101-OR: Systematic Intraoperative Bone Sampling Increases Healing Chances in Diabetic Foot Osteomyelitis

Aim: We aimed to evaluate if a proactive multidisciplinary diagnostic program could improve outcomes in the management of multidrug resistant (MDR) diabetic foot (DF) osteomyelitis (OM).

Methods: We evaluated all the consecutive patients undergoing surgical procedure for OM July-December 2021 in our department (Group A). Intraoperative bone specimens were collected for microbiological and histological analysis on whose results antibacterial therapy was decided. Controls were patients admitted January-June 2021 with same indications (Group B) but with no systematic intraoperative bone sampling. Clinical and demographic characteristics, procedures, healing rate (HR) and healing time (HT), were compared between the groups.

Results: We derived data from 89 patients: 46 in Group A [51.7%; age 68.8±13.5 yrs; diabetes duration (DD) 19.6±11.6 yrs Hba1c 8.7±4.8%] and 43 in Group B [48.3%; age 70.4±12.9 yrs; DD 18.8±12.1 yrs; Hba1c 8.4±5.1%]. No differences in demographic and clinical features, i.e. chronic kidney disease (39.1% vs 37.2%, p=ns), ischemic cardiac disease (41.3% vs 39.5%, p=ns), peripheral arterial disease (65.2% vs 67.4%, p=ns) and peripheral revascularizations (56.5% vs 53.4%, p=ns). Group A had a higher healing rate (80.4% vs 60.4%, p=0.0021) and a shorter healing time (67±41 days vs 134±92 days, p=0.020) compared to Group B.

Conclusions: Systematic intraoperative bone sampling for culture and histology, and consequent antibiotic adjustment, increases healing rates and reduces healing times in DF patients undergoing surgical debridement for OM.