Treatment
ÎÎObtain plain radiographs of the foot, although they have relatively
low sensitivity and specificity for confirming or excluding osteomyelitis
(WR-M).
Note: Consider using serial plain radiographs to diagnose or monitor suspected
DFO (WR-L).
ÎÎFor a diagnostic imaging test for DFO use MRI (SR-M).
Note: MRI is not always necessary for diagnosing or managing DFO (SR-L).
ÎÎIf MRI is unavailable or contraindicated, consider a leukocyte or
antigranulocyte scan, preferably combined with a bone scan (WR-M).
Note: No other types of nuclear medicine investigations are recommended (WR-M).
ÎÎThe most definitive way to diagnose DFO is by the combined findings
on bone culture and histology (SR-M).
• When bone is debrided to treat osteomyelitis, send a sample for culture and
histology (SR-L).
ÎÎFor patients not undergoing bone debridement, consider obtaining
a diagnostic bone biopsy when faced with specific circumstances —
eg, diagnostic uncertainty, inadequate culture information, failure of
response to empiric treatment (WR-L).
ÎÎConsider using either primarily surgical or primarily medical
strategies for treating DFO in properly selected patients (WR-M).
Note: In noncomparative studies each approach has successfully arrested infection in
most patients.
ÎÎWhen a radical resection leaves no remaining infected tissue,
prescribe antibiotic therapy for only a short duration (2-5 days) (WR-L).
When there is persistent infected or necrotic bone, prolong antibiotic
treatment ≥ 4 weeks (WR-L).
ÎÎFor specifically treating DFO, IDSA does NOT currently support using
adjunctive treatments like hyperbaric oxygen therapy, growth factors
(including granulocyte-stimulating factor), maggots (larvae) or topical
negative pressure therapy (eg, vacuum-assisted closure) (WR-L).
Surgical Intervention
ÎÎNonsurgical clinicians should consider requesting an assessment by a
surgeon for patients with a moderate or severe DFI (WR-L).
ÎÎClinicians should debride any wound that has necrotic tissue or
surrounding callus. The required procedure may range from minor to
extensive (SR-L).
ÎÎUrgent surgical intervention is required for most foot infections
accompanied by gas in the deeper tissues, an abscess, or necrotizing
fasciitis, and less urgent surgery for wounds with substantial
nonviable tissue, or extensive bone or joint involvement (SR-L).
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