Antibiotic Loaded Calcium Sulphate Ceramic in the Management of Diabetic Foot Osteomyelitis: An Investigation of Factors that Determine Patient Outcomes

Background: Diabetic foot osteomyelitis is a complex condition to manage with substantial risk of treatment failure which could necessitate major amputations. Limb preservation is a critical goal as amputations are associated with poor outcomes, including high mortality rates and reduced quality of life. Surgical debridement and prolonged systemic antibiotic therapy have been the mainstay of treatment, but recurrence rates remain high. The use of adjuvant local antibiotic therapy has been proposed as a potential adjunct to improve outcomes. Methods: This retrospective study involved 113 patients with diabetic foot osteomyelitis who underwent debridement and application of antibiotic loaded calcium sulphate ceramic from the year 2018 to 2023. Clinical outcomes of interest were eradication of infection, ulcer healing, recurrence of infection, prevention of major amputation and mortality rate. Patient associated factors were identified and analysed. Results: Eradication of infection was achieved in 96%, healing of ulcer in 93% and limb salvage in 95% of patients. The mortality rate for 1 year is 5.4% and 5 years is 25.6%. Peripheral arterial disease was adversely associated with eradication of infection, ulcer healing, recurrence of ulcer and limb salvage. Higher levels of HbA1c were substantially related to poor ulcer healing with longer duration and increased recurrence of infection rate. Higher CRP levels are significantly associated with increased recurrence of infection and mortality rate. Gender, BMI, smoking status, part of foot, charcot arthropathy, duration of antibiotics and microorganism factors had no impact on treatment success. Conclusions: This is the largest single centre study involving Cerament G and V in the management of diabetic foot osteomyelitis and the first investigating the specific factors associated with outcome goals. The use of these antibiotic loaded carrier demonstrated excellent eradication of infection, healing of ulcer and limb salvage and prevention of recurrence of infection.