Diabetic foot osteomyelitis treated with Surgical adjuvant antibiotic loaded bio-composite materials – A comparative retrospective cohort study

Diabetic foot osteomyelitis (DFO) is a challenging component of the diabetic foot syndrome and the pathway to amputation. It is associated with high morbidity, increased hospitalisation, extended use of antibiotics, and is a significant economic burden to healthcare systems. Conventional treatment encompasses combined medical and surgical management including prolonged antibiotic therapy and radical debridement. The advent of antibiotic loaded bio-composite materials may improve cure rates while facilitating a more conservative surgical approach. The purpose of this study was to determine the efficacy of a range of antibiotic loaded bio-composite materials in the presence of DFO. A retrospective cohort study of 133 consecutive DFO cases was conducted over a 60-month period from May 2017 to May 2022 following local ethical approval. All cases were treated with judicious surgical debridement and either hydroxyapatite/calcium sulphate; calcium sulphate; or collagen antibiotic impregnated bio-composite material. The primary outcome measures were re-infection and re-operation rates within 12 months of surgery. 40/133 patients (30.1 %) developed a re-infection at the same location requiring further treatment. 39/133 patients (29.3 %) had revision surgery during the same period. Subgroup analysis comparing re-operation rates classified by specific antibiotic loaded bio-composite material revealed no significant association (p = 0.218). The effect of Diabetes Mellitus control and vascular status did not significantly affect this finding. Adjuvant antibiotic impregnated bio-composite material is a valuable tool in the therapeutic armamentarium against DFO. This material appears to promote a uniformly high rate of infectious clearance while facilitating functional limb salvage.