Transcutaneous bone biopsy (TCB) is the gold standard for taking microbiological specimens in diabetic foot osteomyelitis (DFO), but this technique is not widely used in diabetic foot care centers. We aimed to evaluate the reliability of per-wound bone biopsy (PWB) cultures by comparing them with concomitant TCB cultures obtained through healthy skin. This is a prospective monocentric study including patients seen in consultation for clinical and radiological diabetic foot osteomyelitis with positive probe-bone tests between April 2015 and May 2018. Two bone biopsies were performed on each consenting patient: TCB through a cutaneous incision in healthy skin, and PWB, after careful debridement of the wound. A total of 46 paired cultures were available from 43 eligible patients. Overall, 16 (42%) of the PWB and TCB pairs had identical culture results, but the TCB cultures were sterile in 8 (17%) cases. For 38 paired cultures with positive TCB, the correlation between PWB results and TCB results was 58.4%. PWB revealed all microorganisms found in the transcutaneous specimen in 26/38 samples (68.5%). In patients with DFO, the culture results of specimens taken by per-wound biopsies did not correlate well with those obtained by TCB. PWB should be reserved for cases where the transcutaneous biopsy is sterile or not feasible.
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Jeffcoate WJ, Lipsky BA (2004) Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. Clin Infect Dis Off Publ Infect Dis Soc Am 39(Suppl 2):S115–S122
Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJG, Armstrong DG et al (2012) Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis Off Publ Infect Dis Soc Am 54(12):e132–e173
Zuluaga AF, Galvis W, Saldarriaga JG, Agudelo M, Salazar BE, Vesga O (2006) Etiologic diagnosis of chronic osteomyelitis: a prospective study. Arch Intern Med 166(1):95–100
Société de Pathologie Infectieuse de Langue Française (2007) Management of diabetic foot infections. Long text Société de Pathologie Infectieuse de Langue Française. Med Mal Infect 37(1):26–50
Lipsky BA, Aragón-Sánchez J, Diggle M, Embil J, Kono S, Lavery L et al (2016) IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 32(Suppl 1):45–74
Richard J-L, Lavigne J-P, Got I, Hartemann A, Malgrange D, Tsirtsikolou D et al (2011) Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. Diabetes Metab 37(3):208–215
Lesens O, Desbiez F, Vidal M, Robin F, Descamps S, Beytout J et al (2011) Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 17(2):285–291
Fiquet S, Desbiez F, Tauveron I, Mrozek N, Vidal M, Lesens O (2016) Happy@feet application for the management of diabetic foot osteomyelitis. Med Mal Infect 46(8):419–423
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The authors declare that they have no conflict of interest.
The study protocol was approved by the local ethical research committee (reference number 2014/CE85).
Informed consent was obtained for the collection of anonymized data and their analysis.
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Couturier, A., Chabaud, A., Desbiez, F. et al. Comparison of microbiological results obtained from per-wound bone biopsies versus transcutaneous bone biopsies in diabetic foot osteomyelitis: a prospective cohort study. Eur J Clin Microbiol Infect Dis 38, 1287–1291 (2019). https://doi.org/10.1007/s10096-019-03547-6
- Diabetic foot
- Bone biopsy
- Diabetic foot osteomyelitis