Complications during the treatment of diabetic foot osteomyelitis

Suzanne A.V. van Asten, Moez Mithani, Edgar J.G. Peters, Javier La Fontaine, Paul J. Kim, Lawrence A. Lavery

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)58-64
Number of pages7
JournalDiabetes Research and Clinical Practice
Volume135
DOIs
StatePublished - Jan 1 2018

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Diabetic Foot
Osteomyelitis
Methicillin-Resistant Staphylococcus aureus
Acute Kidney Injury
Bone and Bones
Therapeutics
Hospitalization
Infection
Catheters
Anti-Bacterial Agents
Biopsy
Population
Vancomycin-Resistant Enterococci

Keywords

  • Acute kidney injury
  • Antibiotics
  • Bacterial resistance
  • Diabetic foot
  • Osteomyelitis

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Complications during the treatment of diabetic foot osteomyelitis. / van Asten, Suzanne A.V.; Mithani, Moez; Peters, Edgar J.G.; La Fontaine, Javier; Kim, Paul J.; Lavery, Lawrence A.

In: Diabetes Research and Clinical Practice, Vol. 135, 01.01.2018, p. 58-64.

Research output: Contribution to journalArticle

van Asten, Suzanne A.V. ; Mithani, Moez ; Peters, Edgar J.G. ; La Fontaine, Javier ; Kim, Paul J. ; Lavery, Lawrence A. / Complications during the treatment of diabetic foot osteomyelitis. In: Diabetes Research and Clinical Practice. 2018 ; Vol. 135. pp. 58-64.
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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.",
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N2 - 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.

AB - 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.

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