Apart from storage of antibiotic acts also as a scaffold for bone formation decreasing the risk for a fracture. Infection was eradicated in 90% patients with no systemic side effects. Abstract: Background: Diabetic foot ulcers are associated with a high morbidity and are common cause of non-traumatic lower limb amputations. The effect of debridement and the use of an adjuvant local antibiotic carrier in the treatment of diabetic foot ulcers with osteomyelitis was evaluated. Methods: A retrospective review of patients with diabetic foot ulceration and osteomyelitis treated by debridement with adjuvant local antibiotic was performed. Seventy patients with Texas Grade 3B & 3D lesions were included, with a mean age of 68 years. Cerament G, an antibiotic-loaded absorbable calcium sulphate/hydroxyapatite bio-composite was used along with intraoperative multiple bone sampling and culture-specific systemic antibiotics. Results: Patients were followed up until infection eradication or ulcer healing. Mean follow up was 10 months (4–28months). Nine patients had Charcot foot deformity, 14 had peripheral vascular disease. 62% of patients had forefoot, 5% midfoot and 33% hind foot involvement. Fifty-three patients (87%) had polymicrobial infection. Staphylococcus aureus was the most common microorganism isolated. Infection was eradicated in 63 patients (90%) with mean time to ulcer healing of 12 weeks. Seven patients were not cured and required further treatment. Five patients had below knee amputation. Conclusions: Adjuvant, local antibiotic therapy with an absorbable bio-composite can help achieve up to 90% cure rates in diabetic foot ulceration with osteomyelitis. Cerament G can act as effective void filler allowing dead space management after excision and preventing reinfection and the need for multiple surgical procedures. Level of evidence: Level IV- case series.