Bedside Blind Bone Biopsy (B4) for Suspected Diabetic Foot Osteitis–A Reliable Tool to Manage Medical Treatment?

Abstract

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.