We aimed to assess the feasibility and diagnostic performance of ultrasound-guided bone biopsies at the bedside of diabetic patients admitted for suspected foot osteitis not requiring surgery. In this retrospective monocentric study, we compared the performance of ultrasound-guided ( = 29 consecutive patients, Dec.2020-Oct.2022) versus surgical ( = 24 consecutive patients, Jan.2018-Nov.2020) bone biopsies at confirming or ruling out diabetic foot osteitis (primary outcome). Patient characteristics were similar in the two intervention groups, including arteritis prevalence (62.3 %), SINBAD score, and wound location (phalanges 36 %, metatarsus 43 %, and calcaneus 21 %). However, the ultrasound-guided group was older (67 ± 11 versus 60 ± 13 years respectively, = 0.047) and had more type 2 diabetes (97 % versus 75 %, = 0.038). Diagnostic performance (i.e., capacity to confirm or rule out suspected osteitis) was similar for ultrasound-guided (28/29 cases: 25 confirmations, 3 invalidations) and surgical (24 confirmations/24) biopsies, = 0.358. No biopsy-related side effect or complication was observed for either intervention, even for patients on antiaggregation and/or anticoagulation therapy. The mean (± standard deviation) time necessary to perform the biopsy was shorter in the ultrasound-guided group (2.6 ± 3.0 versus 7.2 ± 5.8 days, respectively, < 0.001) and wound evolution at three months was more favorable (83.3 versus 41.2 %, = 0.005) (94.4 % versus 66.7 %, respectively, patients with new surgical procedure within six months excluded; = 0.055). Even though not statistically significant, healing rates in terms of wound and osteitis at six months were also better in the ultrasound-guided group (wound: 40.9 % versus 36.8 %; = 0.790, and osteitis: 81.8 vs 55.6 % = 0.071). In diabetic patients with suspected foot osteitis not requiring surgery, bedside ultrasound-guided bone biopsies may constitute a promising alternative to surgical biopsies. This intervention provided excellent tolerance and microbiological documentation, short lead-times, and more favorable wound prognosis.

中文翻译：

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BedBiopsy：床旁超声引导骨活检用于治疗糖尿病足感染的诊断性能

我们的目的是评估在疑似足部骨炎而无需手术的糖尿病患者床边进行超声引导骨活检的可行性和诊断性能。在这项回顾性单中心研究中，我们比较了超声引导（= 29 名连续患者，2020 年 12 月至 2022 年 10 月）与手术骨活检（= 24 名连续患者，2018 年 1 月至 2020 年 11 月）在确认或裁定时的表现排除糖尿病足骨炎（主要结果）。两个干预组的患者特征相似，包括动脉炎患病率 (62.3%)、SINBAD 评分和伤口位置（指骨 36%、跖骨 43% 和跟骨 21%）。然而，超声引导组年龄较大（分别为 67 ± 11 岁 vs 60 ± 13 岁，= 0.047），并且患有更多 2 型糖尿病（97 % vs 75 %，= 0.038）。超声引导（28/29 例：25 例确诊，3 例无效）和手术活检（24 例确诊/24）活检的诊断性能（即确认或排除可疑骨炎的能力）相似，= 0.358。这两种干预措施均未观察到与活检相关的副作用或并发症，即使对于接受抗聚集和/或抗凝治疗的患者也是如此。超声引导组进行活检所需的平均（±标准差）时间较短（分别为 2.6 ± 3.0 天与 7.2 ± 5.8 天，< 0.001），并且三个月时伤口的进展情况更为有利（83.3 % 与 41.2 %） ，= 0.005）（排除六个月内接受新手术的患者分别为 94.4 % 和 66.7 %；= 0.055）。尽管没有统计学意义，但超声波引导组在六个月时伤口和骨炎的愈合率也更高（伤口：40.9% vs 36.8%；= 0.790，骨炎：81.8 vs 55.6% = 0.071）。对于疑似足部骨炎且不需要手术的糖尿病患者，床边超声引导骨活检可能是手术活检的一种有希望的替代方法。这种干预措施提供了良好的耐受性和微生物学记录、较短的交货时间和更有利的伤口预后。