Two-Step Sequential Approach for Concomitant Skin and Soft Tissue Infection and Osteomyelitis Complicating the Diabetic Foot

Current guidelines (1,2) do not provide data on the treatment of patients presenting with concomitant soft tissue infection and osteomyelitis of the diabetic foot (DF-STI/DFO). We have developed a two-step sequential approach (TSA) consisting chronologically of 1 ) an empirical antibiotic therapy for diabetic foot soft tissue infection (DF-STI) secondarily adapted to the culture results of a tissue sample taken by curettage from the periphery of the ulcer (step 1), 2 ) an antibiotic-free period of at least 2 weeks, and 3 ) a bone biopsy obtained percutaneously or intraoperatively in case of, respectively, medical or surgical approach of diabetic foot osteomyelitis (DFO) (step 2) chosen according to Lipsky’s recommendations (3). In the present monocentric retrospective 2006–2015 study, 38 adult patients out of a total of 297 patients followed for DFO (12.8%) had concomitant DF-STI and DFO not requiring …