Intra-operative tissue sampling and microbiological analyses during minor lower limb amputations in patients with diabetes are poorly reported and difficult to interpret

Authors

  • Mohamed Gulamhussein Dudley Group NHS Foundation Trust
  • Ridwaan Sohawon Russells Hall Hospital, Dudley Group NHS Foundation Trust
  • Hannah Travers Russells Hall Hospital, Dudley Group NHS Foundation Trust
  • Michael Wall Russells Hall Hospital, Dudley Group NHS Foundation Trust

DOI:

https://doi.org/10.15277/bjd.2022.383

Keywords:

processing, intra-operative, diabetic foot, tissue

Abstract

Diabetic foot disease (DFD) is a leading cause of acute sepsis and has long-term consequences for patients. It poses a strain on health resources in both the developed and developing world, with a significant impact on patient quality of life due to the associated complications of DFD and the often multiple interventions required to control infection and preserve limb tissue. Although there is evidence in the literature regarding early detection and prompt management of this debilitating condition, there is little structured evidence on how to gain accurate tissue sampling with processing to allow targeted antimicrobial therapy from minor amputations where bone cultures have been sent.

Methods: A literature review was conducted to establish the publications on intra-operative bone sampling and processing taken during diabetic foot minor amputations and the pathways described for processing sample acquisition.

Findings: Thirty papers were identified which highlighted some of the processes involved in the procurement of intraoperative tissue samples. No published paper reported a complete pathway for the ascertainment of samples, transfer and processing of these specimens.

Conclusion: There is no published consistent pathway published for procurement of intra-operative diabetic foot specimens, for their storage, transportation and processing. Without documented, reproducible processes, it is difficult to interpret published results. This makes planning for targeted antibiotic therapy more difficult.

References

Diabetic foot problems: prevention and management. NICE guidelines (NG19), Aug 2015. https://www.nice.org.uk/guidance/ng19

Diabetes UK 2015. London: British Diabetic Association; c2021 [cited 2021 May 26]. https://www.diabetes.org.uk/about_us/news/more-than-135-dia-betes-amputations-every-week

Kerr M, Barron E, Chadwick P, et al. The cost of diabetic foot ulcers and amputations to the National Health Service in England. Diabet Med 2019; 36(8):995-1002. https://doi.org/10.1111/dme.13973

Schmidt BM, Jarocki C. Making the equivocal unequivocal: standardization of clean margins in diabetic foot osteomyelitis. Clin Diabetes Endocrinol 2020;6:8. https://doi.org/10.1186/s40842-020-00096-2

Senneville E, Joulie D, Blondiaux N, et al. Surgical techniques for Bone Biopsy in Diabetic Foot Infection, and association between results and treatment duration. J Bone Jt Infect 2020;5(4):198-204. https://doi.org/10.7150/jbji.45338

Dawson J, Travers HC, Wall M, et al. The level of training in microbiological sampling for toe amputations in diabetic foot disease: a survey of UK vascular trainees. The Diabetic Foot Journal 2021;1:30–5. https://diabetesonthenet.com/

Travers HC, Dawson J, Muthasami A, et al. Review of Microbiological sampling in diabetic foot disease. Br J Diabetes 2021;21:233-6. https://doi.org/10.15277/bjd.2021.310

Senneville É, Lipsky BA, Abbas ZG, et al. Diagnosis of infection in the foot in diabetes: Diabetes Metab Res Rev 2020;36(S1):e3281. https://doi.org/10.1002/dmrr.3281.

Atway S, Nerone VS, Springer KD, et al. Rate of residual osteomyelitis after partial foot amputation in diabetic patients: a standardized method for evaluating bone margins with intraoperative culture. J Foot Ankle Surg 2012;51(6):749-52. https://doi.org/10.1053/j.jfas.2012.06.017. Epub 2012 Jul 21.

Cohen M, Cerniglia B, Gorbachova T, et al. Added value of MRI to X-ray in guiding the extent of surgical resection in diabetic forefoot osteomyelitis: a review of pathologically proven, surgically treated cases. Skeletal Radiol 2019;48(3):405-11. https://doi.org/10.1007/s00256-018-3045-y. Epub 2018 Aug 22.

Ledermann G, Klaber I, Urrutia J, et al. A novel intraoperative technique seeding morselized bone tissue into pediatric blood culture bottles improves microbiological diagnosis in patients with foot and ankle osteomyelitis. J Orthop Sci 2020;25(3):492-6. https://doi.org/10.1016/j.jos.2019.05.006. Epub 2019 Jun 4.

UK Standards for Microbiology Investigations. Investigation of bone and soft tissue with osteomyelitis. Public Health England. Bacteriology | B 42 | Issue no: 2 | Issue date: 14.12.15 | Page: 1 of 28. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/491748/B_42i2.pdf

George Dovell, Aleksandra Staniszewska, Jozel Ramirez, et al. A systematic review of outcome reporting for interventions to treat people with diabetic foot ulceration. Diabet Med 2021;38(10):e14664. https://doi.org/10.1111/dme.14664. Epub 2021 Aug 9.

Downloads

Published

2022-12-21