Are We Misdiagnosing Diabetic Foot Osteomyelitis? Is the Gold Standard Gold?
Authors Lavery LA, Crisologo PA, La Fontaine J, Bhavan K, Oz OK, Davis KE
Submitted By Lawrence Lavery on 8/2/2019
Status Published
Journal The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
Year 2019
Date Published
Volume : Pages 58 : 713 - 716
PubMed Reference 31256899
Abstract To compare the incidence of osteomyelitis based on different operational
definitions using the gold standard of bone biopsy, we prospectively enrolled 35
consecutive patients who met the criteria of =21 years of age and a moderate or
severe infection based on the Infectious Diseases Society of America
classification. Bone samples were obtained from all patients by percutaneous
bone biopsy or intraoperative culture if the patient required surgery. Bone
samples were analyzed for conventional culture, histology, and 16S ribosomal RNA
genetic sequencing. We evaluated 5 definitions for osteomyelitis: 1) traditional
culture, 2) histology, 3) genetic sequencing, 4) traditional culture and
histology, and 5) genetic sequencing and histology. There was variability in the
incidence of osteomyelitis based on the diagnostic criteria. Traditional
cultures identified more cases of osteomyelitis than histology (68.6% versus
45.7%, p?=?.06, odds ratio [OR] 2.59, 95% confidence interval [CI] 0.98 to
6.87), but the difference was not significant. In every case that histology
reported osteomyelitis, bone culture was positive using traditional culture or
genetic sequencing. The 16S ribosomal RNA testing identified significantly more
cases of osteomyelitis compared with histology (82.9% versus 45.7%, p?=?.002, OR
5.74, 95% CI 1.91 to 17.28) and compared with traditional cultures but not
significantly (82.9% versus 68.6%, p?=?.17, OR 2.22, 95% CI 0.71 to 6.87). When
both histology and traditional culture (68.6%) or histology and genetic
sequencing cultures (82.9%) were used to define osteomyelitis, the incidence of
osteomyelitis did not change. There is variability in the incidence of
osteomyelitis based on how the gold standard of bone biopsy is defined in
diabetic foot infections.

Investigators with authorship
Lawrence LaveryUniversity of Texas Southwestern