Percutaneous Bone Biopsy for Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis.

diabetic foot infection diabetic foot osteomyelitis percutanous bone biopsy

Journal

Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045

Informations de publication

Date de publication:
Oct 2020
Historique:
received: 29 04 2020
accepted: 24 08 2020
entrez: 2 11 2020
pubmed: 3 11 2020
medline: 3 11 2020
Statut: epublish

Résumé

Diabetes is the leading cause of lower extremity nontraumatic amputation globally, and diabetic foot osteomyelitis (DFO) is usually the terminal event before limb loss. Although guidelines recommend percutaneous bone biopsy (PBB) for microbiological diagnosis of DFO in several common scenarios, it is unclear how frequently PBBs yield positive cultures and whether they cause harm or improve outcomes. We searched the PubMed, EMBASE, and Cochrane Trials databases for articles in any language published up to December 31, 2019, reporting the frequency of culture-positive PBBs. We calculated the pooled proportion of culture-positive PBBs using a random-effects meta-analysis model and reported on PBB-related adverse events, DFO outcomes, and antibiotic adjustment based on PBB culture results where available. Among 861 articles, 11 studies met inclusion criteria and included 780 patients with 837 PBBs. Mean age ranged between 56.6 and 71.0 years old. The proportion of males ranged from 62% to 86%. All studies were longitudinal observational cohorts, and 10 were from Europe. The range of culture-positive PBBs was 56%-99%, and the pooled proportion of PBBs with a positive culture was 84% (95% confidence interval, 73%-91%). There was heterogeneity between studies and no consistency in definitions used to define adverse events. Impact of PBB on DFO outcomes or antibiotic management were seldom reported. This meta-analysis suggests PBBs have a high yield of culture-positive results. However, this is an understudied topic, especially in low- and middle-income countries, and the current literature provides very limited data regarding procedure safety and impact on clinical outcomes or antibiotic management.

Sections du résumé

BACKGROUND BACKGROUND
Diabetes is the leading cause of lower extremity nontraumatic amputation globally, and diabetic foot osteomyelitis (DFO) is usually the terminal event before limb loss. Although guidelines recommend percutaneous bone biopsy (PBB) for microbiological diagnosis of DFO in several common scenarios, it is unclear how frequently PBBs yield positive cultures and whether they cause harm or improve outcomes.
METHODS METHODS
We searched the PubMed, EMBASE, and Cochrane Trials databases for articles in any language published up to December 31, 2019, reporting the frequency of culture-positive PBBs. We calculated the pooled proportion of culture-positive PBBs using a random-effects meta-analysis model and reported on PBB-related adverse events, DFO outcomes, and antibiotic adjustment based on PBB culture results where available.
RESULTS RESULTS
Among 861 articles, 11 studies met inclusion criteria and included 780 patients with 837 PBBs. Mean age ranged between 56.6 and 71.0 years old. The proportion of males ranged from 62% to 86%. All studies were longitudinal observational cohorts, and 10 were from Europe. The range of culture-positive PBBs was 56%-99%, and the pooled proportion of PBBs with a positive culture was 84% (95% confidence interval, 73%-91%). There was heterogeneity between studies and no consistency in definitions used to define adverse events. Impact of PBB on DFO outcomes or antibiotic management were seldom reported.
CONCLUSIONS CONCLUSIONS
This meta-analysis suggests PBBs have a high yield of culture-positive results. However, this is an understudied topic, especially in low- and middle-income countries, and the current literature provides very limited data regarding procedure safety and impact on clinical outcomes or antibiotic management.

Identifiants

DOI: 10.1093/ofid/ofaa393 PMID: 33134407 PMC: PMC7590897
pubmed: 33134407
doi: 10.1093/ofid/ofaa393
pii: ofaa393
pmc: PMC7590897
doi:

Types de publication

Journal Article

Langues

eng

Pagination

ofaa393

Subventions

Organisme : NIDDK NIH HHS
ID : P30 DK111024
Pays : United States

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

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Auteurs

Marcos C Schechter (MC)

Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA.

Mohammed K Ali (MK)

Emory University, Rollins School of Public Health, Department of Global Health and Epidemiology, Atlanta, Georgia, USA.

Benjamin B Risk (BB)

Emory University, Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, Georgia, USA.

Adam D Singer (AD)

Emory University School of Medicine, Grady Memorial Hospital, Department of Radiology and Imaging Sciences, Division of Musculoskeletal Imaging, Atlanta, Georgia, USA.

Gabriel Santamarina (G)

Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, Georgia, USA.

Hannah K Rogers (HK)

Emory University, Woodruff Health Sciences Center Library, Information Services, Atlanta, Georgia, USA.

Ravi R Rajani (RR)

Emory University School of Medicine, Grady Memorial Hospital, Department of Surgery, Division of Vascular Surgery, Atlanta, Georgia, USA.

Guillermo Umpierrez (G)

Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, Georgia, USA.

Maya Fayfman (M)

Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, Georgia, USA.

Russell R Kempker (RR)

Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA.

Classifications MeSH