Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy. (January 2022)

• Record Type: Journal Article
• Authors: Waibel, Felix WA; Schöni, Madlaina; Kronberger, Leo; Flury, Andreas; Berli, Martin C.; Lipsky, Benjamin A.; Uçkay, Ilker; Jud, Lukas
• Is Part Of: International journal of infectious diseases. Volume 114(2022)
• Page Start: 15
• Page End: 20
• Publication Date: 2022-01
• Subjects: DCO Diabetic Charcot Foot Osteomyelitis -- DFO Diabetic Foot Osteomyelitis -- PAD Peripheral Arterial Disease -- CN Charcot Neuroosteoarthropathy; Diabetic foot osteomyelitis -- Charcot neuroosteoarthropathy -- Treatment -- Outcomes -- Risk associations; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.10.036
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Treatment failure rates were equated with and without Charcot arthropathy In the long term, limb loss was significantly more often when Charcot arthropathy was present In Charcot arthropathy, advanced stages of PAD are linked to treatment failure Abstract: Objective: Therapy for diabetic foot osteomyelitis (DFO) with Charcot neuroosteoarthropathy is challenging. In patients with diabetic Charcot osteomyelitis (DCO), both the anatomic deformity and infection must be addressed. This study assessed the outcomes of DCO therapy and variables associated with treatment failure and compared them with outcomes of DFO cases. Methods: A single-center, retrospective, case-control study was performed to compare 93 DCO episodes with 530 DFO episodes, using Kaplan-Meier survival curves and multivariate Cox regression analyses. Results: Clinical failure occurred in 21.5% of DCO compared with 22.3% in DFO episodes ( p =0.89) and was associated with peripheral arterial disease (PAD) stages 3 or 4 (HR 6.1; CI 2.0-18.1) and chronic treatment with immunosuppressives (HR 7.4; CI 2.0-27.1). Major amputations were significantly more frequent in DCO (28% versus 13.6%; p <0.01) and associated with PAD stages 3 and 4 (HR 8.0; CI 2.2-29.4), smoking (HR 5.4; CI 1.2-24.6), alcohol abuse (HR 3.5; CI 1.1-10.6), and renal dialysis (HR 4.9; CI 1.3-18.9). Conclusions: Clinical treatment failures did not differ between DCO and DFO. However, patients with DCO underwent major amputation twice as often as those with DFO. Unlike widespread belief, treatment failure in DCO patients may, similar to DFO, be associated with a striking epidemiological link to severe PAD.