The Best Approach to Treating Foot Infections 
in Diabetics
Foot infections occur in about one quarter of diabetics and are among the most common causes of hospitalization of diabetic patients. More than 50,000 lower-extremity amputations are performed each year, and a substantial number result from the failure to treat infected feet. Clinical findings, bone biopsies, and imaging studies (roentgenograms, bone scans, white blood cell scans, and magnetic resonance imaging) are used to evaluate patients with foot infections, but it is still difficult to tell superficial soft- tissue infections from chronic osteopathy or osteomyelitis.
Recently Eckman et al. reviewed the literature to determine which diagnostic approach is the most cost-effective, while still providing adequate care. They compared the outcomes of various forms of intervention following surgical debridement and intravenous antibiotic therapy:
a short course of antibiotics for presumed soft-tissue infection;
culture-guided empiric treatment with a long course of antibiotics for presumed osteomyelitis;
71 combinations of diagnostic tests (including radiographs, scans, imaging, and biopsies) preceding antibiotic therapy for osteomyelitis;
71 combinations of diagnostic tests preceding amputation; and immediate amputation.
The main outcome measures were quality-adjusted life expectancy and average costs.
The investigators found that culture-guided empiric treatment for osteomyelitis with 10 weeks of oral antibiotic therapy was similar in efficacy, and far less costly, than diagnostic testing followed by antibiotic therapy. Radiographs, scans, magnetic resonance imaging, and biopsies add considerable expense to the treatment of patients with suspected osteomyelitis of the foot -- probably as much as $100 million annually -- yet such testing may result in little improvement in health outcomes. Imaging studies lack precision, and biopsies are too easily contaminated by overlying soft tissue infection.
"Since safe, convenient and effective oral antibiotic regimens are available, there is little to be gained by testing," said the investigators. The only caveat is that vascular perfusion must be assessed; inadequate perfusion can have a negative affect on the outcome of antibiotic therapy. The investigators concluded, "In patients who show no signs of systemic infection and who have adequate perfusion, surgical debridement followed by a 10-week course of culture-guided oral antibiotics may be as effective as and less costly than other approaches."
in DiabeticsFoot infections occur in about one quarter of diabetics and are among the most common causes of hospitalization of diabetic patients. More than 50,000 lower-extremity amputations are performed each year, and a substantial number result from the failure to treat infected feet. Clinical findings, bone biopsies, and imaging studies (roentgenograms, bone scans, white blood cell scans, and magnetic resonance imaging) are used to evaluate patients with foot infections, but it is still difficult to tell superficial soft- tissue infections from chronic osteopathy or osteomyelitis.
Recently Eckman et al. reviewed the literature to determine which diagnostic approach is the most cost-effective, while still providing adequate care. They compared the outcomes of various forms of intervention following surgical debridement and intravenous antibiotic therapy:
a short course of antibiotics for presumed soft-tissue infection;
culture-guided empiric treatment with a long course of antibiotics for presumed osteomyelitis;
71 combinations of diagnostic tests (including radiographs, scans, imaging, and biopsies) preceding antibiotic therapy for osteomyelitis;
71 combinations of diagnostic tests preceding amputation; and immediate amputation.
The main outcome measures were quality-adjusted life expectancy and average costs.
The investigators found that culture-guided empiric treatment for osteomyelitis with 10 weeks of oral antibiotic therapy was similar in efficacy, and far less costly, than diagnostic testing followed by antibiotic therapy. Radiographs, scans, magnetic resonance imaging, and biopsies add considerable expense to the treatment of patients with suspected osteomyelitis of the foot -- probably as much as $100 million annually -- yet such testing may result in little improvement in health outcomes. Imaging studies lack precision, and biopsies are too easily contaminated by overlying soft tissue infection.
"Since safe, convenient and effective oral antibiotic regimens are available, there is little to be gained by testing," said the investigators. The only caveat is that vascular perfusion must be assessed; inadequate perfusion can have a negative affect on the outcome of antibiotic therapy. The investigators concluded, "In patients who show no signs of systemic infection and who have adequate perfusion, surgical debridement followed by a 10-week course of culture-guided oral antibiotics may be as effective as and less costly than other approaches."
Eckman MH et al. JAMA
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