Osteomyelitis in diabetic foot ulcers. Prompt diagnosis can avert amputation.

Osteomyelitis is a prevalent sequela of diabetic foot ulcers. The timing of its diagnosis and treatment is crucial if the diabetic patient is to avoid amputation later. However, detection of this condition can be difficult in the primary care setting. Information gained by physical examination and sequential imaging methods is central to identification of osteomyelitis in its beginning stages. Here, Drs Schinabeck and Johnson review the clinical, laboratory, and radiologic findings critical to making an early diagnosis of osteomyelitis.

Rabbit model of Candida albicans biofilm infection: liposomal amphotericin B antifungal lock therapy.

Catheter-related infections due to Candida albicans biofilms are a leading cause of fungal nosocomial bloodstream infection. In this paper, we describe the development of a model of catheter-associated infection with C. albicans biofilms and show that antifungal lock therapy with liposomal amphotericin B is an effective treatment strategy for these infections. Silicone catheters surgically placed in New Zealand White rabbits were infected with C. albicans, and the rabbits were randomized into three groups: (i) untreated controls, (ii) liposomal amphotericin B lock, and (iii) fluconazole lock. Upon completion of therapy, blood cultures were obtained and the catheters were removed for quantitative culture and scanning electron microscopic analyses. Quantitative cultures revealed that catheters treated with liposomal amphotericin B yielded 0 CFU, which was significant compared to the untreated controls (P < 0.001) and the fluconazole-treated group (P = 0.0079). Although fluconazole treatment tended to have lower CFU compared to untreated controls, there was no difference in mean colony counts between these two groups (1.128 +/- 0.764 and 1.841 +/- 1.141 log(10) CFU/catheter segment, respectively; P = 0.297). Scanning electron microscopy revealed abundant biofilm in the control and fluconazole groups, while the liposomal amphotericin B group was virtually cleared. These findings suggest a possible treatment strategy for the successful salvage of catheters infected with C. albicans biofilms and describe an animal model that may play an important role in the further study of C. albicans biofilm pathogenesis and evaluation of potential antibiofilm agents.