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OBJECTIVE Bone biopsy (BB) performed by a surgeon or an interventional radiologist is recommended for suspicion of osteomyelitis underlying diabetic foot ulcer (DFU). To facilitate its practice, we developed a procedure allowing bedside blind bone biopsy (B4) by a diabetologist. RESEARCH DESIGN AND METHODS We conducted a three-step observational study consisting of a feasibility and safety phase (phase 1) to assess the success and side effects of B4, a validity phase (phase 2) to compare DFU outcomes between positive (B4+) and negative (B4−) bone cultures, and a performance phase (phase 3) to compare B4 with the conventional surgical or radiological procedure basic bone biopsy (B3). Primary end points were the presence of bone tissue (phase 1) and complete DFU healing with exclusive medical treatment at 12 months (phases 2 and 3). RESULTS In phase 1, 37 consecutive patients with clinical and/or radiological suspicion of DFU osteomyelitis underwent B4. Bone tissue was collected in all patients with few side effects. In phase 2, a B4+ bone culture was found in 40 of 79 (50.6%) participants. Among B4+ patients, complete wound healing after treatment was 57.5%. No statistical difference was observed with patients with B4− bone culture not treated with antibiotics (71.8%, P = 0.18). In phase 3, the proportion of patients with positive BB was lower in B4 (40 of 79, 50.6%) than in B3 (34 of 44, 77.3%, P < 0.01). However, complete healing was similar (64.6% vs. 54.6%, P = 0.28). No difference in rate of culture contamination was observed. CONCLUSIONS B4 is a simple, safe, and efficient procedure for the diagnosis of DFU osteomyelitis with a similar proportion of healing to conventional BB.

Diabetes & Metabolism - Sous presse. Manuscrit accepte. Disponible en ligne depuis le jeudi 21 mai 2020

Performed by a diabetologist, B4 has been recently shown as an easy and safe procedure. To assess Exclusive Medical Treatment (EMT: offloading, wound care ± antibiotherapy) determined by B4 in suspected Diabetic Foot Ulcer (DFU) osteitis, we compared DFU outcome between proved (B4+) and ruled out osteitis (B4-) with microbial culture.A prospective observational study was conducted in our Diabetology Unit during a 16-month period (12.17.2015-09.04.2017). Among 244 patients admitted with DFU, we included 31 (13%) consecutive patients with type 2 diabetes mellitus (T2DM) and clinical and/or radiological suspicion of osteitis. For each, B4 was decided by our DFU multidisciplinary board. B4 was performed ≥ 2 weeks after antibiotics discontinuation in case of prior exposure. A 6-weeks targeted antibiotherapy was indicated for proven osteitis by prolonged culture (B4+). In case of negative cultures (B4-), no antibiotherapy was prescribed. The primary outcome was the complete DFU healing with EMT at 6 months.Patients characteristics and results are summarized in Table 1. Around 50% of suspected osteitis was B4-, which prevented from unneeded antibiotics without poorer healing outcomes.B4 might be a reliable tool for managing EMT in suspected DFU osteitis. Disclosure F. Féron: None. D. Gauthier: None. J. Gautier: None. J. Kevorkian: None.