'Multidisciplinary treatment such as cut diabetic osteomyelitis and antimicrobial management'
Sep 25, 2024
If you suffer from diabetes for a long time, you have problems with blood vessels or nerves. The feet also have problems with blood flow, and if the wound is left unattended due to dull sensation, it can lead to ulcers and infections, leading to amputation of the foot.
In general, amputation is performed when the diabetic infection does not respond to antimicrobial treatment, or when the site of the infection is extensive and necrosis progresses. Even if the amputation was performed, the presence or absence of residual infection on the cut surface and the progress after the amputation determine the prognosis of treatment.
Professor Baek Ye-ji and Lee Eun-jung of Soonchunhyang University Seoul Hospital's Foot and Diabetes Center (Jeong Jong-tak, Won Sung-hoon, Ahn Chi-young, Chun Dong-il, and Kim Tae-hyung) studied the epidemiological and clinical characteristics of diabetic osteomyelitis patients who underwent amputation and factors affecting treatment failure.
As a result of the study, peripheral arterial disease and hemodialysis were identified as a major factor in treatment failure after amputation of infected bones.
The subjects of the study were 101 patients with diabetic osteomyelitis who underwent amputation, and a retrospective cohort study was conducted. The factors affecting treatment failure were analyzed by grouping them into treatment success and treatment failure according to the condition of the cut surface after the primary cut and the clinical manifestation results after the cut. Treatment success was defined as the maintenance of the cut surface without signs of infection 6 months after cutoff.
The most common causative agents of diabetic osteomyelitis requiring amputation were Staphylococcus aureus (17%) and Pseudomonas bacteria (14%). Gram-negative bacteria were isolated from 62% of patients.
Hemodialysis and ankle brachial index (ABI) of 0.6 or less were prognostic factors associated with treatment failure in diabetic osteomyelitis patients.
Although proper antimicrobial management did not contribute to the reduction of mortality, patients who were amputated to the upper ankle were able to reduce the duration of antimicrobial treatment compared to patients who were amputated only part of the foot. However, it is still a medical task to maintain and function the feet without cutting as much as possible.
Professor Lee Eun-jung emphasized that `Since resolving blocked blood vessels during the treatment process, determining when surgery is required and the degree of amputation, management and treatment of the cut surface after amputation, subsequent rehabilitation, and the use of appropriate antimicrobial agents against the causative agent of myelitis determine the success of the treatment, multidisciplinary treatment by related departments is very important for the success of treatment.'
The research team's paper was recently published in the journal Open Forum Infectious Disease under the title Diabetic Foot Osteomyelitis Undergoing Amplification: Epidemiology and Prognostic Factors for Treatment Failure.
Meanwhile, Soonchunhyang University Seoul Hospital operates a foot and diabetes center. Every Tuesday, orthopedics, plastic surgery, vascular surgery, radiology, rehabilitation medicine, renal medicine, endocrine metabolism, and infectious medicine medical staff provide optimal treatment to diabetic patients through multidisciplinary treatment.
In general, amputation is performed when the diabetic infection does not respond to antimicrobial treatment, or when the site of the infection is extensive and necrosis progresses. Even if the amputation was performed, the presence or absence of residual infection on the cut surface and the progress after the amputation determine the prognosis of treatment.
Professor Baek Ye-ji and Lee Eun-jung of Soonchunhyang University Seoul Hospital's Foot and Diabetes Center (Jeong Jong-tak, Won Sung-hoon, Ahn Chi-young, Chun Dong-il, and Kim Tae-hyung) studied the epidemiological and clinical characteristics of diabetic osteomyelitis patients who underwent amputation and factors affecting treatment failure.
As a result of the study, peripheral arterial disease and hemodialysis were identified as a major factor in treatment failure after amputation of infected bones.
The subjects of the study were 101 patients with diabetic osteomyelitis who underwent amputation, and a retrospective cohort study was conducted. The factors affecting treatment failure were analyzed by grouping them into treatment success and treatment failure according to the condition of the cut surface after the primary cut and the clinical manifestation results after the cut. Treatment success was defined as the maintenance of the cut surface without signs of infection 6 months after cutoff.
The most common causative agents of diabetic osteomyelitis requiring amputation were Staphylococcus aureus (17%) and Pseudomonas bacteria (14%). Gram-negative bacteria were isolated from 62% of patients.
Hemodialysis and ankle brachial index (ABI) of 0.6 or less were prognostic factors associated with treatment failure in diabetic osteomyelitis patients.
Although proper antimicrobial management did not contribute to the reduction of mortality, patients who were amputated to the upper ankle were able to reduce the duration of antimicrobial treatment compared to patients who were amputated only part of the foot. However, it is still a medical task to maintain and function the feet without cutting as much as possible.
Professor Lee Eun-jung emphasized that `Since resolving blocked blood vessels during the treatment process, determining when surgery is required and the degree of amputation, management and treatment of the cut surface after amputation, subsequent rehabilitation, and the use of appropriate antimicrobial agents against the causative agent of myelitis determine the success of the treatment, multidisciplinary treatment by related departments is very important for the success of treatment.'
The research team's paper was recently published in the journal Open Forum Infectious Disease under the title Diabetic Foot Osteomyelitis Undergoing Amplification: Epidemiology and Prognostic Factors for Treatment Failure.
Meanwhile, Soonchunhyang University Seoul Hospital operates a foot and diabetes center. Every Tuesday, orthopedics, plastic surgery, vascular surgery, radiology, rehabilitation medicine, renal medicine, endocrine metabolism, and infectious medicine medical staff provide optimal treatment to diabetic patients through multidisciplinary treatment.
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