1115_Lavery.ppt

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1、The Effect of Clean and Dirty Bone Margins on the Treatment ParadigmLawrence A.Lavery,DPM,MPHProfessor and Vice Chair of ResearchDepartment of Orthopedic SurgeryUniversity of Texas San AntonioDallas,TexasLaveryuthscsa.edu,Objectives,To discuss IDSA/IWGDF diabetic foot infection classification and To

2、 discuss recommendations for antibiotic duration for diabetic foot infectionsTo discuss outcomes of residual versus resected diabetic foot osteomyelitis,Limitans of Osteomyelitis Research:The Devil is in the Details,Small sample size:50 per groupIs this your patient population?PAD,soft tissue,siteDe

3、finition of osteomyelitisDefinition of successful treatmentOsteomyelitis at the same anatomic siteRe-infection(soft tissue&bone)Wound healingRe-ulcerationAmputation,Reference,Sybenga ABJ Foot Ankle Surg.2020 Jan-Feb;59(1):75-85.Lavery LA:J Foot Ankle Surg.2019 Jul;58(4):713-716.,Senneville E,Diabete

4、s Metab Res Rev.2024 Mar;40(3):e3687,Diabetic Foot Osteomyelitis:are IV antibiotics safe?,Acute Kidney Injury 27-36%Line complications 14-20%Antibiotic resistant pathogens 15%C.Diff infection 1%,6,Lavery LA et al J Amer Pod Med Assoc 2021van Asten,S.A.V.,et al.(2017).Diabetes Res Clin Pract.Schneide

5、r,L.V.,et al.(2015).The Journal of Vascular Access 16(4):299-308.Li H-K,et al.NEJM 2019;380:425-436,When is surgery necessary?,AbscessExposed bone NecrosisAscending cellulitisGas,Medical treatment of diabetic foot osteomdyelitis,When to consider a trial of non-surgical treatment?,Patient preferenceS

6、urgery not required to deal with adjacent soft tissue infection or necrosisNo persisting sepsis Patient comorbidities confer high risk to surgeryNo contraindications to prolonged antibiotic therapy,Lipsky BA et al.Clin Inf Dis,2012,Advantages and disadvantages of medical vs.surgical treatment,Surger