Thank you to Marie-France for sending abstracts about the diabetic
foot.
I was rather disappointed by the article of Kessler et al about
microbiological results of needle puncture in diabetic osteomyelitis.
On the other hand, I very appreciated the paper published by
Senneville et al in Clinical Infectious Diseases (2006;42[1 Jan]:67-
62].
In this article, the authors compare percutaneous bone biopsy vs
superficial swab in diabetic patients with foot osteomyelitis.
Briefly, from January 1996 to June 2004, percutaneous bone biopsy was
performed for suspected osteomyelitis in 190 patients of whom 88 were
suffering from diabetes. In 76 diabetic patients, biopsy was positive
(there were 81 biopsies because 5 patients had 2 different areas of
osteomyelitis); concomittant superficial swab sample were obtained in
69 cases. 125 pathogens were isolated from bone biopsy (1.54 per
biopsy: 96 (76.8%)were gram-positive bacteria in whom 65 (52%) were
Staphylococci; 33 S. aureus (26.4%)were isolated whose 12 (9.6%) were
methicillin-resistant. From superficial swab sample, 109 pathogens
were isolated (1.58 per sample): there were 78 gram-positive bacteria
(71.5%) in whom 41 (37.6%) were Staphilococci; 36 cultures were
positive for S. aureus (33%) whose 11 were methicillin-resistant
(10.1%). Comparing cultures in 69 cases where bone biopsy and
superficial swab were obtained concomitantly, authors found that
results were stictly identical in only 12 cases. Concordance between
the results for swab sample and bone biopsy was 22.5%. The
concordance was very poor for Enterococci, Coagulase-negative
Staphylococci,Anaerobes and Corynebacteria. So, superficial swabing
seems not reliable to identify bone pathogens in osteomyelitic
diabetic foot and in such cases performing percutaneous bone biopsy
should be promoted.According to the authors, no adverse events
occured due to bone biopsy. Moreover, the prevalence of MRSA is
surprising both in bone biopsy and in swab samples althoug patients
were free of antibiotic therapy for at least 4 weeks before sampling.
I have no experience with percutaneous bone biopsy. And you? If yes,
could you comment?