Current health and economic burden of chronic diabetic osteomyelitis

ABSTRACT

Introduction: Diabetic foot ulcer (DFU) prevalence is as high as 25% and 40–80% of DFUs become infected (DFI). About 20% of infected ulcers will spread to bone causing diabetic foot osteomyelitis (DFO). DFU costs Medicare $9–13 billion/year. The most expensive costs associated with DFU are inpatient costs and hospital admissions. DFO costs are driven mostly by surgical procedures. DFU patients have a 3-year cumulative mortality rate of 28% and rates approaching 50% in amputated patients.

Areas covered: This review will summarize the current health and economic burden of DFO covering management, epidemiology, and copious costs associated with DFO. The review began by searching PubMed and Cochrane databases for various terms including, ‘diabetic osteomyelitis costs,’ ‘diabetic foot infection,’ and ‘diabetes and antibiotics.’ Additionally, references from retrieved publications were reviewed. The global burden of DFU calls for investigating new therapeutic options.

Expert opinion: For DFI, anti-biofilm agents have had success because they directly deliver antimicrobials to the infection site. For DFO, intraosseous (I/O) antibiotic therapy similarly bypasses the issue of vascular disease, will likely have improved therapeutic efficacy, and reduced costs for DFO patients. I/O antibiotic therapy has had clinical success in one case report already, and may significantly improve the lives of those afflicted with DFO.

KEYWORDS:

• Antibiotics
• diabetes cost
• diabetic foot infection
• intraosseous
• osteomyelitis

Article Highlights

• Diabetic foot ulceration (DFU) and infection (DFI) fosters a heavy health and economic burden worldwide. Incidence and associated costs are rising for DFU patients, costing the Medicare system up to $13 billion per year.

• Diabetic foot osteomyelitis (DFO) develops in about 20% of DFI patients and some of the highest drivers of costs are inpatient costs, hospital admissions, long-term antibiotic therapy, and surgical procedures.

• Staphylococcus aureus is the most common organism found in DFO patients and was found in the submicron canaliculi of osteocytes of amputated bone and can colonize beyond the regions of surgical debridement, underscoring the need of delivering high bactericidal concentrations of antibiotic directly to bone.

• Intraosseous (I/O) delivery is a viable and optimal form of antibiotic delivery for the treatment of DFO. Though further investigation is needed, I/O delivery has the potential to reduce amputation rate, overall costs by reducing time to healing, and may even decrease the burden of disability for these patients.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded. The work was completed as part of an unpaid internship at FlowFx via the myCHOICE program at University of Chicago.