Percutaneous bedside bone biopsy coupled with gallium SPECT-CT in suspected diabetic foot osteitis: a pilot study
Abstract number: P870
Aslangul E., M'Bemba J., Caillat-Vigneron N., Coignard S., Braun-Mauger A., Sola A., Boitard C., Le Jeunne C.
Objectives: Diagnosing diabetic osteitis might be difficult as it shares with osteoarthropathy the same clinical and radiological inflammatory features. We have evaluated the association of gallium SPECT-CTs and percutaneous bone biopsies to diagnose osteitis in a diabetic foot clinic.
Methods: In a pilot prospective monocentric study, all patients suspected of foot osteitis underwent a gallium SPECT-CT scan (Single Photon Emission Computed Tomography-Computer Tomography), to precisely spot the suspected infection, and apercutaneous bone biopsy performed during the consultation.
Results: From may 2007 to november 2008, 36 diabetic patients suspected of osteitis (because of chronic foot ulcer) were enrolled. They all had a gallium SPECT-CT scan to detect an inflammatory bone lesion in regard of the skin ulceration evocative of osteitis. Five patients (14%) did not demonstrate any inflammatory bone fixation, so therefore no biopsy was performed. The other 31 patients demonstrated a bone gallium fixation next to the chronic skin ulcer. A bone punction with a Mallarmé needle was performed. Bone aspiration was inoculated in Bactec® haemoculture aerobic and anaerobic bottles.
Three out of 36 punctions were excluded because antibiotics were started before the punction. Fourteen punctions (42%) were negative with a good 3 months outcome without antibiotics. Nineteen punctions (58%) were positive: one Streptococcus, twelve coagulase negative Staphylococcus and six Staphylococcus aureus (three MRSA). All cultures were monomicrobic and positive within the first 24 hours. All patients with positive bone cultures received antibiotics adapted to the sensitivity for 8 weeks (including ofloxacin, rifampicin, linezolid), and were evaluated at least three months after. They all were improved with no local inflammatory signs, nor tomographic spoting when available.
Conclusion: The coupled procedure, gallium SPECT-CT scan-bone aspiration with Mallarmé needle is efficient to diagnose bone osteitis in diabetic feet. Gallium SPECT-CT scan provides a functional and exact imaging of bone inflammation when punction isolates the responsible micro-organism in case of infection. The main interest remains a bedside procedure after imaging. Coagulase negative Staphylococcus seems to be the most frequent germ found in diabetic osteitis.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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