{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:30:22Z","timestamp":1785256222745,"version":"3.55.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003092","name":"Dutch Diabetes Research Foundation","doi-asserted-by":"publisher","award":["2017.82.014"],"award-info":[{"award-number":["2017.82.014"]}],"id":[{"id":"10.13039\/501100003092","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ZONMW-VICI","award":["09150182010020"],"award-info":[{"award-number":["09150182010020"]}]},{"name":"ERC-Advanced grant 2023","award":["101141346"],"award-info":[{"award-number":["101141346"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percutaneous bone biopsy is the reference standard for guiding antibiotic therapy in diabetic foot osteomyelitis (DFO). However, ulcer bed biopsies are commonly used in practice. This study aimed to compare 12-month outcomes of patients with conservatively treated DFO whose antibiotic regimens were based on cultures of either percutaneous bone or ulcer bed biopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter, double-blind randomized clinical trial in 84 adult participants with DFO. All underwent a percutaneous bone biopsy and an ulcer bed biopsy. Participants were randomly allocated to antibiotic treatment based on either bone biopsy cultures or ulcer bed biopsy cultures. The primary outcome, DFO remission, was assessed at 12 months using both intention-to-treat and per-protocol analyses with generalized linear models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The remission rate in the bone biopsy group was 31.4% (95% confidence interval [CI], 18.1\u201348.7) and 39.4% (95% CI, 24.2\u201357.0) in the ulcer bed biopsy group. The relative risk of not achieving remission at 12 months in the bone biopsy group was 1.13 (95% CI, 0.80\u20131.60) in the intention-to-treat analyses and ranged from 1.12 to 1.18 in the per-protocol analyses. Antibiotics targeting bacteria identified in the unblinded sample were effective against all bacteria cultured from the blinded sample in 85.9% of cases (n = 61).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study found no evidence to recommend bone biopsies prior to the start of antibiotics in patients with DFO. In most cases, the antibiotics targeted bacteria in both samples, possibly contributing to the equivalence of the results in outcomes in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trials registration<\/jats:title>\n                    <jats:p>Netherlands Trial Register NL 7582.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf684","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:12:57Z","timestamp":1765545177000},"page":"436-442","source":"Crossref","is-referenced-by-count":6,"title":["Bone Biopsy not Superior to Ulcer Bed Biopsy\u2013guided Antibacterial Therapy on Remission of Diabetic Foot Osteomyelitis: A Randomized Controlled Trial"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4163-1768","authenticated-orcid":false,"given":"Rimke S","family":"Lagrand","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise W E","family":"Sabelis","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meryl C T T","family":"Gramberg","sequence":"additional","affiliation":[{"name":"Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Amsterdam Institute for Infection & Immunity, Infectious Diseases, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehtab","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Liverpool Hospital, Sydney, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna J F","family":"van den Bosch","sequence":"additional","affiliation":[{"name":"Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Amsterdam Institute for Infection & Immunity, Infectious Diseases, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter","family":"Brekelmans","sequence":"additional","affiliation":[{"name":"Department of Surgery, Alrijne Medical Group, Leiderdorp, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4946-2332","authenticated-orcid":false,"given":"Jarne M","family":"van Hattem","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Infection & Immunity, Infectious Diseases, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Department of Medical Microbiology, Amsterdam UMC, Academic Medical Centre, Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3620-5617","authenticated-orcid":false,"given":"Martin","family":"den Heijer","sequence":"additional","affiliation":[{"name":"Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The \u00a0","place":["Netherlands"]},{"name":"Amsterdam Institute for Infection & Immunity, Infectious Diseases, Amsterdam UMC, Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willemijn","family":"Kortmann","sequence":"additional","affiliation":[{"name":"Department of Internal 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