Universität zu Köln

Jung, N. and Rieg, S. (2018). Diabetic foot osteomyelitis. A diagnostic and therapeutic challenge. Diabetologe, 14 (3). S. 145 - 153. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1860-9724

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Abstract

Foot infections are common complications in patients with poorly controlled diabetes. Osteomyelitis, the most serious complication, mostly arises from a soft tissue infection that spreads into the bone and occurs in 10-15% of moderate and 50% of severe soft tissue infections. The forefoot is involved in 90% of cases. Establishing the diagnosis of osteomyelitis remains a challenge due to unspecific symptoms, yet two clinical signs that are predictive for osteomyelitis can be helpful: width (> 2aEuro cm(2)) and depth (> 3aEuro mm) of foot ulcers and a positive probe-to-bone test. Serum inflammatory markers are significantly higher in osteomyelitis than in soft tissue infection. The erythrocyte sedimentation rate (ESR) appears to be the best marker, which remains elevated for a longer period of time. Initial plain xaEurorays may be helpful despite the low sensitivity and specificity. For further evaluation, magnetic resonance imaging (MRI) with gadolinium is the method of choice as it exhibits a high sensitivity (90%) and specificity (85%). An aseptically collected bone sample for microbiological culture and histopathology is the diagnostic gold standard. Superficial swabs of infected wounds or fistulae should not be analyzed due to the low correlation between isolated and causative pathogen (< 40%). Treatment consists of resection of the affected bone and antibiotic therapy. In selected uncomplicated cases, antibiotic treatment alone might be sufficient. The duration of therapy is still a matter of debate; in the current International Working Group on the Diabetic Foot guidelines, 6 weeks are recommended in cases without bone resection and no more than 1 week after complete resection.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Jung, N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rieg, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-188081
DOI:	10.1007/s11428-018-0321-3
Journal or Publication Title:	Diabetologe
Volume:	14
Number:	3
Page Range:	S. 145 - 153
Date:	2018
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1860-9724
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TO-BONE TEST; ANTIBIOTICS; INFECTION; SURGERY Multiple languages Endocrinology & Metabolism Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18808