| Background:Diabetic foot osteomyelitis(DFO)is a disease in which diabetic foot ulcers progress to bone tissue.About 40% to 60% of patients with diabetic foot have osteomyelitis.DFO infection is deep and wound infection is complicated,which is one of the most important risk factors for amputation(toe).Finding DFO in time and actively controlling infection are important to reduce amputation(toe).“IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes” recommended to choose bone biopsy and bone culture for diagnosis and treatment.Bone biopsy confirmed by histopathology.Bone culture can provide infected pathogens and guide the application of antibiotics in the next step.The swab method is used to obtain wound exudates for bacterial culture to analyze the pathogenic bacteria of DFO in clinic,but studies had shown that the correlation between secretion culture and bone culture results is very low.Bone culture results were more accurate.Bone specimens have high requirements.Due to the limited technical skills of physicians,while surgeons don't pay much attention to medical treatment in related fields.At present,there are few studies on bone culture in China.Objective:This study used bone biopsy and bone culture to confirm the diagnosis of DFO.Using bone culture to analyze the characteristics of pathogenic bacterial infection and drug sensitivity of DFO.Provid a basis for clinical diagnosis and treatment of DFO.Methods:105 cases of suspected diabetic foot osteomyelitis in endocrinology department of Henan Provincial People's Hospital were collected from September 2017 to January 2020.Collect all patients' medical history data,body temperature,blood routine,C-reactive protein(CRP),glycated hemoglobin,(Hb A1c)liver and kidney function and other data at admission.After admission,2 suspicious bone tissue specimens obtained during surgery or percutaneous bone puncture.After the first wound debridement,one specimen of the basal tissue of the wound is retained.All specimens are placed in the specimen cup for examination within 1 hour.1 bone specimen was examined by histopathology,and the tissue morphology was observed after HE staining.Bacterial culture was performed on 1 bone specimen and basal tissue of the wound.The specimens were inoculated on Blood agar plates,Mac Conkey agar plates,and Chocolate agar plates,respectively.And then they were cultured at 37? and 2% CO2 for 18 to 24 hours.The bacteria were identified and the drug sensitivity were tested using VITEK 2 COMPACT of Biomerieu.At the same time,the drug sensitivity test was reviewed by the K-B method.Bone biopsy confirmed the pathological diagnosis,and bone culture confirmed the pathogenic bacteria and drug sensitivity.Comparison of the bacterial spectrum structure of the bone culture and basal tissue culture and analyzing the consistency and difference between the two.And analysis of distribution characteristics and drug sensitivity of DFO pathogens based on bone culture results,and the clinical data were compared with those of patients without cultured bacteria.Results:1.105 patients were diagnosed as DFO after bone biopsy.2.All 105 patients underwent bone culture,and 55 patients were positive(7 of them had mixed infection),the positive rate was about 52.38%.A total of 62 bacteria were cultured in bone culture.Gram-positive bacteria accounting for 48.39% and Gram-negative bacteria accounting for 51.61%.Of all the cultured bacteria,Staphylococcus aureus(22.58%)is the most common,followed by Escherichia coli (9.68%),Proteus mirabilis(9.68%),Streptococcus agalactiae(9.68%),Klebsiella pneumoniae(8.07%)and so on.3.83 patients underwent bone culture,and 61 patients were positive(8 of them had mixed infection),the positive rate was about 73.49%.A total of 69 bacteria were cultured,Gram-positive bacteria accounting for 52.17% and Gram-negative bacteria accounting for 47.83%.Of all the cultured bacteria,Staphylococcus aureus(30.43%)is the most common,followed by Enterococcus faecalis(11.59%),Escherichia coli(8.69%),Proteus mirabilis(7.24%)and so on.4.83 patients underwent bone culture and basal tissue culture simultaneously.47 patients were cultured with the same bacteria,which was about 56.63%.In addition,23 patients had negative bone culture results and positive basal tissue culture;5 patients had positive bone culture results and negative basal tissue culture.5.Comparison of clinical data found in patients with bone culture positive and negative groups:The CRP was higher in the bone culture-positive group than in the bone culture-negative group(P <0.05).There was no significant difference in gender,age,duration of diabetes,white blood cells(WBC),Hb A1 c,and creatinine(CREA)between the two groups of patients(P >0.05).6.Gram-positive bacteria were highly sensitive to vancomycin,linezolid,tigecyclin,and teicoplanin,followed by quinupristin/dalfopristin,but erythromycin,clindamycin,penicillin is less sensitive.Gram-negative bacteria are more sensitive to tigecycline,carbapenems,cefoperazone / sulbactam,and less sensitive to ampicillin and cefazolin.Staphylococcus were completely sensitive to vancomycin,linezolid,tigecycline,teicoplanin,quinupristin/dalfopristin,but fully resistant to penicillin.Escherichia were completely sensitive to carbapenems,amikacin,tigecycline,while which were less sensitive to cephalosporins,quinolones.Proteus and Morganella were sensitive to carbapenems, cefoperazone/sulbactam,piperacillin/tazobactam,but they were resistant to polymyxin and tetracycline.Klebsiella,Acinetobacter,and Pseudomonas were sensitive to tigecycline,polymyxin,etc.While which were less sensitive to ampicillin,piperacillin,cefotaxime,and aztreonam.Conclusion:1.For patients with high suspicion of DFO,bone biopsy and bone culture should be diagnosed in time.2.The results of bone culture are more accurate and reliable,and have more clinical guidance significance for the pathogenic bacteria infection characteristics of DFO patients.It is necessary to standardize and retain bone specimens for active bone culture in a timely manner.3.Gram-negative bacteria are common in DFO infection.Staphylococcus aureus occupies the first single species,followed by Escherichia coli,Proteus mirabilis,Streptococcus agalactiae,Klebsiella pneumoniae.4.Gram-positive bacteria are highly sensitive to drugs such as vancomycin and linezolid.Gram-negative bacteria are highly sensitive to drugs such as tigecycline,carbapenems,cefoperazone /sulbactam.Patients should choose antibiotics with higher sensitivity based on specific pathogens and drug sensitivity tests. |
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