BedBiopsy: Diagnostic performance of bedside ultrasound-guided bone biopsies for the management of diabetic foot infection

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2024-03-03 DOI:10.1016/j.diabet.2024.101525

Nolan Hassold , Hélène Bihan , Yolène Pambo Moumba , Isabelle Poilane , Frédéric Méchaï , Nabil Assad , Véronique Labbe-Gentils , Meriem Sal , Omar Nouhou Koutcha , Antoine Martin , Dana Radu , Emmanuel Martinod , Hugues Cordel , Nicolas Vignier , Sopio Tatulashvili , Narimane Berkane , Etienne Carbonnelle , Olivier Bouchaud , Emmanuel Cosson

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Abstract

Objective

We aimed to assess the feasibility and diagnostic performance of ultrasound-guided bone biopsies at the bedside of diabetic patients admitted for suspected foot osteitis not requiring surgery.

Research Design and Methods

In this retrospective monocentric study, we compared the performance of ultrasound-guided (n = 29 consecutive patients, Dec.2020-Oct.2022) versus surgical (n = 24 consecutive patients, Jan.2018-Nov.2020) bone biopsies at confirming or ruling out diabetic foot osteitis (primary outcome).

Results

Patient characteristics were similar in the two intervention groups, including arteritis prevalence (62.3 %), SINBAD score, and wound location (phalanges 36 %, metatarsus 43 %, and calcaneus 21 %). However, the ultrasound-guided group was older (67 ± 11 versus 60 ± 13 years respectively, P = 0.047) and had more type 2 diabetes (97 % versus 75 %, P = 0.038). Diagnostic performance (i.e., capacity to confirm or rule out suspected osteitis) was similar for ultrasound-guided (28/29 cases: 25 confirmations, 3 invalidations) and surgical (24 confirmations/24) biopsies, P = 0.358. No biopsy-related side effect or complication was observed for either intervention, even for patients on antiaggregation and/or anticoagulation therapy. The mean (± standard deviation) time necessary to perform the biopsy was shorter in the ultrasound-guided group (2.6 ± 3.0 versus 7.2 ± 5.8 days, respectively, P < 0.001) and wound evolution at three months was more favorable (83.3 versus 41.2 %, P = 0.005) (94.4 % versus 66.7 %, respectively, patients with new surgical procedure within six months excluded; P = 0.055). Even though not statistically significant, healing rates in terms of wound and osteitis at six months were also better in the ultrasound-guided group (wound: 40.9 % versus 36.8 %; P = 0.790, and osteitis: 81.8 vs 55.6 % P = 0.071).

Conclusion

In diabetic patients with suspected foot osteitis not requiring surgery, bedside ultrasound-guided bone biopsies may constitute a promising alternative to surgical biopsies. This intervention provided excellent tolerance and microbiological documentation, short lead-times, and more favorable wound prognosis.

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床旁活检：用于糖尿病足感染治疗的床旁超声引导骨活检的诊断性能。

研究设计与方法：- 在这项回顾性单中心研究中，我们比较了超声引导下（2020 年 12 月至 2022 年 10 月，连续 29 例患者）与手术（2018 年 1 月至 2022 年 11 月，连续 24 例患者）骨活检在确诊或排除糖尿病足骨炎（主要结果）方面的表现。2022 年 10 月）与手术（n=24 名连续患者，2018 年 1 月至 2020 年 11 月）骨活检在确认或排除糖尿病足骨炎方面的表现（主要结果）：- 两个干预组的患者特征相似，包括动脉炎患病率（62.3%）、SINBAD评分和伤口位置（趾骨36%、跖骨43%和小腿骨21%）。然而，超声引导组的年龄更大（分别为 67 ± 11 岁和 60 ± 13 岁，P = 0.047），2 型糖尿病患者更多（分别为 97% 和 75%，P = 0.038）。超声引导活检（28/29 例：25 例确诊，3 例无效）和手术活检（24 例确诊/24 例）的诊断效果（即确诊或排除疑似骨炎的能力）相似，P = 0.358。两种方法均未发现与活检相关的副作用或并发症，即使是正在接受抗聚集和/或抗凝治疗的患者也是如此。超声引导组进行活检所需的平均（± 标准差）时间更短（分别为 2.6 ± 3.0 天对 7.2 ± 5.8 天，P < 0.001），三个月后的伤口愈合情况更好（分别为 83.3% 对 41.2%，P = 0.005）（分别为 94.4% 对 66.7%，排除六个月内进行过新手术的患者；P = 0.055）。尽管没有统计学意义，但超声引导组患者六个月后伤口和骨炎的愈合率也更好（伤口：40.9% 对 36.8%；P = 0.790；骨炎：81.8% 对 55.6% P = 0.071）。这一干预措施提供了极佳的耐受性和微生物记录，缩短了准备时间，并使伤口预后更为有利。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.