ABSTRACT
We present the first case of a complicated foot infection caused by Fusobacterium russii in Austria. F. russii is highly associated with mammals such as cats and dogs. Our case underlines the difficulties in isolation and identification of anaerobes and the pitfalls in antimicrobial treatment of polymicrobial infections.
Subject(s)
Foot Ulcer/microbiology , Forefoot, Human/microbiology , Fusobacterium Infections/microbiology , Fusobacterium/isolation & purification , Pasteurella Infections/microbiology , Streptococcal Infections/microbiology , Aged , Anaerobiosis , Animals , Anti-Bacterial Agents/therapeutic use , Cats , Coinfection , Foot Ulcer/drug therapy , Foot Ulcer/pathology , Foot Ulcer/surgery , Forefoot, Human/pathology , Forefoot, Human/surgery , Fusobacterium/drug effects , Fusobacterium/genetics , Fusobacterium Infections/drug therapy , Fusobacterium Infections/pathology , Fusobacterium Infections/surgery , Humans , Male , Pasteurella Infections/drug therapy , Pasteurella Infections/pathology , Pasteurella Infections/surgery , Pasteurella multocida/drug effects , Pasteurella multocida/genetics , Pasteurella multocida/isolation & purification , RNA, Ribosomal, 16S/genetics , Streptococcal Infections/drug therapy , Streptococcal Infections/pathology , Streptococcal Infections/surgery , Streptococcus/drug effects , Streptococcus/genetics , Streptococcus/isolation & purificationABSTRACT
BACKGROUND: To evaluate the prevalence of osteomyelitis in different areas of the foot and the possible correlation between localization and outcome of major amputation. METHODS: From January 2008 to December 2010, a total of 350 diabetic patients were admitted to our diabetic foot unit for the surgical treatment of osteomyelitis. Osteomyelitis was diagnosed when both the probe-to-bone maneuver and plain radiography were positive. In all of these patients, osteomyelitis was confirmed by histological examination. RESULTS: Osteomyelitis was localized to the forefoot in 300 (85.7%) patients, to the midfoot in 27 (7.7%) patients, and to the hindfoot in the remaining 23 (6.75) patients. On average, foot lesions had developed 6.6 ± 5.6 months before admission to our unit. Transtibial amputation was performed in 1 (0.33%) patient with forefoot osteomyelitis, in 5 (18.5%) patients with midfoot osteomyelitis, and in 12 (52.2%) patients with osteomyelitis of the heel (χ(2) = 128.4, P < .001). Multivariate analysis showed the independent role that osteomyelitis in the heel region had in major amputation outcome (odds ratio 15.3; P < .001; confidence interval, 17.4-5336.0), dialysis treatment (odds ratio 6.3; P = .012; confidence interval, 2.5-1667.2), and leukocyte count greater than 10(3) mm(3) (odds ratio 2.25; P = .036; confidence interval, 1.1-76.6). CONCLUSIONS: We found a higher rate of transtibial amputation when osteomyelitis involved the heel instead of the midfoot or forefoot in diabetic patients. LEVEL OF EVIDENCE: Level III, retrospective comparative series.
Subject(s)
Amputation, Surgical/statistics & numerical data , Diabetic Foot/microbiology , Diabetic Foot/surgery , Osteomyelitis/surgery , Aged , Diabetic Foot/complications , Female , Forefoot, Human/microbiology , Forefoot, Human/surgery , Heel/microbiology , Heel/surgery , Humans , Leukocyte Count , Male , Middle Aged , Multivariate Analysis , Osteomyelitis/etiology , Osteomyelitis/microbiology , Renal Dialysis , Tibia/surgeryABSTRACT
This article discusses the causes, pathogenesis, diagnosis, prevention, and treatment of infections associated with implant arthroplasties of the forefoot. Topics covered include isolated organisms, routes of infection, bacterial glycocalyx (that is, biofilm or slime layer) production, preoperative evaluation, air filtration systems, surgical technique, use of prophylactic antibiotics, inflammatory reactions (arthritic detritus, metallosis), differential diagnosis, and treatment protocols.
