Microbiologic and histopathological findings of osteomyelitis in diabetic patients

Abstract

Osteomyelitis can present as a severe complication in diabetic patients. The present study was structured to evaluate the histopathological characteristics of bone infection in the feet of diabetic patients and to associate any clinical variables seen with each type of bone infection. Eighty-four cases of osteomyelitis were evaluated microbiologically and histopathologically after samples were collected under sterile conditions in an operating room. The data generated were analysed using SPSS software. Polymorphonuclear neutrophil (PMN) infiltrates were associated with acute osteomyelitis (AO) (22 cases (26.2%)) and chronic acute osteomyelitis (CAO) (10 cases (11.9%)), whereas a strong association was observed between mononuclear infiltrates and chronic osteomyelitis (CO) (33 cases (39.3%)) and fibrosis (19 cases (22.6%)). Ulcer longevity on hospital admission varied for each condition: AO (10.9 + 22 weeks), CO (29.1 + 20.6 weeks), CAO (31.5 + 22.2 weeks) and fibrosis (30.5 + 23 weeks) (P < 0.05) (values expressed as mean + SD). The same was true for the presence of pathogenic bacteria: AO (16/22, 72.7%), CO (27/33, 81.8%), CAO (7/10, 70%) and fibrosis (16/19, 84.2%). There was significant correlation between histopathological features and presence of bacteria and longevity of the ulcer on presentation (P < 0.05). Osteomyelitis in the feet of diabetic patients should be classified as four specific but interlinked groups: acute, chronic, acute on chronic and fibrosis.