{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:07:27Z","timestamp":1790258847687,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To describe organisms most frequently identified on bone biopsy or deep tissue culture and determine how culture data impacted antibiotic management in patients with diabetic foot osteomyelitis (DFO).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively reviewed patients admitted with a diabetic foot ulcer (DFU) between 3 March 2018 and 31 December 2019 and selected for patients diagnosed with infectious osteomyelitis (OM) of the lower extremity. We stratified patients by whether a bone biopsy or deep tissue culture was obtained and compared rates of antibiotic utilization with chi-squared and Fisher\u2019s exact tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 305 patients with a DFU, 152 (50%) were clinically diagnosed with DFO. Forty-seven patients received 41 deep tissue cultures and 29 bone biopsy cultures for a total of 70 cultures. Of 45 (64%) positive cultures, 36 (80%) had Gram-positive organisms and 19 (42%) had Gram-negative organisms. MDR organisms were isolated in 7 (15%) patients. Culture data resulted in antibiotic changes in 41 (87%) patients. Therapy was narrowed in 29 (62%) patients and broadened due to inadequate empirical coverage in 4 (9%) patients. Culture data from 18 (40%) patients showed susceptibility to an oral treatment regimen with high bioavailability. There was no significant difference in rates of antibiotic utilization at discharge between patients who underwent bone biopsy or deep tissue culture relative to those who did not (77% versus 75%, P\u200a=\u200a0.86), although less MRSA coverage was used (34% versus 50%, P\u200a=\u200a0.047).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In patients with DFO, deep tissue and bone biopsy cultures were infrequently obtained but resulted in targeted therapy changes in most patients. Culture data usually allowed for narrowing of antibiotics but revealed inadequate empirical coverage in a subset of patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkac345","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T09:23:33Z","timestamp":1665393813000},"page":"3482-3486","source":"Crossref","is-referenced-by-count":10,"title":["Role of bone biopsy and deep tissue culture for antibiotic stewardship in diabetic foot osteomyelitis"],"prefix":"10.1093","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7082-7482","authenticated-orcid":false,"given":"Sara M","family":"Hockney","sequence":"first","affiliation":[{"name":"Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4866-7432","authenticated-orcid":false,"given":"Danielle","family":"Steker","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Bhasin","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL , USA"},{"name":"Division of Hospital Based Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M","family":"Krueger","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Galvin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"key":"2023062919535388000_dkac345-B1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer","volume":"13","author":"Armstrong","year":"2020","journal-title":"J Foot Ankle Res"},{"key":"2023062919535388000_dkac345-B2","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"key":"2023062919535388000_dkac345-B3","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.endinu.2016.10.008","article-title":"Diagnostic and therapeutic update on diabetic foot osteomyelitis","volume":"64","author":"L\u00e1zaro-Mart\u00ednez","year":"2017","journal-title":"Endocrinol Diabetes Nutr"},{"key":"2023062919535388000_dkac345-B4","first-page":"26","article-title":"Diabetic foot infections: a comprehensive overview","volume":"23","author":"Pitocco","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2023062919535388000_dkac345-B5","doi-asserted-by":"crossref","first-page":"ofaa393","DOI":"10.1093\/ofid\/ofaa393","article-title":"Percutaneous bone biopsy for diabetic foot osteomyelitis: a systematic review and meta-analysis","volume":"7","author":"Schechter","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2023062919535388000_dkac345-B6","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1093\/cid\/ciz489","article-title":"The infected diabetic foot: re-evaluating the Infectious Diseases Society of America diabetic foot infection classification","volume":"70","author":"Lavery","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2023062919535388000_dkac345-B7","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/cis346","article-title":"2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2023062919535388000_dkac345-B8","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/QCO.0000000000000530","article-title":"Principles and practice of antibiotic stewardship in the management of diabetic foot infections","volume":"32","author":"U\u00e7kay","year":"2019","journal-title":"Curr Opin Infect Dis"},{"key":"2023062919535388000_dkac345-B9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ijid.2022.03.049","article-title":"The impact of the length of total and intravenous systemic antibiotic therapy for the remission of diabetic foot infections","volume":"120","author":"Haug","year":"2022","journal-title":"Int J Infect Dis"},{"key":"2023062919535388000_dkac345-B10","doi-asserted-by":"crossref","first-page":"e16954","DOI":"10.1097\/MD.0000000000016954","article-title":"Impact of diagnostic bone biopsies on the management of non-vertebral osteomyelitis: a retrospective cohort study","volume":"98","author":"Hirschfeld","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2023062919535388000_dkac345-B11","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ejrad.2019.01.032","article-title":"Percutaneous CT guided bone biopsy for suspected osteomyelitis: diagnostic yield and impact on patient\u2019s treatment change and recovery","volume":"114","author":"Hoang","year":"2019","journal-title":"Eur J Radiol"},{"key":"2023062919535388000_dkac345-B12","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s00256-019-3152-4","article-title":"Percutaneous image-guided bone biopsy of osteomyelitis in the foot and pelvis has a low impact on guiding antibiotics management: a retrospective analysis of 60 bone biopsies","volume":"48","author":"Said","year":"2019","journal-title":"Skeletal Radiol"},{"issue":"Suppl 1","key":"2023062919535388000_dkac345-B13","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1002\/dmrr.2739","article-title":"Diabetic foot infections: current treatment and delaying the \u2018post-antibiotic era\u2019","volume":"32","author":"Lipsky","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"2023062919535388000_dkac345-B14","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4239\/wjd.v8.i4.135","article-title":"Osteomyelitis in diabetic foot: a comprehensive overview","volume":"8","author":"Giurato","year":"2017","journal-title":"World J Diabetes"},{"key":"2023062919535388000_dkac345-B15","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/j.1469-0691.2005.01279.x","article-title":"Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers","volume":"12","author":"Tentolouris","year":"2006","journal-title":"Clin Microbiol Infect"},{"key":"2023062919535388000_dkac345-B16","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.ijid.2021.10.016","article-title":"Predictors and outcomes of diabetic foot ulcer infection with ESBL-producing bacteria in a large tertiary center","volume":"113","author":"Leibovitch","year":"2021","journal-title":"Int J Infect Dis"},{"key":"2023062919535388000_dkac345-B17","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.3390\/jcm10091948","article-title":"The influence of multidrug-resistant bacteria on clinical outcomes of diabetic foot ulcers: a systematic review","volume":"10","author":"Matta-Guti\u00e9rrez","year":"2021","journal-title":"J Clin Med"},{"key":"2023062919535388000_dkac345-B18","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/1071100712467980","article-title":"Severity of diabetic foot infection and rate of limb salvage","volume":"34","author":"Wukich","year":"2013","journal-title":"Foot Ankle Int"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/77\/12\/3482\/50741126\/dkac345.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/77\/12\/3482\/50741126\/dkac345.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T19:54:07Z","timestamp":1688068447000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/77\/12\/3482\/6754674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,10]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,10,10]]},"published-print":{"date-parts":[[2022,11,28]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkac345","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,12,1]]},"published":{"date-parts":[[2022,10,10]]}}}