Diabetic Foot Problems

Rifampin Tied to Better Outcomes in Diabetic Foot Osteomyelitis

Rifampin may be associated with lower rates of mortality and amputation compared with other antibiotics among patients with diabetic foot osteomyelitis (DFO), according to new research published in JAMA Network Open.

“These results coupled with existing evidence from small clinical trials suggest the addition of rifampin to current treatment regimens may be a useful antimicrobial option in the treatment of DFO,” the study authors said of their findings.

YOU MIGHT LIKE
AHA 2019: Specialists Talk Diabetes and Multi-Organ Dysfunction
Diabetes and PAD: Risk Management, Treatment Options

Brigid M. Wilson, PhD, from the Veterans Affairs Northeast Ohio Healthcare System, and colleagues arrived at their conclusion following an observational cohort study, during which index cases of DFO from January 1, 2009, through December 31, 2013, were identified using Veterans Health Administration (VHA) databases. Ultimately, 130 rifampin-treated patients and 6044 patients treated without rifampin were included in the final analysis.

The study excluded patients who had died or experienced a major amputation within 90 days of diagnosis, who did not receive systemic antibiotics dispensed by the VHA within 6 weeks of diagnosis, or who received treatment at facilities where rifampin was not dispensed for DFO.

Results of the study demonstrated lower rates of events among rifampin-treated patients (35 of 130, 26.9%) compared with non-rifampin-treated patients (2250 vs 6044, 37.2%). Notably, the following factors were observed in patients treated with rifampin compared with non-rifampin-treated patients:

  • Younger age (mean age 62.2 years vs 64.9 years)
  • Fewer comorbidities (mean Charlson comorbidity index score 3.5 vs 4.0)
  • More infectious disease specialty consultations (63 of 130 [48.5%] vs 1960 of 6044 [32.4%])
  • More often had Staphylococcus aureus identified in cultures (55 of 130 [42.3%] vs 1755 of 6044 [29.0%])


A significant association of rifampin was yielded via a logistic regression estimated the odds of events and controlling for the above and other covariates (odds ratio 0.65).

—Christina Vogt

Reference:
Wilson BM, Bessesin MT, Doros G, et al. Adjunctive rifampin therapy for diabetic foot osteomyelitis in the Veterans Health Administration. JAMA Netw Open. 2019;2(11):e1916003. doi:10.1001/jamanetworkopen.2019.16003.