BedBiopsy: Diagnostic performance of bedside ultrasound-guided bone biopsies for the management of diabetic foot infection

Objective: 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. Research Design and Methods: In this retrospective monocentric study, we compared the performance of ultrasound -guided (n = 29 consecutive patients, Dec.2020-Oct.2022) versus surgical (n = 24 consecutive patients, Jan.2018-Nov.2020) bone biopsies at confirming or ruling out diabetic foot osteitis (primary outcome). Results: 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, P = 0.047) and had more type 2 diabetes (97 % versus 75 %, P = 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, P = 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, P < 0.001) and wound evolution at three months was more favorable (83.3 versus 41.2 %, P = 0.005) (94.4 % versus 66.7 %, respectively, patients with new surgical procedure within six months excluded; P = 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 %; P = 0.790, and osteitis: 81.8 vs 55.6 % P = 0.071). Conclusion: 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.