ABSTRACT
To compare the incidence of osteomyelitis based on different operational definitions
using the gold standard of bone biopsy, we prospectively enrolled 35 consecutive patients
who met the criteria of ≥21 years of age and a moderate or severe infection based
on the Infectious Diseases Society of America classification. Bone samples were obtained
from all patients by percutaneous bone biopsy or intraoperative culture if the patient
required surgery. Bone samples were analyzed for conventional culture, histology,
and 16S ribosomal RNA genetic sequencing. We evaluated 5 definitions for osteomyelitis:
1) traditional culture, 2) histology, 3) genetic sequencing, 4) traditional culture
and histology, and 5) genetic sequencing and histology. There was variability in the
incidence of osteomyelitis based on the diagnostic criteria. Traditional cultures
identified more cases of osteomyelitis than histology (68.6% versus 45.7%, p = .06, odds ratio [OR] 2.59, 95% confidence interval [CI] 0.98 to 6.87), but the
difference was not significant. In every case that histology reported osteomyelitis,
bone culture was positive using traditional culture or genetic sequencing. The 16S
ribosomal RNA testing identified significantly more cases of osteomyelitis compared
with histology (82.9% versus 45.7%, p = .002, OR 5.74, 95% CI 1.91 to 17.28) and compared with traditional cultures but
not significantly (82.9% versus 68.6%, p = .17, OR 2.22, 95% CI 0.71 to 6.87). When both histology and traditional culture
(68.6%) or histology and genetic sequencing cultures (82.9%) were used to define osteomyelitis,
the incidence of osteomyelitis did not change. There is variability in the incidence
of osteomyelitis based on how the gold standard of bone biopsy is defined in diabetic
foot infections.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: This study was funded by the National Institutes of Health grant 3 U24 DK076169-08S4.
Conflict of Interest: L.A.L. discloses positions on speaker bureaus for Osiris, Integra, and Smith & Nephew, and consultancy roles with Aplion Medical Users, Harbor MedTech, Boehringer Ingelheim, and Medline Industries, Inc., as well as research grant funding from Cardinal.
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