Complications during the treatment of diabetic foot osteomyelitis

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 12months 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.

Keywords: Acute kidney injury; Antibiotics; Bacterial resistance; Diabetic foot; Osteomyelitis.