Table 1.
Patients' characteristics.
| Patients | Age/sex | Comorbities | OM location | Diagnosed by | Surgical intervention | Microbiology | Outcomea | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Preoperative cultures | Prior antibiotics | Intraoperative cultures | Antibiotics postintervention | |||||||
| 1 | 61/M | Unresectable HCC (on sorafenib), cirrhosis due to HCV | Left sternoclavicular joint | Positive PTB | Debridement, clavicle removal | MSSA, P. aeruginosa, diphtheroids | (Nafcillin, cefazolin, cephalexin), meropenem | C. striatum | Vancomycin | Cure |
| 2 | 53/M | IDDM, neuropathy, ESRD via A-V fistula, s/p left TMA | Left TMA amputation | Positive PTB, MRI | Debridement | E. coli, Enterococcus faecium, diphtheroids | Ceftriaxone- > cefepime, metronidazole | Enterobacter cloacae, K. oxytoca, Enterococcus faecium (VRE), Staph. lugdunensis, C. striatum | Vancomycin, cefepime, metronidazole | Cure |
| 3 | 70/F | IDDM, polyneuropathy, CAD, CHF, and tobacco abuse | Left calcaneus | Positive PTB, MRI | Partial calcanectomy with graft | P. aeruginosa, diphtheroids | Ciprofloxacin, metronidazole | C. striatum, VRE | Linezolid, ciprofloxacin, metronidazole | Cure |
| 4 | 71/M | DM, s/p R BKA, chronic venous stasis | Left heel | Positive PTB | Debridement | Polymicrobial, not identified further | Amoxicillin-clavulanate, levofloxacin | C. striatum ESBL E.coli VRE | Vancomycin, ertapenem | Cure |
| 5 | 87/M | DM, CHF, prostate cancer in remission | Left calcaneus | Positive PTB | Debridement | E. faecalis, MRSA, Morganella spp, C. striatum | Vancomycin, piperacillin-tazobactum | C. striatum | Vancomycin | Cure |
| 6 | 48/F | Diabetic neuropathy, PAD, and tobacco abuse | Left great toe | Positive PTB | Amputation | P. aeruginosa, E. faecalis, C. striatum | Cephalexin- > vancomycin, meropenem | C. striatum | Vancomycin, meropenem- > linezolid, ciprofloxacin | Cure |
| 7 | 61/M | DM neuropathy | Right calcaneus | Positive PTB, MRI | Excisional debridement, calcanectomy | K. oxytoca, Proteus mirabilis, Myroides spp, diphtheroids | Amoxicillin-clavulanate, ciprofloxacin | C. striatum | Vancomycin ceftriaxone metronidazole | Cure |
aCure is defined as granulation of the infected wound and resolution of clinical symptoms at 6- to 8-week follow-up. A-V fistula: arteriovenous fistula; CAD: coronary artery disease; CHF: congestive heart failure; C. striatum: Corynebacterium striatum; DM: diabetes mellitus; E. faecalis: Enterococcus faecalis; E.coli: Escherichia coli; ESBL: extended-spectrum beta-lactamase; ESRD: end-stage renal disease; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; K. oxytoca: Klebsiella oxytoca; MSSA: methicillin-susceptible Staphylococcus aureus; MRI: magnetic resonance imaging; MRSA: methicillin-resistant Staphylococcus aureus; OM: osteomyelitis; PTB: probe to bone; Staph: Staphylococcus; VRE: vancomycin-resistant Enterococcus; P. aeruginosa: Pseudomonas aeruginosa; TMA: transmetatarsal amputation.