Osteomyelitis of the foot in people with diabetes: Un pasito adelante y un pasito para atrás

THIS THESIS REGARDS – AIMS AND SUMMARY Aims of this thesis – from diagnosis to pathogen identification and treatment of diabetes related foot infection: In this thesis, our overarching aim is to advance the understanding and management of diabetes-related foot infection, from diagnosis to bacterial identification and treatment. Our first aim is to determine the optimal strategy for diagnosing diabetes-related foot osteomyelitis. We present a protocol of a randomised controlled trial to compare the effectiveness of two diagnostic modalities: ulcer bed biopsy and bone biopsy, and we investigate if there is an association between bacterial profiles and outcome the role of sampling method on this outcome. Next, we aim to investigate methods for identifying causative bacteria in ulcer bed and bone samples from individuals with diabetes-related foot osteomyelitis. By comparing different techniques, we seek to identify the most reliable method for accurately identifying the bacteria causative for the infection, thus informing guided antibiotic therapy. Furthermore, we will explore the impact of prior antibiotic treatment on culture outcomes of ulcer bed and bone samples. Understanding how previous antibiotic use influences culture results is crucial for optimising treatment strategies and preventing antimicrobial resistance. In summary, our thesis aims to contribute to the improvement of diagnosis and treatment of diabetes-related foot osteomyelitis, ultimately reducing adverse events like risk of amputation and mortality associated with this serious diabetes-related complication.