Therapy with Vancomycin-Loaded Polymethylmethacrylate Cement Demonstrates Limited Advantage in the Treatment of Infected Diabetes-Related Foot Ulcers: Only Patients with Osteomyelitis Benefited.

Abstract

BackgroundThe use of vancomycin-loaded polymethylmethacrylate cement (vPMMA) has been widely implemented in the treatment of infected diabetes-related foot ulcers (IDFUs). However, its clinical efficacy remains controversial due to limited sample sizes and significant biases in existing studies.MethodsA total of 66 patients diagnosed with IDFUs were retrospectively analyzed and assigned to four groups based on the sensitivity of the isolated pathogens to vancomycin and whether vPMMA was administered. Each group was further stratified into two subgroups according to the presence of osteomyelitis or simple soft tissue infection (STI). Clinical outcomes, including wound healing duration, number of debridement procedures, and pathogen-positive duration, were collected to evaluate the therapeutic effect of vPMMA.ResultsAfter verifying statistical comparability using the WIfI (Wound, Ischemia, and foot Infection) classification system, the statistically significant improvement in wound healing duration was observed in the subgroup A + (with osteomyelitis caused by vancomycin-sensitive pathogens, treated with vPMMA) (69.0 ± 29.6 days, P < 0.05). While, no significant differences were observed among the four groups (A, B, C, D) with respect to wound healing duration (71.5 ± 25.2, 93.5 ± 26.5, 91.0 ± 41.9, 97.1 ± 43.2 days, P > 0.05), debridement numbers (P > 0.05), or pathogen-positive duration (P > 0.05).ConclusionsContrary to previous reports, our findings do not support the use of vPMMA as a universally effective treatment for IDFUs. The therapy demonstrated superior efficacy compared to simple debridement only in cases where osteomyelitis was present and complete surgical clearance of the lesion was not feasible.