Diabetic Foot Ulcers and Osteomyelitis: Use of Biodegradable Calcium Sulfate Beads Impregnated With Antibiotics for Treatment of Multidrug-Resistant Organisms

Prashant Patil, MCh, FDFS; Rajeev Singh, MS; Apurva Agarwal, MS; Rajiv Wadhwa, MS; Aran Bal, MS, PhD; Sanjay Vaidya, MS, MCh

Disclosures

Wounds. 2021;33(3):70-76.

Conclusions

The use of locally released antibiotics from synthetic recrystallized calcium sulfate may offer substantial benefits in the management of infected DFU that is compromised by poor circulation, polymicrobial growth, and associated renal and cardiac comorbidities. The flexibility of combining different antibiotics enables a strategy that is specifically tailored to pathogens. Additionally, this treatment is less expensive and requires fewer resources (eg, no hospital admission required, nursing care not required for 24 hours) than conventional IV antibiotic therapy. The present authors conclude that there is a need for well-designed and adequately powered trials with suitable blinding to investigate whether the use of local antibiotics improves wound healing and reduces the reoperation rate in the management of DFI.

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Table 1. Antibiotics used in the study
ANTIBIOTIC	CONCENTRATION	VOLUME OF CALCIUM SULFATE POWDER USED (cc)	NO. OF PATIENTS
Meropenem	500mg	10	34
Meropenem	1000mg	20	30
Colistin	3MU	10	21
Colistin	6MU	20	14
Vancomycin	500mg	10	5
Vancomycin	1000mg	20	2

Table 2. Summary of procedures performed in which calcium sulfate beads were used
PROCEDURE	TOTAL CASES
Minor debridement	21
Major debridement	18
Single toe amputation	35
Multiple toe amputation	19
Forefoot amputation	7
Below-knee amputation	2
Necrotizing fasciitis	4

Table 3. Postoperative regimen for soft tissue coverage
POSTOPERATIVE REGIMEN	NO. OF PATIENTS
Skin grafting	18
Dressing changes	51
Delayed wound closure	30
NPWT and skin grafting	7a

NPWT: negative pressure wound therapy
^aOut of 18 patients needing skin grafting, NPWT was used in 7 patients.

Table 4. Microbiological results
ORGANISM	NO. OF PATIENTS
Pseudomonas aeruginosa	72
Klebsiella pneumoniae	70
Escherichia coli	54
Proteus	31
Enterococcus	39
Methicillin-resistant Staphylococcus aureus	17
Methicillin-susceptible S aureus	15

Table 5. Avg. duration of wound healing, d
PROCEDURE	AVG. NO. OF DAYS TO HEALING
Minor debridement	47
Major debridement	64
Single toe amputation	50
Multiple toe amputation	65
Forefoot amputation	62
Below-knee amputation	51
Necrotizing fasciitis	90
Avg: average; d: day(s)