Terapi Non-Operatif pada Osteomielitis Kaki Diabetes Melitus (DM): Laporan Kasus

Abstract

Osteomielitis kaki DM merupakan komplikasi lanjut pada infeksi kaki DM yang dapat meningkatkan risiko amputasi. Sebuah kasus pada seorang perempuan berusia 50 tahun dengan luka pada ibu jari kaki kiri yang semakin membengkak disertai warna merah kebiruan dalam satu bulan. Pasien menunda berobat karena pandemi COVID-19. Pasien merupakan penderita DM dan hipertensi sejak 20 tahun dan tidak terkontrol. Pada pemeriksaan fisik ditemukan sausage toe digiti I pedis sinistra dengan luka 4 x 4 cm disertai sekret purulen, probe to bone (PTB) positif. Pemeriksaan penunjang menunjukan adanya leukositosis, peningkatan laju endap darah (LED) dan c-reactive protein (CRP), gula darah sewaktu (GDS) 415 mg/dL, dan HbA1c 13,1%, disertai destruksi dan fragmentasi os phalang digiti 1 pedis sinistra. Karena menolak tindakan operasi minor, kemudian dilakukan perawatan luka dengan membuang serpihan tulang yang terinfeksi secara teratur dan pemberian antibiotik intravena (IV) selama 4 minggu. Untuk pengendalian gula darah, diberikan insulin IV kontinyu dan dilanjutkan pemberian insulin basal bolus subkutan. Kemudian dilanjutkan rawat jalan dengan pemberian antibiotik oral. Setelah tujuh minggu, menifestasi klinis infeksi membaik, luas luka mengecil, dan antibiotik dihentikan, namun perawatan luka tetap dilanjutkan. Kendali metabolik disertai pemberian antibiotik jangka panjang dan perawatan luka pada kaki diabetes dengan osteomielitis dapat digunakan sebagai alternatif selain tindakan operatif. Kata Kunci: Osteomielitis kaki DM, terapi non-operatif Non-Operative Management of Diabetic Foot Osteomyelitis: A Case Report Diabetic foot osteomyelitis is an advanced complication of diabetic foot infection which can increase the risk of amputation. This report discusses a case of a 50-year-old female with a wound on the thumb of her left foot that became more swollen with a bluish red color within one month. The patient delayed her treatment due to the COVID-19 pandemic. She has had diabetes and hypertension for 20 years which is uncontrolled. Physical examination showed a sausage toe digiti 1 left pedis with wound 4 x 2 cm with purulent discharge, Probe to Bone (PTB) positive. Laboratory and x-ray examination showed leukocytosis, increased erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), glucose level 415 mg/dL, and HbA1c 13.1%, with destruction and fragmentation in first toe bone of the left foot. Because she refused minor surgery, the wound was treated regularly by removing infected bone fragments and giving intravenous (IV) antibiotics for four weeks. For glucose level control, continuous IV insulin was given with subcutaneous basal-bolus insulin, then continued by outpatient care with oral antibiotics. After seven weeks, manifestations of infection improved, the wound area was reduced, and antibiotics were discontinued, but wound care was continued. Metabolic control along with long-term antibiotics and wound care for diabetic foot osteomyelitis can be used as an alternative to surgery.