Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy

Objective: Therapy for diabetic foot osteomyelitis (DFO) with Charcot neuroosteoarthropathy is challenging. In patients with diabetic Charcot osteomyelitis (DCO), both the anatomic deformity and infection must be addressed. This study assessed the outcomes of DCO therapy and variables associated wit...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Felix WA Waibel, Madlaina Schöni, Leo Kronberger, Andreas Flury, Martin C. Berli, Benjamin A. Lipsky, Ilker Uçkay, Lukas Jud
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Diabetic foot osteomyelitis Charcot neuroosteoarthropathy Treatment Outcomes Risk associations Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/f3e465184fd448528a89bf9048b011d1
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:f3e465184fd448528a89bf9048b011d1
record_format	dspace
spelling	oai:doaj.org-article:f3e465184fd448528a89bf9048b011d12021-11-22T04:19:30ZTreatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy1201-971210.1016/j.ijid.2021.10.036https://doaj.org/article/f3e465184fd448528a89bf9048b011d12022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S120197122100833Xhttps://doaj.org/toc/1201-9712Objective: Therapy for diabetic foot osteomyelitis (DFO) with Charcot neuroosteoarthropathy is challenging. In patients with diabetic Charcot osteomyelitis (DCO), both the anatomic deformity and infection must be addressed. This study assessed the outcomes of DCO therapy and variables associated with treatment failure and compared them with outcomes of DFO cases. Methods: A single-center, retrospective, case-control study was performed to compare 93 DCO episodes with 530 DFO episodes, using Kaplan-Meier survival curves and multivariate Cox regression analyses. Results: Clinical failure occurred in 21.5% of DCO compared with 22.3% in DFO episodes (p=0.89) and was associated with peripheral arterial disease (PAD) stages 3 or 4 (HR 6.1; CI 2.0-18.1) and chronic treatment with immunosuppressives (HR 7.4; CI 2.0-27.1). Major amputations were significantly more frequent in DCO (28% versus 13.6%; p<0.01) and associated with PAD stages 3 and 4 (HR 8.0; CI 2.2-29.4), smoking (HR 5.4; CI 1.2-24.6), alcohol abuse (HR 3.5; CI 1.1-10.6), and renal dialysis (HR 4.9; CI 1.3-18.9). Conclusions: Clinical treatment failures did not differ between DCO and DFO. However, patients with DCO underwent major amputation twice as often as those with DFO. Unlike widespread belief, treatment failure in DCO patients may, similar to DFO, be associated with a striking epidemiological link to severe PAD.Felix WA WaibelMadlaina SchöniLeo KronbergerAndreas FluryMartin C. BerliBenjamin A. LipskyIlker UçkayLukas JudElsevierarticleDiabetic foot osteomyelitisCharcot neuroosteoarthropathyTreatmentOutcomesRisk associationsInfectious and parasitic diseasesRC109-216ENInternational Journal of Infectious Diseases, Vol 114, Iss , Pp 15-20 (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diabetic foot osteomyelitis Charcot neuroosteoarthropathy Treatment Outcomes Risk associations Infectious and parasitic diseases RC109-216
spellingShingle	Diabetic foot osteomyelitis Charcot neuroosteoarthropathy Treatment Outcomes Risk associations Infectious and parasitic diseases RC109-216 Felix WA Waibel Madlaina Schöni Leo Kronberger Andreas Flury Martin C. Berli Benjamin A. Lipsky Ilker Uçkay Lukas Jud Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy
description	Objective: Therapy for diabetic foot osteomyelitis (DFO) with Charcot neuroosteoarthropathy is challenging. In patients with diabetic Charcot osteomyelitis (DCO), both the anatomic deformity and infection must be addressed. This study assessed the outcomes of DCO therapy and variables associated with treatment failure and compared them with outcomes of DFO cases. Methods: A single-center, retrospective, case-control study was performed to compare 93 DCO episodes with 530 DFO episodes, using Kaplan-Meier survival curves and multivariate Cox regression analyses. Results: Clinical failure occurred in 21.5% of DCO compared with 22.3% in DFO episodes (p=0.89) and was associated with peripheral arterial disease (PAD) stages 3 or 4 (HR 6.1; CI 2.0-18.1) and chronic treatment with immunosuppressives (HR 7.4; CI 2.0-27.1). Major amputations were significantly more frequent in DCO (28% versus 13.6%; p<0.01) and associated with PAD stages 3 and 4 (HR 8.0; CI 2.2-29.4), smoking (HR 5.4; CI 1.2-24.6), alcohol abuse (HR 3.5; CI 1.1-10.6), and renal dialysis (HR 4.9; CI 1.3-18.9). Conclusions: Clinical treatment failures did not differ between DCO and DFO. However, patients with DCO underwent major amputation twice as often as those with DFO. Unlike widespread belief, treatment failure in DCO patients may, similar to DFO, be associated with a striking epidemiological link to severe PAD.
format	article
author	Felix WA Waibel Madlaina Schöni Leo Kronberger Andreas Flury Martin C. Berli Benjamin A. Lipsky Ilker Uçkay Lukas Jud
author_facet	Felix WA Waibel Madlaina Schöni Leo Kronberger Andreas Flury Martin C. Berli Benjamin A. Lipsky Ilker Uçkay Lukas Jud
author_sort	Felix WA Waibel
title	Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy
title_short	Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy
title_full	Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy
title_fullStr	Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy
title_full_unstemmed	Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy
title_sort	treatment failures in diabetic foot osteomyelitis associated with concomitant charcot arthropathy: the role of underlying arteriopathy
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/f3e465184fd448528a89bf9048b011d1
work_keys_str_mv	AT felixwawaibel treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy AT madlainaschoni treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy AT leokronberger treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy AT andreasflury treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy AT martincberli treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy AT benjaminalipsky treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy AT ilkeruckay treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy AT lukasjud treatmentfailuresindiabeticfootosteomyelitisassociatedwithconcomitantcharcotarthropathytheroleofunderlyingarteriopathy
_version_	1718418256961732608

Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy

Ejemplares similares