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Abstract：
Background: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines \'Diabetic foot problems: prevention and management\'. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021-31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient outcomes.
摘要：
背景：糖尿病足骨髓炎（DFO）是一种主要并发症，可导致严重的发病率和死亡率。全身性抗生素治疗通常是一线开始的，以实现感染的静止。对英格兰和威尔士的成人DFO患者进行系统性抗生素干预的多中心病例回顾，并与国家指南“糖尿病足问题：预防和管理”进行比较。方法：来自英格兰和威尔士的八个中心从电子病例记录中回顾性地整理了至少五名成年人（年龄≥18岁）的数据。在新诊断DFO（2021年6月1日至2021年12月31日）后，所有患者均接受了全身抗生素治疗。结果：纳入40例患者（男35例，女5例）；平均年龄为62.3岁（标准差（SD）13.0）。新诊断DFO后，患者开始全身口服14（35％）或静脉内26（65％）抗生素治疗。在12周的时间内，有27名（67.5％）患者接受了医学或手术治疗，并伴有感染的临床静止。21例患者（52.5%）在12周内未出现DFO感染复发；其中17例（42.5%）患者在未进行手术干预的情况下单独使用全身抗生素进行临床静止感染，其中9例（22.5%）患者未出现DFO复发。没有严重截肢或死亡的病例。所有中心在全身抗生素管理方面均表现出显著的中心内差异；在临床和数量指标中报告了差异，特别是在抗生素选择方面，单一治疗与双重治疗，分娩方式和治疗持续时间。结论：本病例综述确定了使用全身抗生素治疗成人DFO时存在差异。需要进一步的国家指导来标准化服务提供和护理，以改善患者预后。
