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Diabetic foot osteomyetitis: a progress report on diagnosis and a systematic review of treatment

Berendt, A R; Peters, E J G; Bakker, K; Embil, J M; Eneroth, Magnus LU ; Hinchliffe, R J; Jeffcoate, W J; Lipsky, B A; Senneville, E and Teh, J, et al. (2008) In Diabetes/Metabolism Research Reviews 24(S1). p.145-161
Abstract
The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006. The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations. The... (More)
The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006. The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations. The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae. We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited and further research is, urgently needed. (Less)
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Contribution to journal
publication status
published
subject
keywords
diagnosis, surgery, antibiotics, osteomyelitis, diabetes, diabetic foot, systematic review
in
Diabetes/Metabolism Research Reviews
volume
24
issue
S1
pages
145 - 161
publisher
John Wiley & Sons
external identifiers
  • wos:000256408300026
  • scopus:43049133822
ISSN
1520-7552
DOI
10.1002/dmrr.836
language
English
LU publication?
yes
id
9afeff23-b7db-48c6-9e32-3bb1a5baeb43 (old id 1201376)
date added to LUP
2008-09-15 10:02:17
date last changed
2017-09-03 03:38:51
@article{9afeff23-b7db-48c6-9e32-3bb1a5baeb43,
  abstract     = {The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006. The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations. The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae. We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited and further research is, urgently needed.},
  author       = {Berendt, A R and Peters, E J G and Bakker, K and Embil, J M and Eneroth, Magnus and Hinchliffe, R J and Jeffcoate, W J and Lipsky, B A and Senneville, E and Teh, J and Valk, G D},
  issn         = {1520-7552},
  keyword      = {diagnosis,surgery,antibiotics,osteomyelitis,diabetes,diabetic foot,systematic review},
  language     = {eng},
  number       = {S1},
  pages        = {145--161},
  publisher    = {John Wiley & Sons},
  series       = {Diabetes/Metabolism Research Reviews},
  title        = {Diabetic foot osteomyetitis: a progress report on diagnosis and a systematic review of treatment},
  url          = {http://dx.doi.org/10.1002/dmrr.836},
  volume       = {24},
  year         = {2008},
}