Osteomyelitis Way Back When

[Kooky Korky, BSN, RN]

Back in the Dark Ages when I began my Nursing career, osteo was treated aggressively with 6 weeks of IV antibiotics in the hospital, followed by a long course of oral antibiotic.

Now it seems it is not considered as a "must treat" condition.

The Podiatrist who comes to our facility says he has patients who have had osteo for decades!  He says he does not necessarily treat osteo at all.  ?

I know many things have changed over more than 40 years and osteo treatment seems to be one of them.

What is your experience with osteomyelitis, particularly in diabetics?

[Hannahbanana, BSN, MSN]

When I was a probie with Florence we had a number of old vets with 30+ year-old osteomyelitis. Several were alcoholics who would snooze off in the sun, have flies stop by for a snack, and come in c a new crop of maggots. Their wounds were never cleaner. They’d been doing this for years and years. No pain, had enough bone to keep their tibias from collapsing. 
 

The diabetics tended to get gangrenous and septic, though. 

[JBMmom, MSN, NP]

I still see plenty of people admitted for osteomyelitis, especially diabetics with wounds that require surgical debridement. They usually end up with PICC lines for long term antibiotics. But I guess since I work inpatient I don't see patients that come to the ED but aren't admitted, so I'm not sure how many people with osteo are being admitted/treated vs discharged to home. 

[MunoRN, RN]

I think it may be more that the podiatrist's practice is out of date, rather than best practice changing to less aggressive care.

It used to be that osteomyelitis was considered incurable, and that there weren't really any effective treatments, so these patients were just treated with symptom management.

Osteomyelitis treatment has since advanced and effective treatments are readily available, although there are no doubt podiatrists who are still living in the past.

[CalicoKitty, BSN, MSN, RN]

If diabetics can't get their sugars under control, it really doesn't matter what happens. The high blood sugars end up with poor perfusion and a nonfunctional immune system. Poor perfusion, the antibiotics may not even circulate well enough to the troubled areas. Antibiotics if actively infected (foul drainage, edema, etc). In the end, without caring for the diabetes, an amputation is likely to occur.   But, once you start cutting, the cutting often continues. Antibiotic treatments are still pretty long 6 wks - 3 months, but can have lots of side effects.  The jury is still out according to this journal article that I googled...

 

Osteomyelitis in diabetic foot: A comprehensive overview (2017)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394733/#:~:text=Diabetic foot osteomyelitis (DFO) is,in case of ulcer recurrence.

[Kooky Korky, BSN, RN]

3 hours ago, MunoRN said:

I think it may be more that the podiatrist's practice is out of date, rather than best practice changing to less aggressive care.

It used to be that osteomyelitis was considered incurable, and that there weren't really any effective treatments, so these patients were just treated with symptom management.

Osteomyelitis treatment has since advanced and effective treatments are readily available, although there are no doubt podiatrists who are still living in the past.

He is actually a pretty young doctor.  Which doesn't mean that his educators taught him well.

We have a wound care specialist MD who is older and shares the DPM's view.  I am amazed at this laissez faire attitude.

What are some of the more modern treatments?

Thanks in advance.

[Jedrnurse, BSN, RN]

My brother just had a partial foot amputation due to osteo. He has type 2 diabetes.

He originally had a blister that his podiatrist was treating "conservatively".

[Hannahbanana, BSN, MSN]

My first father-in-law died suddenly of ?sepsis after a similar course of “treatment,” but that was decades ago. 

[Kooky Korky, BSN, RN]

I hope your brother is able to adjust, Jedrnurse.  

It is scary that this escalated to such a degree. 

What do you think could have prevented amputation?

What was the "conservative" treatment?

[Kooky Korky, BSN, RN]

On 4/23/2021 at 6:45 AM, Hannahbanana said:

My first father-in-law died suddenly of ?sepsis after a similar course of “treatment,” but that was decades ago. 

Wow, I am so sorry.

Was your FIL diabetic? 

Do you recall what was the cause of the sepsis and what the treatment was?

[Kooky Korky, BSN, RN]

On 4/22/2021 at 10:19 PM, CalicoKitty said:

If diabetics can't get their sugars under control, it really doesn't matter what happens. The high blood sugars end up with poor perfusion and a nonfunctional immune system. Poor perfusion, the antibiotics may not even circulate well enough to the troubled areas. Antibiotics if actively infected (foul drainage, edema, etc). In the end, without caring for the diabetes, an amputation is likely to occur.   But, once you start cutting, the cutting often continues. Antibiotic treatments are still pretty long 6 wks - 3 months, but can have lots of side effects.  The jury is still out according to this journal article that I googled...

 

Osteomyelitis in diabetic foot: A comprehensive overview (2017)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394733/#:~:text=Diabetic foot osteomyelitis (DFO) is,in case of ulcer recurrence.

I have been reading these articles.  Very informative.  Thank you, CalicoKitty.

[Hannahbanana, BSN, MSN]

1 hour ago, Kooky Korky said:

Was your FIL diabetic? 

 Do you recall what was the cause of the sepsis and what the treatment was?

He was, but didn’t tell the allegedly licensed podiatrist who was treating a chronic foot wound because he had some stupid idea that his insurance rates would go up if it appeared in his records and who apparently didn’t think to wonder why it wasn’t healing.
For a university professor he was not too smart about some things. He felt unwell one day and refused to go to the hospital so it wasn’t until he collapsed that his wife, also a university professor, called 911, and he was DOA. Never saw his baby grandson bec we lived in the other side of the continent. It was a looong time ago.