Polymicrobial infection in bone biopsies and relapse in diabetic foot osteomyelitis: The role of soft tissue involvement

The purpose of this study was to examine whether polymicrobial infection in bone biopsies is associated with infection relapse following surgery for diabetic foot osteomyelitis. Relapse of infection presents a major challenge in treating diabetic foot osteomyelitis, yet the role of microbiological factors in predicting relapse remains underexplored. We conducted a retrospective analysis of 100 patients treated surgically for diabetic foot osteomyelitis. Bone biopsies were obtained intraoperatively for microbiological and histopathological examination. Relapse was defined as the recurrence of infection in bone or soft tissue necessitating additional surgical intervention or antibiotic therapy. Our findings indicate that soft tissue involvement, rather than polymicrobial infection in bone biopsies, is a significant predictor of relapse, with patients exhibiting soft tissue involvement showing a markedly higher likelihood of relapse. In contrast, polymicrobial growth in bone biopsies was not significantly associated with infection relapse. These results highlight the importance of soft tissue integrity in treatment outcomes and suggest that local tissue damage, rather than microbiological diversity, may play a more critical role in relapse. This study challenges the assumption that polymicrobial infection directly influences relapse risk and raises questions regarding the reliance on wound healing as an indicator of successful infection management. Future studies should focus on refining treatment indicators and exploring comprehensive approaches that address both bone and soft tissue infections to reduce relapse rates and improve patient outcomes.