529-P: Diagnosis Approach of Suspected Osteitis in Diabetic Foot Ulcer—The Multicentric French 2023 Survey

Bedside Blind Bone Biopsy (B4) through healthy skin is a valid alternative to bone biopsy usually performed in the operating (OR) or radiology (RR) room for the diagnosis of diabetic foot ulcer osteitis (DFU) (IWGDF/IFDSA 2023 guidelines). From 12.17.2015 to 12.31.2023, in our Diabetology unit, 451 B4 have been carried out in 1434 patients admitted with a DFU (31%). B4 rate and performance increased with skill over time (B4 rate: 2023, 55% vs 2016, 15%, proven osteitis: 2023, 68% vs 2016, 50%).

A 19 items quiz has been emailed to the 159 DFU centers (10.22.23-11.07.23 request) in order to assess the diagnosis procedures habits in France in case of DFU suspected osteitis. Respondent rate is 47% (75/159, diabetology units 77%). Microbiological sampling is performed in 92% (samples other than bone biopsy or probabilistic treatment 8%). If bone biopsy performed, B4 is the procedure of choice in 42%, done in various circumstances (conventional hospitalization 79%, ambulatory 62%, consultation 41%). A >2 years experiment is declared in 72%, ≥2 B4/month 55%, ≥2 samples/B4 69%, specific bone biopsy trocar 38%, through healthy skin 79%, systematical post-B4 blood cultures 21%. Conventional bone biopsy (58%) is performed exclusively in the OR (58%) or in the RR (12%), in one or the other (30%). Treatment of DFU osteitis is based on non validated procedures in 16%. A DFU multidisciplinary team is available in 44% of the centers practicing B4. Despite its proven feasibility and valuable help for the diagnosis of DFU osteitis, B4 is poorly and imperfectly used in french DFU centers.