IDSA - Approach to Treating a Patient With Diabetic Foot Osteomyelitis

When to consider a trial of nonsurgical treatment:

 • No persisting sepsis (after 48–72 h if on treatment)

 • Patient can receive and tolerate appropriate antibiotic therapy

 • Degree of bony destruction has not caused irretrievable compromise to mechanics of foot (bearing in mind potential for bony reconstitution)

 • Patient prefers to avoid surgery

 • Patient comorbidities confer high risk to surgery

 • No contraindications to prolonged antibiotic therapy (eg, high risk for C. difficile infection)

 • Surgery not otherwise required to deal with adjacent soft tissue infection or necrosis

When to consider bone resection:

 • Persistent sepsis syndrome with no other explanation

 • Inability to deliver or patient to tolerate appropriate antibiotic therapy

 • Progressive bony deterioration despite appropriate therapy

 • Degree of bony destruction irretrievably compromises mechanics of foot

 • Patient prefers to avoid prolonged antibiotics or to hasten wound healing

 • To achieve a manageable soft tissue wound or primary closure

 • Prolonged antibiotic therapy is relatively contraindicated or is not likely to be effective (eg, presence of renal failure)



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