Work

Association of Magnetic Resonance Imaging–Guided Management With Reamputation Rates in Diabetic Foot Osteomyelitis

Year: 2025

Type: article

Abstract: Background Diabetic foot infections constitute 20% of hospital admissions and are the underlying cause of 80% of amputations annually. Staging magnetic resonance imaging (MRI) may decrease reamputation rates in diabetic foot osteomyelitis. Methods A retrospective chart review was conducted to analyze the risk of reamputation in patients with diabetic foot osteomyelitis hospitalized between 2005 and 2022. MRI-guided therapy and proximal surgical margin pathologic evidence of osteomyelitis were compared. The primary outcome was the rate of reamputation up to 365 days. Results Enrollment consisted of 386 veterans with a diabetic foot infection complicated by osteomyelitis that required initial amputation, of which 110 patients required reamputation. MRI-guided therapy occurred in 89 of these patients. Preoperative MRI and subsequent MRI-guided therapy were associated with a significant decrease in the chance of reamputation for up to a year after the initial amputation as compared with non–MRI-guided therapy (14/89 [15.7%] vs 96/297 [32.3%], respectively; P = .0024, χ2 test). A Cox proportional hazard model demonstrated that MRI-guided therapy had a significant association with decreasing the relative risk of reamputation (hazard ratio, 0.47; 95% CI, .26–.83; P = .0098). Initial proximal margin pathologic findings consistent with osteomyelitis were not associated with the risk of reamputation (hazard ratio, 1.25; 95% CI, .81–1.93; P = .31). Conclusions These findings support that incorporating preamputation MRI and MRI-guided therapy into the diagnostic and treatment approach for diabetic foot osteomyelitis may reduce the risk for subsequent amputations over 1 year.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofaf189