Do antibiotic impregnated calcium sulphate beads improve the healing of neuropathic foot ulcers with osteomyelitis undergoing surgical debridement?

Dekker, Andrew; Uzoho, Chukwudi; Scammell, Brigitte

Abstract

Background: Neuropathic foot ulcers are common and difficult to treat. Calcium sulphate has been used for antibiotic delivery with success in treating osteomyelitis. Recent case series suggest success in treating osteomyelitis of the foot with a mean time to healing of 4 months, however there are few studies with a control group for comparison. This study aimed to determine if antibiotic impregnated CAS beads improved the healing of neuropathic foot ulcers with proven osteomyelitis undergoing surgical debridement.

Methods: A consecutive retrospective cohort study of 50 patients undergoing surgical debridement of neuropathic foot ulcers for osteomyelitis was performed. Exclusion criteria were amputations and microbiology findings inconsistent with osteomyelitis. Patients were analysed comparing one group having sharp surgical debridement (SD) and another having debridement and implantation of calcium sulphate (CAS) impregnated with vancomycin and gentamicin.

Results: 42 eligible patients after exclusions; 29 in the CAS group and 13 in the SD group. In the SD group the mean time to healing was 5.8 months (2 to 9 months), and in the CAS group it was 5.5 months (2 to 13 months). There was no significant difference in ulcer healing (p=0.81), time to healing (p=0.79), re-operation rate (p=0.51), length of stay (p=0.74), or mortality (p=0.13) between the two groups.

Conclusions: Ulcer healing in patients treated with antibiotic impregnated calcium sulphate beads was not significantly improved. Healing rates in both groups were similar to those in the recent literature. Sharp surgical debridement alone may be as effective as supplementation with local antibiotics in a bioabsorbable carrier.

Citation

Dekker, A., Uzoho, C., & Scammell, B. (2019). Do antibiotic impregnated calcium sulphate beads improve the healing of neuropathic foot ulcers with osteomyelitis undergoing surgical debridement?. Wounds, 31(6), 145–150

• Journal Article Type: Article
• Acceptance Date: Mar 19, 2019
• Online Publication Date: Apr 18, 2019
• Publication Date: 2019-06
• Deposit Date: Mar 22, 2019
• Publicly Available Date: Mar 22, 2019
• Print ISSN: 1044-7946
• Electronic ISSN: 1943-2704
• Publisher: HMP Communictions
• Peer Reviewed: Peer Reviewed
• Volume: 31
• Issue: 6
• Pages: 145–150
• Public URL: https://nottingham-repository.worktribe.com/output/1677568
• Publisher URL: https://www.woundsresearch.com/article/do-antibiotic-impregnated-calcium-sulfate-beads-improve-healing-neuropathic-foot-ulcers
• Contract Date: Mar 22, 2019