1. Introduction
Diabetes-related foot osteomyelitis (DFO) is a frequent and severe complication in patients with diabetes [1]. Current estimates indicate that around 131 million people (1.8% of the global population) have diabetes-related lower extremity complications such as neuropathy, peripheral artery disease, ulceration and/or infection of the foot [2]. Twenty percent of people with foot complications also have osteomyelitis, which is a leading cause of adverse clinical outcomes such as lower extremity amputation and loss of quality of life [3]. Approximately 50% to 77% of people with DFO ultimately need amputation of the lower extremity despite targeted and long-term antimicrobial therapy [4,5,6].
In short, the pathogenesis of DFO involves structural alterations and foot deformities due to persistent hyperglycemia. A combination of neuropathy (including loss of foot sensation), immune dysfunction, peripheral artery disease, and foot deformities predisposes individuals to ulcer formation and subsequent ulcer infection. If left untreated, the infection can eventually spread to the bone [7,8].
The cornerstone of conservative treatment for DFO includes systemic antimicrobial therapy, often combined with surgical intervention (e.g., ulcer debridement and/or partial amputation). In addition, optimal management of diabetes, wound care, and offloading of pressure from the affected foot are crucial components of treatment. Systemic antimicrobial therapy is preferably based on accurate cultures obtained before initiating treatment [1,9,10]. However, the effectiveness of this therapy can be compromised by difficulties in delivering antibiotics to areas with necrosis, poor blood flow, and the formation of biofilms on bone sequesters, which protect bacteria from both antibiotic action and immune responses [11].
Due to the pathophysiology of diabetes-related foot osteomyelitis (DFO), this infection generally requires surgery and systemic antibacterial therapy [1]. However, the optimal duration for systemic antibacterial therapy (sATD) remains unclear [12,13]. The goal of treatment is to address the signs and symptoms of infection, eradicate bacterial pathogens in the foot, and prevent further tissue destruction. Culture-guided treatment with an appropriate duration can lower the risk of adverse outcomes such as hospitalization, sepsis, amputation, or death [1,14].
International treatment guidelines generally suggest a treatment duration of approximately six weeks. Longer durations may be recommended for patients who do not undergo surgical debridement of the infected bone, while shorter durations are suggested for those who receive complete surgical debridement or amputation of the infected bone [1]. The guidelines emphasize tailoring the duration of therapy based on the extent of surgical intervention and the patient’s clinical response.
Shorter courses of antibiotics may offer reduced adverse effects (e.g., hepatotoxicity, acute kidney injury, skin rash, or Clostridioides difficile-associated diarrhea) and improved patient adherence compared with longer treatment durations [15]. This approach aligns with findings from studies on other types of infections, where shorter durations are as effective as traditional longer courses [16,17]. However, studies on other types of infections indicate that there is a potential for increased risk of infection recurrence and other negative outcomes, such as prolonged hospitalization, increased healthcare costs, development of antibiotic resistance, and higher morbidity and mortality rates, if the infection is not fully resolved [18]. Therefore, further research is needed to identify the most effective and safest sATD for DFO, considering both the potential for improved patient outcomes and the minimization of treatment-related adverse effects. In this systematic review (SR), the objective was to compare the effects of a shorter antimicrobial treatment duration with a longer one in people with diabetes-related foot osteomyelitis, aiming to assess the efficacy and safety of systemic antibacterial therapy.
2. Results
2.1. Literature Search
The literature search generated 2708 references: 1231 in Ovid Medline, 818 in Embase.com, 422 in the Cochrane Library, 148 in CINAHL, 26 in CT.gov, and 63 in ICTRP. After removing duplicates, 2173 unique references remained. After title and abstract selection, and full read, two articles were included (PRISMA flow, Figure 1).
2.2. Characteristics of the Included Studies
The RCTs included in this review were published in 2015 and 2021, respectively, and involved 133 participants Tone 2015 [19] and Gariani 2021 [20].
Follow-up duration varied, with Tone (2015) [19] providing 12 months of follow-up and Gariani (2021) [20] providing two months after treatment for primary outcomes. Tone (2015) [19] included 40 participants, evenly split between the intervention and comparison groups. In contrast, Gariani (2021) [20] included 93 participants, with a different distribution for intention-to-treat and per-protocol analyses.
2.3. Interventions and Comparisons
Table 1 provides a comprehensive overview of the participant characteristics and study details, highlighting differences in culture types, treatment durations, and the use of partial amputation. Antimicrobial treatment was based on bone culture in one study Tone (2015) [19] and tissue or bone culture in another Gariani (2021) [20]. The treatment duration was six versus 12 weeks in Tone (2015) [19] and 3 versus 6 weeks in Gariani (2021) [20]. Although both studies included ulcer debridement as standard care, partial amputation was permitted only in Gariani (2021) [20]. Neither study reported on mortality, quality of life, or treatment costs. Due to the essential differences mentioned above, there was clinically important heterogeneity. Therefore, we performed an evidence synthesis without meta-analyses.
2.4. Primary Outcome, Secondary Outcomes, Remission, Surgical Interventions, and Adverse Events
One study reported on the primary outcome of amputation, with a rate of 10% in both the intervention and comparison groups (p = 1.00). Both studies reported remission rates, which ranged from 60% to 84%, with no significant difference between shorter and longer treatment durations. Adverse events were less common in the intervention group, with significant differences observed in one study (p = 0.04) (Table 2 for a complete description of the results).
2.5. Risk of Bias Assessment
Both studies showed a low risk of bias regarding randomization and clear outcome definitions, but deviations from intended interventions in Gariani (2021), including participant exclusions and late amputations, raised concerns. Additionally, the short and inconsistent follow-up in Gariani’s study may have led to misclassification of remission and overlooked late clinical failures. These factors contribute to imprecision in the treatment effects. Overall, the risk of bias was low to moderate, with the main issues arising from deviations in intervention and variability in outcome measurement. These biases suggest that while the evidence offers valuable insights, caution is needed when interpreting the results, as these factors may impact the reliability and generalizability of the findings (Appendix C).
2.6. GRADE
We used the GRADE methodology to systematically assess the quality of the evidence. We rated the evidence as low, moderate, or high. The quality of evidence was downgraded, i.e., because of a risk of bias, inconsistency, indirectness, imprecision, or publication bias.
3. Discussion
This systematic review, despite a comprehensive and thorough search strategy, identified only two randomized controlled trials (RCTs) assessing the efficacy of shorter versus longer antimicrobial treatment durations for DFO. The limited number of studies highlights this area’s scarcity of high-quality evidence.
Due to substantial heterogeneity between the studies, a meta-analysis was not feasible. Our findings suggest that, for DFO, shorter antibiotic treatment (6 weeks) may be as effective as longer treatment (12 weeks) to achieve remission. However, the primary outcome of amputation showed no difference between groups, with a 10% rate in both the intervention and comparison arms of one study. Adverse events were less frequent in the shorter treatment group, with a significant difference noted in one study. The findings should be interpreted with caution when considering the risk of bias.
Strengths of the studies include clear outcome definitions and comprehensive follow-up, but limitations such as deviations from intended interventions, short follow-up periods, and lack of confidence intervals reduce the reliability of the results. These biases suggest that while shorter treatment may be promising, the evidence remains moderate, and further high-quality trials are needed to confirm these findings.
Furthermore, the studies’ geographical distribution, spanning Europe (France and Switzerland), suggests applicability primarily to Western countries with advanced healthcare systems; however, generalization to regions with differing healthcare qualities is cautioned.
Quality of evidence ranged from moderate for the outcome of amputation to very low for remission, influenced by concerns over bias, indirectness, and imprecision among the included studies. Our review adhered to Cochrane protocols to minimize potential biases in the review process; however, ongoing and unpublished trials represent a potential source of bias that could affect our conclusions.
Comparative literature suggests that shorter antibiotic courses may be safe for other forms of osteomyelitis and infections, such as vertebral and pediatric osteomyelitis, and infections involving prosthetic joints and soft tissues [16,17,21]. However, given the unique challenges faced by individuals with diabetes, such as peripheral artery disease and immune dysfunction, caution is needed before extrapolating these findings to the DFO population. This underscores the need for more high-quality, targeted studies. Senneville et al. may help address this evidence gap and provide clearer guidance on the safety and efficacy of shorter antibiotic regimens for DFO [1]. In the context of our findings, the limited number of high-quality RCTs makes it difficult to draw definitive conclusions regarding the optimal treatment duration for DFO. While our review indicates that shorter treatment may be as effective as longer treatment, the small sample size and moderate risk of bias in the available studies limit the strength of this conclusion. More robust evidence is needed to determine whether these findings can be generalized to the broader DFO population, especially in light of the clinical complexity of these patients.
A multidisciplinary approach that includes not only antimicrobial therapy but also standardized protocols for offloading, vascular optimization, wound care, and glycemic control is essential in the management of DFO. These treatment components can significantly influence outcomes, and future studies on antibiotic treatment duration should ensure that these elements are consistently applied and standardized across both intervention and control groups.
3.1. Recommendations for Future Research
To advance the understanding of optimal treatment duration for DFO, future studies should adopt standardized treatment protocols that include antimicrobial therapy and key components such as offloading, vascular optimization, wound care, and glycemic control. Ensuring that these elements are uniformly applied in both intervention and control groups is crucial for accurately assessing the effect of treatment duration on outcomes. In addition to clinical outcomes, future research should incorporate a comprehensive set of outcome measures, including patient-reported outcomes and quality-of-life assessments, vital for patient-centered care. Primary outcomes should include remission rates and amputation necessity, while secondary outcomes could examine antibiotic resistance, adverse events, and long-term functional outcomes. Economic evaluations, such as cost-effectiveness analyses, should also be integrated to assess the feasibility of different treatment durations in various healthcare settings, particularly in resource-limited environments. Additionally, future research should incorporate subgroup analyses to explore how patient-specific factors, such as age, gender, diabetes type, osteomyelitis severity, and peripheral arterial disease, may impact the optimal treatment duration. By ensuring that these key factors are uniformly managed and documented, future studies can provide more accurate and tailored guidelines for the management of DFO, leading to more effective and individualized treatment strategies. Furthermore, the impact of antimicrobial duration on microbial resistance patterns warrants discussion. With the global rise in antibiotic resistance, understanding how shorter treatment regimens might mitigate this risk is crucial for guiding future treatment protocols. Finally, studies should ensure adequate follow-up periods to capture late clinical failures and recurrences. Subgroup analyses, considering factors like age, gender, diabetes type, and osteomyelitis severity, can help tailor treatment guidelines to diverse patient populations. By addressing these gaps, future research can provide more precise and globally applicable recommendations for managing DFO. These limitations underscore the need for further research with larger, more diverse populations and standardized outcome measures. Future studies should ensure that treatment protocols include antibiotic therapy and essential components, all applied consistently across intervention and control groups. Additionally, incorporating long-term follow-up is critical to assess the sustainability of treatment effects, particularly regarding recurrence rates, antibiotic resistance, and long-term functional outcomes. Future research should equally include patient-reported outcomes and quality-of-life measures, as these provide valuable insights into the patient experience that clinical outcomes alone cannot capture. Economic evaluations, such as cost-effectiveness analyses, are integral in assessing the feasibility of different treatment durations for DFO across diverse healthcare settings. By understanding the potential cost savings associated with shorter antibiotic courses—while maintaining clinical outcomes—healthcare providers and policymakers can make informed decisions that balance effective patient care with resource allocation. This approach may guide policy recommendations for antimicrobial stewardship and optimize treatment strategies, particularly in resource-constrained settings where prolonged antibiotic use may present additional financial and logistical burdens. Subgroup analyses could help tailor treatment guidelines for specific patient populations. Addressing these gaps will contribute to a more comprehensive and globally applicable understanding of the optimal duration of antibiotic treatment for diabetic foot osteomyelitis, improving patient care and treatment outcomes in diverse clinical settings.
3.2. Limitations
Addressing the limitations of our systematic review is crucial for understanding the context and scope of our findings. A significant limitation stems from the small sample sizes of the included studies, which precluded the possibility of conducting a meta-analysis. This constraint limits the statistical power and generalizability of our conclusions, as the heterogeneity and variability inherent in the study designs, populations, and interventions could not be quantified or systematically compared. Another critical limitation is the challenge of adequately controlling for confounding factors. Given the observational nature of some of the included data and the variability in study designs, fully adjusting for all potential confounders that could influence the outcomes of antibiotic duration for diabetes-related foot osteomyelitis was not feasible. This could lead to residual confounding, affecting the validity of the findings. Additionally, the heterogeneity in outcome definitions and measurement across studies introduces variability that complicates the synthesis of results. This inconsistency makes it challenging to draw firm conclusions about the efficacy and safety of shorter versus longer antibiotic treatments. Furthermore, the lack of long-term follow-up in the included studies restricts our understanding of the sustainability of treatment effects, particularly concerning recurrence rates, resistance development, and long-term patient outcomes. The absence of patient-reported outcomes in the reviewed literature is another limitation, as it overlooks the subjective experience of the disease and treatment, which is crucial for a holistic understanding of treatment impact.
And lastly, the current antimicrobial treatments for DFO, which extend beyond treatment duration, are the growing concern of antibiotic resistance. Prolonged or repeated antibiotic courses can contribute to resistance, limiting future treatment options and potentially decreasing the efficacy of standard regimens. Moreover, the presence of biofilms—structured bacterial communities that adhere to tissue and implant surfaces—presents a significant barrier to successful treatment. Biofilms protect bacteria from immune responses and limit antibiotic penetration, complicating eradication and often necessitating more aggressive or extended therapies. These challenges underscore the need for more tailored treatment strategies to address antibiotic resistance and biofilm-associated infections, which are frequent and problematic in DFO patients. Future research should explore alternative or adjunct therapies to overcome these limitations and improve treatment outcomes.
4. Materials and Methods
We conducted a SR in accordance with the PRISMA (Reporting Items for Systematic Reviews and Meta-Analyses guidelines) by Moher et al. [22] (Checklist Appendix A). The objective of this SR was to compare the effects of a shorter antimicrobial treatment duration with a longer antimicrobial treatment duration in people with diabetes-related foot osteomyelitis.
4.1. Search Strategy
To identify the relevant publications, we conducted systematic searches in the bibliographic databases Ovid Medline, Embase.com, Wiley/Cochrane Library, and Ebsco/CINAHL from inception to 19 January 2024, in collaboration with a medical information specialist. We used the following terms (including synonyms and closely related words) as index terms or free-text words: “Osteomyelitis”, “Osteitis,” “Diabetic foot”, “Anti-Bacterial Agents”, and “randomized controlled trials”. The full search strategies for all databases can be found in Appendix B. Additionally, we searched ClinicalTrials.gov and ICTRP. Also, we searched grey literature and performed a reference crosscheck to identify eligible articles not identified through previous searches. There were no restrictions on language or publication date. We excluded duplicate articles using Endnote X21.0.1 (Clarivatetm).
4.2. Study Eligibility Criteria
Only randomized controlled trials (RCTs) were included. Cohort, cross-sectional studies, case–control studies, and case reports were excluded.
4.3. Outcomes
The primary outcome was amputation, including part of the foot (i.e., minor, distal to the malleoli), leg (i.e., major, proximal to the malleoli), or complete bone resection. The secondary outcomes are clinical remission; surgical intervention of the foot, including surgical debridement and partial bone resection without removing the complete bone or performing an amputation; adverse events, expressed as the proportion of participants in each group with an event; mortality; and costs.
4.4. Types of Participants
Participants included patients with type 1 or 2 diabetes mellitus (DM) and osteomyelitis distal to the malleoli.
4.5. Study Selection and Data Extraction
Two independent reviewers (MG, SvA) screened the studies’ titles and abstracts using the inclusion and exclusion criteria in the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia). Subsequently, the same reviewers independently reviewed the remaining full-text reports for eligibility. Data from the full-text articles were extracted independently. In all stages, we resolved disagreements by discussing or consulting a third independent reviewer (EP).
4.6. Assessment of Risk of Bias
Two reviewers (MG, BT) independently assessed the risk of bias (RoB) for the methodological quality of each included study using the PRISMA guidelines Moher et al. [22] and the Cochrane risk of bias tool for randomized trials (RoB 2). We tested the RoB on the domains of randomization, deviations from intended interventions, missing outcome data, measurement of outcome, and selection of the reported results. We scored all domains from low to high risk of bias.
4.7. Statistical Analysis
We extracted all studies, and we displayed the characteristics of the variables displayed to the definitions used in the articles. Heterogeneity was evaluated using the tau-squared (I2) statistic. I2 of 0–40% was considered as low heterogeneity, 30–50% as moderate heterogeneity, 50–75% as substantial heterogeneity, and 75–100% as high heterogeneity, respectively. When heterogeneity was greater than 60% or if definitions of the outcome, or outcomes were not displayed, a meta-analysis was not performed. We set statistical significance at p < 0.05 and performed all analyses using Review Manager version 5.4.1 (Review Manager 2020 [Computer program]).
5. Conclusions
The limited number of studies and participants, combined with substantial risk of bias and the absence of data on key outcomes such as mortality, treatment costs, and quality of life, restricts the scope of this review and the completeness and applicability of the available evidence. Our findings suggest that a shorter duration of antimicrobial treatment for DFO may be as effective as a longer one in terms of amputation and remission, with fewer adverse events. However, the limited number of studies, their heterogeneity, and overall low quality of evidence—characterized by biases, imprecision, and indirectness—necessitate caution in drawing firm conclusions. More high-quality research is needed to define the optimal treatment duration better.
M.C.T.T.G. led the research, screened the articles, performed data extraction and analysis, and guided the writing of the manuscript. Together with B.T., she performed the risk of bias assessment. B.T. also performed data extraction and analysis and made noteworthy contributions to writing the final manuscript. S.v.A. screened the articles and contributed the risk of bias assessment and contributed to the final article according to her expertise. E.S., L.W.E.S. and M.d.H. contributed to the final article according to their expertise. R.d.V. is formal analysis, data curation, and resource. V.d.G. and E.J.G.P. also contributed according to their expertise and made noteworthy contributions to finalising the final manuscript. All authors have read and agreed to the published version of the manuscript.
This study was conducted according to our previously published protocol at the Cochrane library and is cited as Gramberg MC, Sieswerda E, van Asten SAV, Sabelis LWE, de Vries R, Peters EJG. Duration of antibiotic treatment for foot osteomyelitis in people with diabetes. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD014750. DOI: 10.1002/14651858.CD014750. Accessed 18 September 2024.
Not applicable.
No new data were created or analyzed in this study. Data sharing is not applicable to this article.
Dutch Diabetes Research Foundation.
The authors declare no conflicts of interest.
Footnotes
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Study characteristics.
| Author | Tone 2015 [ | Gariani 2021 [ |
|---|---|---|
| Study design | Randomized controlled trial, parallel group | Randomized controlled trial, parallel group |
| Duration of study | 3 years | 3 years |
| Outcome assessment | 12 months | 2 months after end of treatment |
| Interventions (Group 1) | Antimicrobial treatment: 6 weeks | Antimicrobial treatment: 3 weeks |
| Comparison (Group 2) | Antimicrobial treatment: 12 weeks | Antimicrobial treatment: 6 weeks |
| Number of participants | n = 40 | n = 93 |
| Age (years) | Group 1: 64.6 ± 11.2 | Group 1 n = 70 ± not mentioned |
| Sex ratio (male/female) n= | 11/29 | 76/17 |
| Type of diabetes | Type 2, duration > 10 years in 73% of participants | Type 1 and 2 diabetes mellitus |
| Pre-disease duration | Not specified | Not specified |
| Inclusion criteria | Included: ≥18 years | Included: ≥18 years, DFO |
| Exclusion criteria | Absence of both pedal pulses, gangrene, severe peri-osteoarticular damage | DFO associated with an implant; recent antibiotic therapy within 96 h; total amputation of infected bone; complete bone destruction beyond cortical level; or remote infection needing over 21 days of another antibiotic therapy. |
| Outcome | Remission | Remission |
| Outcomes: mortality, costs, and quality of life | No information | No information |
DFO = diabetes-related foot osteomyelitis. AEs = adverse events.
Study outcomes and complications.
| Author | Tone 2015 [ | Gariani 2021 [ |
|---|---|---|
| Remission | Group 1 * | Group 1 * |
| Surgical interventions | No information. The study did not permit partial amputation within its protocol. | The median number of surgical |
| Major amputation | Group 1: 2 (10%) | No information |
| Overall failure | Group 1: 8 (40%) | Group 1: 3 (3.2%) |
| Noncomplete healing | Group 1: 2 (10%) | No information |
| Relapsing osteomyelitis | Group 1: 2 (10%) | No information |
| Worsening radiological bone abnormalities | Group 1: 6 (30%) | No information |
| Bone resection | Group 1: 2 (10%) | No information |
| Spread of osteomyelitis to contiguous sites | Group 1: 4 (20%) | No information |
| Nausea | Group 1: 1 (5%) | 1 (1.1%)—treatment group not specified |
| Vomiting | Group 1: 1 (5%) | No information |
| Diarrhoea | Group 1: 0 (0%) | 1 (1.1%)—treatment group not specified |
| Fungal intertrigo | No information | 4 (4.3%)—treatment group not specified |
| Anaphylaxis | No information | 1 (1.1%)—treatment group not specified |
| Drug fever | No information | 1 (1.1%)—treatment group not specified |
| Skin rash | No information | 3 (3.2%)—treatment group not specified |
| Hepatic cytolysis/cholestasis | Group 1: 1 (5%) | No information |
* Group 1 is the group with a shorter treatment duration. ** Group 2 is the group with a longer treatment duration.
Appendix A
PRISMA (Reporting Items for Systematic Reviews and Meta-Analyses guidelines) checklist.
| Section and Topic | Item # | Checklist Item | Location Where Item Is Reported |
|---|---|---|---|
| Title | |||
| Title | 1 | Identify the report as a systematic review. | 1 |
| Abstract | |||
| Abstract | 2 | See the PRISMA 2020 for Abstracts checklist. | 1 |
| Introduction | |||
| Rationale | 3 | Describe the rationale for the review in the context of existing knowledge. | 2, 3 |
| Objectives | 4 | Provide an explicit statement of the objective(s) or question(s) the review addresses. | 11 |
| Methods | |||
| Eligibility criteria | 5 | Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses. | 5 |
| Information sources | 6 | Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted. | 11 |
| Search strategy | 7 | Present the full search strategies for all databases, registers and websites, including any filters and limits used. | |
| Selection process | 8 | Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process. | 11 |
| Data collection process | 9 | Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process. | 11 |
| Data items | 10a | List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g., for all measures, time points, analyses), and if not, the methods used to decide which results to collect. | 5 |
| 10b | List and define all other variables for which data were sought (e.g., participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information. | 5 | |
| Study risk of bias assessment | 11 | Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process. | 9 |
| Effect measures | 12 | Specify for each outcome the effect measure(s) (e.g., risk ratio, mean difference) used in the synthesis or presentation of results. | 4 |
| Synthesis methods | 13a | Describe the processes used to decide which studies were eligible for each synthesis (e.g., tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)). | n.a. |
| 13b | Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions. | n.a. | |
| 13c | Describe any methods used to tabulate or visually display results of individual studies and syntheses. | 4 | |
| 13d | Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used. | 4 | |
| 13e | Describe any methods used to explore possible causes of heterogeneity among study results (e.g., subgroup analysis, meta-regression). | 11 | |
| 13f | Describe any sensitivity analyses conducted to assess robustness of the synthesized results. | n.a. | |
| Reporting bias assessment | 14 | Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases). | 11 |
| Certainty assessment | 15 | Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome. | 9 |
| Results | |||
| Study selection | 16a | Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram. | |
| 16b | Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded. | | |
| Study characteristics | 17 | Cite each included study and present its characteristics. | |
| Risk of bias in studies | 18 | Present assessments of risk of bias for each included study. | |
| Results of individual studies | 19 | For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g., confidence/credible interval), ideally using structured tables or plots. | |
| Results of syntheses | 20a | For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies. | n.a. |
| 20b | Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary estimate and its precision (e.g., confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect. | n.a. | |
| 20c | Present results of all investigations of possible causes of heterogeneity among study results. | n.a. | |
| 20d | Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results. | n.a. | |
| Reporting biases | 21 | Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed. | |
| Certainty of evidence | 22 | Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed. | 5, 6, 7, 8 |
| Discussion | |||
| Discussion | 23a | Provide a general interpretation of the results in the context of other evidence. | 9, 10 |
| 23b | Discuss any limitations of the evidence included in the review. | 9, 10, 11 | |
| 23c | Discuss any limitations of the review processes used. | 10, 11 | |
| 23d | Discuss implications of the results for practice, policy, and future research. | 10 | |
| Other Information | |||
| Registration and protocol | 24a | Provide registration information for the review, including register name and registration number, or state that the review was not registered. | 12 |
| 24b | Indicate where the review protocol can be accessed, or state that a protocol was not prepared. | Cochrane | |
| 24c | Describe and explain any amendments to information provided at registration or in the protocol. | n.a. | |
| Support | 25 | Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review. | 12 |
| Competing interests | 26 | Declare any competing interests of review authors. | 12 |
| Availability of data, code and other materials | 27 | Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review. | 12 |
Appendix B
Search Strategy.
| Ovid Medline Session Results (19 January 2024) | ||
| Search | Query | Items Found |
| #12 | #10 AND #11 | 1231 |
| #11 | (randomized controlled trial.pt. OR controlled clinical trial.pt. OR randomized.ab. OR placebo.ab. OR drug therapy.fs. OR randomly.ab. OR trial.ab. OR groups.ab.) NOT (exp animals/not humans.sh.) | 5,118,413 |
| #10 | #7 AND #8 AND #9 | 2973 |
| #9 | exp Diabetes Mellitus/OR (diabetes OR diabetic* OR dm2 OR niddm OR dm-2 OR t2d* OR dm-type-2 OR dm-type-II OR dm1 OR iddm OR dm-1 OR t1d* OR dm-type-1 OR dm-type-I).ab,ti,kf. | 869,270 |
| #8 | “Anti-Infective Agents”/OR exp “Anti-Bacterial Agents”/OR exp Penicillins/OR exp Trimethoprim/OR exp Sulfamethoxazole/OR (antibacterial* OR anti-bacterial* OR antibiotic* OR acedapson* OR aconiazide* OR actinonin* OR actinorhodin* OR alamethicin* OR albomycin* OR amdinocillin* OR amifloxacin* OR amikacin* OR aminosalicylic acid* OR amoxicillin* OR amphomycin* OR amphotericin-B* OR ampicillin* OR amprenavir* OR angustmycin* OR anisomycin* OR antimycin* OR antofloxacin* OR apramycin* OR arsphenamin* OR aurodox OR avibactam* OR avilamycin* OR azithromycin* OR azlocillin* OR aztreonam* OR bacampicillin* OR bacitracin* OR bacteriocins* OR balofloxacin* OR bambermycins* OR bedaquilin* OR bekanamycin* OR benzathine cloxacillin* OR berythromycin* OR beta-lactam* OR bialaphos* OR bicozamycin* OR blasticidin* OR bongkrekic-Acid* OR bredinin* OR brefeldin* OR broadcillin* OR brobactam* OR butirosin-sulfate* OR cactinomycin* OR calcimycin* OR candicidin* OR capreomycin* OR carbenicillin* OR carfecillin* OR cefaclor* OR cefadroxil* OR cefamandol* OR cefatrizin* OR cefazedon* OR cefazolin* OR cefdinir* OR cefditoren* OR cefepim* OR cefetamet* OR cefiderocol* OR cefixim* OR cefmenoxim* OR cefmetazole* OR cefminox* OR cefodizim* OR cefonicid* OR cefoperazon* OR ceforanide* OR cefoselis* OR cefotaxim* OR cefotetan* OR cefotiam* OR cefoxitin* OR cefpimizol* OR cefpiramid* OR cefpirom* OR cefpodoxim* OR cefprozil* OR cefsulodin* OR ceftarolin* OR ceftazidim* OR cefteram-pivoxil* OR ceftezol* OR ceftibuten* OR ceftiofur* OR ceftizoxim* OR ceftobiprole* OR ceftolozan* OR ceftriaxon* OR cefuroxim* OR cefuroxime-axetil* OR cephacetrile* OR cephalexin* OR cephaloglycin* OR cephaloridin* OR cephalosporin* OR cephalothin* OR cephamycin* OR cephapirin* OR cephradin* OR cethromycin* OR chelerythrin* OR chloramphenicol* OR chloroxin* OR chlortetracyclin* OR ciprofloxacin* OR citrinin* OR clarithromycin* OR clavulanic-acid* OR clinafloxacin* OR clindamycin* OR clofazimin* OR cloxacillin* OR colistin* OR cotrim* OR cyclacillin* OR cycloserin* OR dactinomycin* OR dalbavancin* OR dalfopristin* OR dapson* OR daptomycin* OR decamethoxin* OR demeclocyclin* OR desoxyfructo-serotonin* OR diarylquinolin* OR dibekacin* OR dicloxacillin* OR dihydrostreptomycin-sulfate* OR diketopiperazin* OR dirithromycin* OR distamycin* OR diucifon* OR doripenem* OR doxycyclin* OR dynemicin-a OR echinomycin* OR edein* OR efrotomycin* OR emiglitate* OR enoxacin* OR enviomycin* OR epicillin* OR eravacyclin* OR ertapenem* OR erythromycin* OR ethambutol* OR ethionamid* OR fidaxomicin* OR filipin* OR florfenicol* OR floxacillin* OR flucloxacillin* OR fluoroquinolon* OR forphenicinol* OR fosfomycin* OR framycetin* OR fumagillin* OR fusafungin* OR fusidic-acid* OR gamithromycin* OR garenoxacin* OR gatifloxacin* OR gemifloxacin* OR gentamicin* OR gramicidin* OR grepafloxacin* OR herbimycin* OR hygromycin b OR imipenem* OR immunomycin* OR isatoic-anhydride* OR isepamicin* OR isoniazid* OR izumenolid* OR josamycin* OR kanamycin* OR kitasamycin* OR lactacystin* OR lactam* OR lacticin-481 OR lactoferricin-b OR lasalocid* OR leucomycin* OR levofloxacin* OR lincomycin* OR lincosamid* OR linezolid* OR lomefloxacin* OR loracarbef* OR lucensomycin* OR lydiamycin-a OR lymecyclin* OR maduramicin* OR maltotetraos* OR manoalid* OR manumycin* OR marbofloxacin* OR meclocyclin* OR mepartricin* OR meropenem* OR methacyclin* OR methampicillin* OR methicillin* OR metronidazol* OR mevastatin* OR mezlocillin* OR micronomicin* OR midecamycin* OR mikamycin* OR minocyclin* OR miocamycin* OR mirincamycin* OR mocimycin* OR moxalactam* OR moxifloxacin* OR muconomycin-a OR mupirocin* OR mycobacillin* OR nadifloxacin* OR nafcillin* OR nalidixic-acid* OR narasin* OR natamycin* OR nebacetin* OR nebramycin* OR nebularin* OR neomycin* OR netilmicin* OR netropsin* OR nigericin* OR nisin OR nitrofurantoin* OR nojirimycin* OR norfloxacin* OR novobiocin* OR nystatin* OR ofloxacin* OR oleandomycin* OR oligomycin* OR oxacillin* OR oxetanocin* OR oxolinic acid* OR oxytetracyclin* OR panipenem-betamipron* OR paromomycin* OR pazufloxacin* OR pediocin* OR pefloxacin* OR penicill* OR penimepicyclin* OR phenethicillin* OR phosphoramidon* OR piericidin-a OR pipemidic-acid* OR piperacillin* OR pivampicillin* OR plazomycin* OR pluracidomycin* OR polymyxins* OR polyoxorim* OR pristinamycin* OR prodigiosin* OR propicillin* OR prothionamid* OR prulifloxacin* OR pyrazinamid* OR pyrazofurin* OR quinupristin* OR radezolid* OR ramoplanin* OR ribostamycin* OR rifabutin* OR rifamexil* OR rifampin* OR rifamycins* OR rifapentin* OR rifaximin* OR ristocetin* OR rolitetracyclin* OR roxarson* OR roxithromycin* OR rutamycin* OR saframycin-a OR salinomycin* OR sangivamycin* OR sirolimus OR sisomicin* OR sitafloxacin* OR sodium-thiosulfat* OR sparfloxacin* OR spectinomycin* OR spiramycin* OR squalamin* OR staphylococcin* OR stigmatellin* OR streptogramin* OR streptomycin* OR streptovaricin* OR sulbactam* OR sulbenicillin* OR sulfadiazin* OR sulfaguanol* OR sulfamerazin* OR sulfameter* OR sulfamethoxazol* OR sulfamethoxypyridazin* OR sulfanilamid* OR sultamicillin* OR suncillin* OR syringomycin* OR talampicillin* OR tazobactam* OR tedizolid* OR teicoplanin* OR telavancin* OR telithromycin* OR temafloxacin* OR temocillin* OR tetarimycin* OR tetracenomycin* OR tetracyclin* OR thalidomid* OR thiamphenicol* OR thienamycin* OR thienamycin* OR thioacetazon* OR thiobenzamid* OR thiocarlid* OR thiolactomycin* OR thiomandelic-acid* OR thiostrepton* OR thymopoietin* OR tiamulin* OR ticarcillin* OR tigecyclin* OR tilmicosin* OR tobramycin* OR tomaymycin* OR torezolid* OR trimethoprim* OR triostin-a OR troleandomycin* OR tunicamycin* OR tylosin* OR tyrocidin* OR tyrothricin* OR ubenimex OR ulifloxacin* OR undecylprodigiosin* OR vaborbactam* OR valinomycin* OR vancomycin* OR vernamycin-b OR viomycin* OR virginiamycin*).ab,ti,kf. | 1,288,916 |
| #7 | #3 OR #4 OR #5 OR #6 | 27,808 |
| #6 | ((diabet* foot) OR (diabet* feet) OR (diabet* ulcer*) OR (diabet* wound*)).ab,ti,kf. | 15,593 |
| #5 | exp Diabetic Foot/ | 11,727 |
| #4 | ((exp “Foot Bones”/OR metatarsal.ab,ti,kf. OR tarsal.ab,ti,kf. OR cuneiform.ab,ti,kf. OR cuboid.ab,ti,kf. OR navicular*.ab,ti,kf. OR calcaneus.ab,ti,kf. OR talus.ab,ti,kf.) AND (exp Osteomyelitis/OR exp Osteitis/OR osteomyelit*.ab,ti,kf. OR osteitis.ab,ti,kf. OR ostitis.ab,ti,kf. OR Infections/OR Inflammation/OR infect*.ab,ti,kf. OR inflam*.ab,ti,kf.)) | 3811 |
| #3 | #1 AND #2 | 8,632 |
| #2 | exp Foot/OR exp Amputation Stumps/OR (foot OR feet OR forefoot OR metatarsus OR toe OR toes OR hallux OR tarsus OR heel OR lower-extremit* OR ankle OR ankles OR amputation-stump*).ab,ti,kf. | 301,036 |
| #1 | exp Osteomyelitis/OR exp Osteitis/OR osteomyelit*.ab,ti,kf. OR osteitis.ab,ti,kf. OR ostitis.ab,ti,kf. OR ((“Bone and Bones”/OR exp “Bones of Lower Extremity”/OR bone.ab,ti,kf. OR bones.ab,ti,kf. OR osseous.ab,ti,kf. OR osseus.ab,ti,kf.) AND (Infections/OR Inflammation/OR infect*.ab,ti,kf. OR inflam*.ab,ti,kf.)) | 158,420 |
| Embase.com Session Results (19 January 2024) | ||
| Search | Query | Items Found |
| #12 | #10 AND #11 | 818 |
| #11 | (‘randomized controlled trial’/de OR ‘controlled clinical trial’/de OR random*:ti,ab,tt OR ‘randomization’/de OR ‘intermethod comparison’/de OR placebo:ti,ab,tt OR (compare:ti,tt OR compared:ti,tt OR comparison:ti,tt) OR ((evaluated:ab OR evaluate:ab OR evaluating:ab OR assessed:ab OR assess:ab) AND (compare:ab OR compared:ab OR comparing:ab OR comparison:ab)) OR (open NEXT/1 label):ti,ab,tt OR ((double OR single OR doubly OR singly) NEXT/1 (blind OR blinded OR blindly)):ti,ab,tt OR ‘double blind procedure’/de OR (parallel NEXT/1 group*):ti,ab,tt OR (crossover:ti,ab,tt OR ‘cross over’:ti,ab,tt) OR ((assign* OR match OR matched OR allocation) NEAR/6 (alternate OR group OR groups OR intervention OR interventions OR patient OR patients OR subject OR subjects OR participant OR participants)):ti,ab,tt OR (assigned:ti,ab,tt OR allocated:ti,ab,tt) OR (controlled NEAR/8 (study OR design OR trial)):ti,ab,tt OR (volunteer:ti,ab,tt OR volunteers:ti,ab,tt) OR ‘human experiment’/de OR trial:ti,tt) NOT ((((random* NEXT/1 sampl* NEAR/8 (‘cross section*’ OR questionnaire* OR survey OR surveys OR database OR databases)):ti,ab,tt) NOT (‘comparative study’/de OR ‘controlled study’/de OR ‘randomised controlled’:ti,ab,tt OR ‘randomized controlled’:ti,ab,tt OR ‘randomly assigned’:ti,ab,tt)) OR (‘cross-sectional study’ NOT (‘randomized controlled trial’/de OR ‘controlled clinical study’/de OR ‘controlled study’/de OR ‘randomised controlled’:ti,ab,tt OR ‘randomized controlled’:ti,ab,tt OR ‘control group’:ti,ab,tt OR ‘control groups’:ti,ab,tt)) OR (‘case control*’:ti,ab,tt AND random*:ti,ab,tt NOT (‘randomised controlled’:ti,ab,tt OR ‘randomized controlled’:ti,ab,tt)) OR (‘systematic review’:ti,tt NOT (trial:ti,tt OR study:ti,tt)) OR (nonrandom*:ti,ab,tt NOT random*:ti,ab,tt) OR ‘random field*’:ti,ab,tt OR (‘random cluster’ NEAR/4 sampl*):ti,ab,tt OR (review:ab AND review:it NOT trial:ti,tt) OR (‘we searched’:ab AND (review:ti,tt OR review:it)) OR ‘update review’:ab OR (databases NEAR/5 searched):ab OR ((rat:ti,tt OR rats:ti,tt OR mouse:ti,tt OR mice:ti,tt OR swine:ti,tt OR porcine:ti,tt OR murine:ti,tt OR sheep:ti,tt OR lambs:ti,tt OR pigs:ti,tt OR piglets:ti,tt OR rabbit:ti,tt OR rabbits:ti,tt OR cat:ti,tt OR cats:ti,tt OR dog:ti,tt OR dogs:ti,tt OR cattle:ti,tt OR bovine:ti,tt OR monkey:ti,tt OR monkeys:ti,tt OR trout:ti,tt OR marmoset*:ti,tt) AND ‘animal experiment’/de) OR (‘animal experiment’/de NOT (‘human experiment’/de OR ‘human’/de))) | 5,736,038 |
| #10 | #9 NOT (‘conference abstract’/it OR ‘conference review’/it) | 6590 |
| #9 | #6 AND #7 AND #8 | 7741 |
| #8 | ‘diabetes mellitus’/exp OR diabetes:ab,ti,kw OR diabetic*:ab,ti,kw OR dm2:ab,ti,kw OR niddm:ab,ti,kw OR ‘dm 2’:ab,ti,kw OR t2d*:ab,ti,kw OR ‘dm type 2’:ab,ti,kw OR ‘dm type II’:ab,ti,kw OR dm1:ab,ti,kw OR iddm:ab,ti,kw OR ‘dm 1’:ab,ti,kw OR t1d*:ab,ti,kw OR ‘dm type 1’:ab,ti,kw OR ‘dm type I’:ab,ti,kw | 1,536,278 |
| #7 | ‘antiinfective agent’/exp OR antibacterial*:ab,ti,kw OR (anti NEXT/1 bacterial*):ab,ti,kw OR antibiotic*:ab,ti,kw OR acedapson*:ab,ti,kw OR aconiazide*:ab,ti,kw OR actinonin*:ab,ti,kw OR actinorhodin*:ab,ti,kw OR alamethicin*:ab,ti,kw OR albomycin*:ab,ti,kw OR amdinocillin*:ab,ti,kw OR amifloxacin*:ab,ti,kw OR amikacin*:ab,ti,kw OR (aminosalicylic NEXT/1 acid*):ab,ti,kw OR amoxicillin*:ab,ti,kw OR amphomycin*:ab,ti,kw OR (amphotericin NEXT/1 b):ab,ti,kw OR ampicillin*:ab,ti,kw OR amprenavir*:ab,ti,kw OR angustmycin*:ab,ti,kw OR anisomycin*:ab,ti,kw OR antimycin*:ab,ti,kw OR antofloxacin*:ab,ti,kw OR apramycin*:ab,ti,kw OR arsphenamin*:ab,ti,kw OR aurodox:ab,ti,kw OR avibactam*:ab,ti,kw OR avilamycin*:ab,ti,kw OR azithromycin*:ab,ti,kw OR azlocillin*:ab,ti,kw OR aztreonam*:ab,ti,kw OR bacampicillin*:ab,ti,kw OR bacitracin*:ab,ti,kw OR bacteriocins*:ab,ti,kw OR balofloxacin*:ab,ti,kw OR bambermycins*:ab,ti,kw OR bedaquilin*:ab,ti,kw OR bekanamycin*:ab,ti,kw OR (benzathine NEXT/1 cloxacillin*):ab,ti,kw OR berythromycin*:ab,ti,kw OR (beta NEXT/1 lactam*):ab,ti,kw OR bialaphos*:ab,ti,kw OR bicozamycin*:ab,ti,kw OR blasticidin*:ab,ti,kw OR (bongkrekic NEXT/1 acid*):ab,ti,kw OR bredinin*:ab,ti,kw OR brefeldin*:ab,ti,kw OR broadcillin*:ab,ti,kw OR brobactam*:ab,ti,kw OR (butirosin NEXT/1 sulfate*):ab,ti,kw OR cactinomycin*:ab,ti,kw OR calcimycin*:ab,ti,kw OR candicidin*:ab,ti,kw OR capreomycin*:ab,ti,kw OR carbenicillin*:ab,ti,kw OR carfecillin*:ab,ti,kw OR cefaclor*:ab,ti,kw OR cefadroxil*:ab,ti,kw OR cefamandol*:ab,ti,kw OR cefatrizin*:ab,ti,kw OR cefazedon*:ab,ti,kw OR cefazolin*:ab,ti,kw OR cefdinir*:ab,ti,kw OR cefditoren*:ab,ti,kw OR cefepim*:ab,ti,kw OR cefetamet*:ab,ti,kw OR cefiderocol*:ab,ti,kw OR cefixim*:ab,ti,kw OR cefmenoxim*:ab,ti,kw OR cefmetazole*:ab,ti,kw OR cefminox*:ab,ti,kw OR cefodizim*:ab,ti,kw OR cefonicid*:ab,ti,kw OR cefoperazon*:ab,ti,kw OR ceforanide*:ab,ti,kw OR cefoselis*:ab,ti,kw OR cefotaxim*:ab,ti,kw OR cefotetan*:ab,ti,kw OR cefotiam*:ab,ti,kw OR cefoxitin*:ab,ti,kw OR cefpimizol*:ab,ti,kw OR cefpiramid*:ab,ti,kw OR cefpirom*:ab,ti,kw OR cefpodoxim*:ab,ti,kw OR cefprozil*:ab,ti,kw OR cefsulodin*:ab,ti,kw OR ceftarolin*:ab,ti,kw OR ceftazidim*:ab,ti,kw OR (cefteram NEXT/1 pivoxil*):ab,ti,kw OR ceftezol*:ab,ti,kw OR ceftibuten*:ab,ti,kw OR ceftiofur*:ab,ti,kw OR ceftizoxim*:ab,ti,kw OR ceftobiprole*:ab,ti,kw OR ceftolozan*:ab,ti,kw OR ceftriaxon*:ab,ti,kw OR cefuroxim*:ab,ti,kw OR (cefuroxime NEXT/1 axetil*):ab,ti,kw OR cephacetrile*:ab,ti,kw OR cephalexin*:ab,ti,kw OR cephaloglycin*:ab,ti,kw OR cephaloridin*:ab,ti,kw OR cephalosporin*:ab,ti,kw OR cephalothin*:ab,ti,kw OR cephamycin*:ab,ti,kw OR cephapirin*:ab,ti,kw OR cephradin*:ab,ti,kw OR cethromycin*:ab,ti,kw OR chelerythrin*:ab,ti,kw OR chloramphenicol*:ab,ti,kw OR chloroxin*:ab,ti,kw OR chlortetracyclin*:ab,ti,kw OR ciprofloxacin*:ab,ti,kw OR citrinin*:ab,ti,kw OR clarithromycin*:ab,ti,kw OR (clavulanic NEXT/1 acid*):ab,ti,kw OR clinafloxacin*:ab,ti,kw OR clindamycin*:ab,ti,kw OR clofazimin*:ab,ti,kw OR cloxacillin*:ab,ti,kw OR colistin*:ab,ti,kw OR cotrim*:ab,ti,kw OR cyclacillin*:ab,ti,kw OR cycloserin*:ab,ti,kw OR dactinomycin*:ab,ti,kw OR dalbavancin*:ab,ti,kw OR dalfopristin*:ab,ti,kw OR dapson*:ab,ti,kw OR daptomycin*:ab,ti,kw OR decamethoxin*:ab,ti,kw OR demeclocyclin*:ab,ti,kw OR (desoxyfructo NEXT/1 serotonin*):ab,ti,kw OR diarylquinolin*:ab,ti,kw OR dibekacin*:ab,ti,kw OR dicloxacillin*:ab,ti,kw OR (dihydrostreptomycin NEXT/1 sulfate*):ab,ti,kw OR diketopiperazin*:ab,ti,kw OR dirithromycin*:ab,ti,kw OR distamycin*:ab,ti,kw OR diucifon*:ab,ti,kw OR doripenem*:ab,ti,kw OR doxycyclin*:ab,ti,kw OR (dynemicin NEXT/1 a):ab,ti,kw OR echinomycin*:ab,ti,kw OR edein*:ab,ti,kw OR efrotomycin*:ab,ti,kw OR emiglitate*:ab,ti,kw OR enoxacin*:ab,ti,kw OR enviomycin*:ab,ti,kw OR epicillin*:ab,ti,kw OR eravacyclin*:ab,ti,kw OR ertapenem*:ab,ti,kw OR erythromycin*:ab,ti,kw OR ethambutol*:ab,ti,kw OR ethionamid*:ab,ti,kw OR fidaxomicin*:ab,ti,kw OR filipin*:ab,ti,kw OR florfenicol*:ab,ti,kw OR floxacillin*:ab,ti,kw OR flucloxacillin*:ab,ti,kw OR fluoroquinolon*:ab,ti,kw OR forphenicinol*:ab,ti,kw OR fosfomycin*:ab,ti,kw OR framycetin*:ab,ti,kw OR fumagillin*:ab,ti,kw OR fusafungin*:ab,ti,kw OR (fusidic NEXT/1 acid*):ab,ti,kw OR gamithromycin*:ab,ti,kw OR garenoxacin*:ab,ti,kw OR gatifloxacin*:ab,ti,kw OR gemifloxacin*:ab,ti,kw OR gentamicin*:ab,ti,kw OR gramicidin*:ab,ti,kw OR grepafloxacin*:ab,ti,kw OR herbimycin*:ab,ti,kw OR (hygromycin NEXT/1 b):ab,ti,kw OR imipenem*:ab,ti,kw OR immunomycin*:ab,ti,kw OR (isatoic NEXT/1 anhydride*):ab,ti,kw OR isepamicin*:ab,ti,kw OR isoniazid*:ab,ti,kw OR izumenolid*:ab,ti,kw OR josamycin*:ab,ti,kw OR kanamycin*:ab,ti,kw OR kitasamycin*:ab,ti,kw OR lactacystin*:ab,ti,kw OR lactam*:ab,ti,kw OR (lacticin NEXT/1 481):ab,ti,kw OR (lactoferricin NEXT/1 b):ab,ti,kw OR lasalocid*:ab,ti,kw OR leucomycin*:ab,ti,kw OR levofloxacin*:ab,ti,kw OR lincomycin*:ab,ti,kw OR lincosamid*:ab,ti,kw OR linezolid*:ab,ti,kw OR lomefloxacin*:ab,ti,kw OR loracarbef*:ab,ti,kw OR lucensomycin*:ab,ti,kw OR (lydiamycin NEXT/1 a):ab,ti,kw OR lymecyclin*:ab,ti,kw OR maduramicin*:ab,ti,kw OR maltotetraos*:ab,ti,kw OR manoalid*:ab,ti,kw OR manumycin*:ab,ti,kw OR marbofloxacin*:ab,ti,kw OR meclocyclin*:ab,ti,kw OR mepartricin*:ab,ti,kw OR meropenem*:ab,ti,kw OR methacyclin*:ab,ti,kw OR methampicillin*:ab,ti,kw OR methicillin*:ab,ti,kw OR metronidazol*:ab,ti,kw OR mevastatin*:ab,ti,kw OR mezlocillin*:ab,ti,kw OR micronomicin*:ab,ti,kw OR midecamycin*:ab,ti,kw OR mikamycin*:ab,ti,kw OR minocyclin*:ab,ti,kw OR miocamycin*:ab,ti,kw OR mirincamycin*:ab,ti,kw OR mocimycin*:ab,ti,kw OR moxalactam*:ab,ti,kw OR moxifloxacin*:ab,ti,kw OR (muconomycin NEXT/1 a):ab,ti,kw OR mupirocin*:ab,ti,kw OR mycobacillin*:ab,ti,kw OR nadifloxacin*:ab,ti,kw OR nafcillin*:ab,ti,kw OR (nalidixic NEXT/1 acid*):ab,ti,kw OR narasin*:ab,ti,kw OR natamycin*:ab,ti,kw OR nebacetin*:ab,ti,kw OR nebramycin*:ab,ti,kw OR nebularin*:ab,ti,kw OR neomycin*:ab,ti,kw OR netilmicin*:ab,ti,kw OR netropsin*:ab,ti,kw OR nigericin*:ab,ti,kw OR nisin:ab,ti,kw OR nitrofurantoin*:ab,ti,kw OR nojirimycin*:ab,ti,kw OR norfloxacin*:ab,ti,kw OR novobiocin*:ab,ti,kw OR nystatin*:ab,ti,kw OR ofloxacin*:ab,ti,kw OR oleandomycin*:ab,ti,kw OR oligomycin*:ab,ti,kw OR oxacillin*:ab,ti,kw OR oxetanocin*:ab,ti,kw OR (oxolinic NEXT/1 acid*):ab,ti,kw OR oxytetracyclin*:ab,ti,kw OR (panipenem NEXT/1 betamipron*):ab,ti,kw OR paromomycin*:ab,ti,kw OR pazufloxacin*:ab,ti,kw OR pediocin*:ab,ti,kw OR pefloxacin*:ab,ti,kw OR penicill*:ab,ti,kw OR penimepicyclin*:ab,ti,kw OR phenethicillin*:ab,ti,kw OR phosphoramidon*:ab,ti,kw OR (piericidin NEXT/1 a):ab,ti,kw OR (pipemidic NEXT/1 acid*):ab,ti,kw OR piperacillin*:ab,ti,kw OR pivampicillin*:ab,ti,kw OR plazomycin*:ab,ti,kw OR pluracidomycin*:ab,ti,kw OR polymyxins*:ab,ti,kw OR polyoxorim*:ab,ti,kw OR pristinamycin*:ab,ti,kw OR prodigiosin*:ab,ti,kw OR propicillin*:ab,ti,kw OR prothionamid*:ab,ti,kw OR prulifloxacin*:ab,ti,kw OR pyrazinamid*:ab,ti,kw OR pyrazofurin*:ab,ti,kw OR quinupristin*:ab,ti,kw OR radezolid*:ab,ti,kw OR ramoplanin*:ab,ti,kw OR ribostamycin*:ab,ti,kw OR rifabutin*:ab,ti,kw OR rifamexil*:ab,ti,kw OR rifampin*:ab,ti,kw OR rifamycins*:ab,ti,kw OR rifapentin*:ab,ti,kw OR rifaximin*:ab,ti,kw OR ristocetin*:ab,ti,kw OR rolitetracyclin*:ab,ti,kw OR roxarson*:ab,ti,kw OR roxithromycin*:ab,ti,kw OR rutamycin*:ab,ti,kw OR (saframycin NEXT/1 a):ab,ti,kw OR salinomycin*:ab,ti,kw OR sangivamycin*:ab,ti,kw OR sirolimus:ab,ti,kw OR sisomicin*:ab,ti,kw OR sitafloxacin*:ab,ti,kw OR (sodium NEXT/1 thiosulfat*):ab,ti,kw OR sparfloxacin*:ab,ti,kw OR spectinomycin*:ab,ti,kw OR spiramycin*:ab,ti,kw OR squalamin*:ab,ti,kw OR staphylococcin*:ab,ti,kw OR stigmatellin*:ab,ti,kw OR streptogramin*:ab,ti,kw OR streptomycin*:ab,ti,kw OR streptovaricin*:ab,ti,kw OR sulbactam*:ab,ti,kw OR sulbenicillin*:ab,ti,kw OR sulfadiazin*:ab,ti,kw OR sulfaguanol*:ab,ti,kw OR sulfamerazin*:ab,ti,kw OR sulfameter*:ab,ti,kw OR sulfamethoxazol*:ab,ti,kw OR sulfamethoxypyridazin*:ab,ti,kw OR sulfanilamid*:ab,ti,kw OR sultamicillin*:ab,ti,kw OR suncillin*:ab,ti,kw OR syringomycin*:ab,ti,kw OR talampicillin*:ab,ti,kw OR tazobactam*:ab,ti,kw OR tedizolid*:ab,ti,kw OR teicoplanin*:ab,ti,kw OR telavancin*:ab,ti,kw OR telithromycin*:ab,ti,kw OR temafloxacin*:ab,ti,kw OR temocillin*:ab,ti,kw OR tetarimycin*:ab,ti,kw OR tetracenomycin*:ab,ti,kw OR tetracyclin*:ab,ti,kw OR thalidomid*:ab,ti,kw OR thiamphenicol*:ab,ti,kw OR thienamycin*:ab,ti,kw OR thienamycin*:ab,ti,kw OR thioacetazon*:ab,ti,kw OR thiobenzamid*:ab,ti,kw OR thiocarlid*:ab,ti,kw OR thiolactomycin*:ab,ti,kw OR (thiomandelic NEXT/1 acid*):ab,ti,kw OR thiostrepton*:ab,ti,kw OR thymopoietin*:ab,ti,kw OR tiamulin*:ab,ti,kw OR ticarcillin*:ab,ti,kw OR tigecyclin*:ab,ti,kw OR tilmicosin*:ab,ti,kw OR tobramycin*:ab,ti,kw OR tomaymycin*:ab,ti,kw OR torezolid*:ab,ti,kw OR trimethoprim*:ab,ti,kw OR (triostin NEXT/1 a):ab,ti,kw OR troleandomycin*:ab,ti,kw OR tunicamycin*:ab,ti,kw OR tylosin*:ab,ti,kw OR tyrocidin*:ab,ti,kw OR tyrothricin*:ab,ti,kw OR ubenimex:ab,ti,kw OR ulifloxacin*:ab,ti,kw OR undecylprodigiosin*:ab,ti,kw OR vaborbactam*:ab,ti,kw OR valinomycin*:ab,ti,kw OR vancomycin*:ab,ti,kw OR (vernamycin NEXT/1 b):ab,ti,kw OR viomycin*:ab,ti,kw OR virginiamycin*:ab,ti,kw | 5,231,602 |
| #6 | #4 OR #5 | 43,200 |
| #5 | ‘diabetic foot’/exp OR ‘diabetic foot infection’/exp OR ‘diabetic foot osteomyelitis’/exp OR ‘diabetic foot ulcer’/exp OR ‘diabet* foot’:ab,ti,kw OR ‘diabet* feet’:ab,ti,kw OR ‘diabet* ulcer*’:ab,ti,kw OR ‘diabet* wound*’:ab,ti,kw | 28,565 |
| #4 | (#1 AND #2) OR #3 | 17,579 |
| #3 | ((‘foot bone’/exp OR metatarsal:ab,ti,kw OR tarsal:ab,ti,kw OR cuneiform:ab,ti,kw OR cuboid:ab,ti,kw OR navicular*:ab,ti,kw OR calcaneus:ab,ti,kw OR talus:ab,ti,kw) AND (‘osteitis’/de OR ‘osteomyelitis’/exp OR ‘osteomyelitis therapy’/exp OR ‘osteomyelitis diagnosis’/exp OR osteomyelit*:ab,ti,kw OR osteitis:ab,ti,kw OR ostitis:ab,ti,kw OR ‘infection’/de OR ‘inflammation’/de OR infect*:ab,ti,kw OR inflam*:ab,ti,kw)) | 5598 |
| #2 | ‘foot’/exp OR ‘amputation stump’/exp OR foot:ab,ti,kw OR feet:ab,ti,kw OR forefoot:ab,ti,kw OR metatarsus:ab,ti,kw OR toe:ab,ti,kw OR toes:ab,ti,kw OR hallux:ab,ti,kw OR tarsus:ab,ti,kw OR heel:ab,ti,kw OR ‘lower extremit*’:ab,ti,kw OR ankle:ab,ti,kw OR ankles:ab,ti,kw OR ‘amputation stump*’:ab,ti,kw | 413,453 |
| #1 | ‘osteitis’/de OR ‘osteomyelitis’/exp OR ‘osteomyelitis therapy’/exp OR ‘osteomyelitis diagnosis’/exp OR osteomyelit*:ab,ti,kw OR osteitis:ab,ti,kw OR ostitis:ab,ti,kw OR ((‘bone’/de OR ‘bones of the leg and foot’/exp OR bone:ab,ti,kw OR bones:ab,ti,kw OR osseous:ab,ti,kw OR osseus:ab,ti,kw) AND (‘infection’/de OR ‘inflammation’/de OR infect*:ab,ti,kw OR inflam*:ab,ti,kw)) | 249,457 |
| Wiley/Cochrane Library Session Results (19 January 2024) | ||
| Search | Query | Items Found |
| #10 | #7 AND #8 AND #9 | 422 |
| #9 | [mh “diabetes mellitus”] OR diabetes:ab,ti,kw OR diabetic*:ab,ti,kw OR dm2:ab,ti,kw OR niddm:ab,ti,kw OR (dm NEXT 2):ab,ti,kw OR t2d*:ab,ti,kw OR (dm NEXT type NEXT 2):ab,ti,kw OR (dm NEXT type NEXT II):ab,ti,kw OR dm1:ab,ti,kw OR iddm:ab,ti,kw OR (dm NEXT 1):ab,ti,kw OR t1d*:ab,ti,kw OR (dm NEXT type NEXT 1):ab,ti,kw OR (dm NEXT type NEXT I):ab,ti,kw | 120,266 |
| #8 | [mh ^”Anti-Infective Agents”] OR [mh “Anti-Bacterial Agents”] OR [mh Penicillins] OR [mh Trimethoprim] OR [mh Sulfamethoxazole] OR antibacterial*:ab,ti,kw OR (anti NEXT bacterial*):ab,ti,kw OR (anti NEXT therap*):ab,ti,kw OR antibiotic*:ab,ti,kw OR acedapson*:ab,ti,kw OR aconiazide*:ab,ti,kw OR actinonin*:ab,ti,kw OR actinorhodin*:ab,ti,kw OR alamethicin*:ab,ti,kw OR albomycin*:ab,ti,kw OR amdinocillin*:ab,ti,kw OR amifloxacin*:ab,ti,kw OR amikacin*:ab,ti,kw OR (aminosalicylic NEXT acid*):ab,ti,kw OR amoxicillin*:ab,ti,kw OR amphomycin*:ab,ti,kw OR (amphotericin NEXT b):ab,ti,kw OR ampicillin*:ab,ti,kw OR amprenavir*:ab,ti,kw OR angustmycin*:ab,ti,kw OR anisomycin*:ab,ti,kw OR antimycin*:ab,ti,kw OR antofloxacin*:ab,ti,kw OR apramycin*:ab,ti,kw OR arsphenamin*:ab,ti,kw OR aurodox:ab,ti,kw OR avibactam*:ab,ti,kw OR avilamycin*:ab,ti,kw OR azithromycin*:ab,ti,kw OR azlocillin*:ab,ti,kw OR aztreonam*:ab,ti,kw OR bacampicillin*:ab,ti,kw OR bacitracin*:ab,ti,kw OR bacteriocins*:ab,ti,kw OR balofloxacin*:ab,ti,kw OR bambermycins*:ab,ti,kw OR bedaquilin*:ab,ti,kw OR bekanamycin*:ab,ti,kw OR (benzathine NEXT cloxacillin*):ab,ti,kw OR berythromycin*:ab,ti,kw OR (beta NEXT lactam*):ab,ti,kw OR bialaphos*:ab,ti,kw OR bicozamycin*:ab,ti,kw OR blasticidin*:ab,ti,kw OR (bongkrekic NEXT acid*):ab,ti,kw OR bredinin*:ab,ti,kw OR brefeldin*:ab,ti,kw OR broadcillin*:ab,ti,kw OR brobactam*:ab,ti,kw OR (butirosin NEXT sulfate*):ab,ti,kw OR cactinomycin*:ab,ti,kw OR calcimycin*:ab,ti,kw OR candicidin*:ab,ti,kw OR capreomycin*:ab,ti,kw OR carbenicillin*:ab,ti,kw OR carfecillin*:ab,ti,kw OR cefaclor*:ab,ti,kw OR cefadroxil*:ab,ti,kw OR cefamandol*:ab,ti,kw OR cefatrizin*:ab,ti,kw OR cefazedon*:ab,ti,kw OR cefazolin*:ab,ti,kw OR cefdinir*:ab,ti,kw OR cefditoren*:ab,ti,kw OR cefepim*:ab,ti,kw OR cefetamet*:ab,ti,kw OR cefiderocol*:ab,ti,kw OR cefixim*:ab,ti,kw OR cefmenoxim*:ab,ti,kw OR cefmetazole*:ab,ti,kw OR cefminox*:ab,ti,kw OR cefodizim*:ab,ti,kw OR cefonicid*:ab,ti,kw OR cefoperazon*:ab,ti,kw OR ceforanide*:ab,ti,kw OR cefoselis*:ab,ti,kw OR cefotaxim*:ab,ti,kw OR cefotetan*:ab,ti,kw OR cefotiam*:ab,ti,kw OR cefoxitin*:ab,ti,kw OR cefpimizol*:ab,ti,kw OR cefpiramid*:ab,ti,kw OR cefpirom*:ab,ti,kw OR cefpodoxim*:ab,ti,kw OR cefprozil*:ab,ti,kw OR cefsulodin*:ab,ti,kw OR ceftarolin*:ab,ti,kw OR ceftazidim*:ab,ti,kw OR (cefteram NEXT pivoxil*):ab,ti,kw OR ceftezol*:ab,ti,kw OR ceftibuten*:ab,ti,kw OR ceftiofur*:ab,ti,kw OR ceftizoxim*:ab,ti,kw OR ceftobiprole*:ab,ti,kw OR ceftolozan*:ab,ti,kw OR ceftriaxon*:ab,ti,kw OR cefuroxim*:ab,ti,kw OR (cefuroxime NEXT axetil*):ab,ti,kw OR cephacetrile*:ab,ti,kw OR cephalexin*:ab,ti,kw OR cephaloglycin*:ab,ti,kw OR cephaloridin*:ab,ti,kw OR cephalosporin*:ab,ti,kw OR cephalothin*:ab,ti,kw OR cephamycin*:ab,ti,kw OR cephapirin*:ab,ti,kw OR cephradin*:ab,ti,kw OR cethromycin*:ab,ti,kw OR chelerythrin*:ab,ti,kw OR chloramphenicol*:ab,ti,kw OR chloroxin*:ab,ti,kw OR chlortetracyclin*:ab,ti,kw OR ciprofloxacin*:ab,ti,kw OR citrinin*:ab,ti,kw OR clarithromycin*:ab,ti,kw OR (clavulanic NEXT acid*):ab,ti,kw OR clinafloxacin*:ab,ti,kw OR clindamycin*:ab,ti,kw OR clofazimin*:ab,ti,kw OR cloxacillin*:ab,ti,kw OR colistin*:ab,ti,kw OR cotrim*:ab,ti,kw OR cyclacillin*:ab,ti,kw OR cycloserin*:ab,ti,kw OR dactinomycin*:ab,ti,kw OR dalbavancin*:ab,ti,kw OR dalfopristin*:ab,ti,kw OR dapson*:ab,ti,kw OR daptomycin*:ab,ti,kw OR decamethoxin*:ab,ti,kw OR demeclocyclin*:ab,ti,kw OR (desoxyfructo NEXT serotonin*):ab,ti,kw OR diarylquinolin*:ab,ti,kw OR dibekacin*:ab,ti,kw OR dicloxacillin*:ab,ti,kw OR (dihydrostreptomycin NEXT sulfate*):ab,ti,kw OR diketopiperazin*:ab,ti,kw OR dirithromycin*:ab,ti,kw OR distamycin*:ab,ti,kw OR diucifon*:ab,ti,kw OR doripenem*:ab,ti,kw OR doxycyclin*:ab,ti,kw OR (dynemicin NEXT a):ab,ti,kw OR echinomycin*:ab,ti,kw OR edein*:ab,ti,kw OR efrotomycin*:ab,ti,kw OR emiglitate*:ab,ti,kw OR enoxacin*:ab,ti,kw OR enviomycin*:ab,ti,kw OR epicillin*:ab,ti,kw OR eravacyclin*:ab,ti,kw OR ertapenem*:ab,ti,kw OR erythromycin*:ab,ti,kw OR ethambutol*:ab,ti,kw OR ethionamid*:ab,ti,kw OR fidaxomicin*:ab,ti,kw OR filipin*:ab,ti,kw OR florfenicol*:ab,ti,kw OR floxacillin*:ab,ti,kw OR flucloxacillin*:ab,ti,kw OR fluoroquinolon*:ab,ti,kw OR forphenicinol*:ab,ti,kw OR fosfomycin*:ab,ti,kw OR framycetin*:ab,ti,kw OR fumagillin*:ab,ti,kw OR fusafungin*:ab,ti,kw OR (fusidic NEXT acid*):ab,ti,kw OR gamithromycin*:ab,ti,kw OR garenoxacin*:ab,ti,kw OR gatifloxacin*:ab,ti,kw OR gemifloxacin*:ab,ti,kw OR gentamicin*:ab,ti,kw OR gramicidin*:ab,ti,kw OR grepafloxacin*:ab,ti,kw OR herbimycin*:ab,ti,kw OR (hygromycin NEXT b):ab,ti,kw OR imipenem*:ab,ti,kw OR immunomycin*:ab,ti,kw OR (isatoic NEXT anhydride*):ab,ti,kw OR isepamicin*:ab,ti,kw OR isoniazid*:ab,ti,kw OR izumenolid*:ab,ti,kw OR josamycin*:ab,ti,kw OR kanamycin*:ab,ti,kw OR kitasamycin*:ab,ti,kw OR lactacystin*:ab,ti,kw OR lactam*:ab,ti,kw OR (lacticin NEXT 481):ab,ti,kw OR (lactoferricin NEXT b):ab,ti,kw OR lasalocid*:ab,ti,kw OR leucomycin*:ab,ti,kw OR levofloxacin*:ab,ti,kw OR lincomycin*:ab,ti,kw OR lincosamid*:ab,ti,kw OR linezolid*:ab,ti,kw OR lomefloxacin*:ab,ti,kw OR loracarbef*:ab,ti,kw OR lucensomycin*:ab,ti,kw OR (lydiamycin NEXT a):ab,ti,kw OR lymecyclin*:ab,ti,kw OR maduramicin*:ab,ti,kw OR maltotetraos*:ab,ti,kw OR manoalid*:ab,ti,kw OR manumycin*:ab,ti,kw OR marbofloxacin*:ab,ti,kw OR meclocyclin*:ab,ti,kw OR mepartricin*:ab,ti,kw OR meropenem*:ab,ti,kw OR methacyclin*:ab,ti,kw OR methampicillin*:ab,ti,kw OR methicillin*:ab,ti,kw OR metronidazol*:ab,ti,kw OR mevastatin*:ab,ti,kw OR mezlocillin*:ab,ti,kw OR micronomicin*:ab,ti,kw OR midecamycin*:ab,ti,kw OR mikamycin*:ab,ti,kw OR minocyclin*:ab,ti,kw OR miocamycin*:ab,ti,kw OR mirincamycin*:ab,ti,kw OR mocimycin*:ab,ti,kw OR moxalactam*:ab,ti,kw OR moxifloxacin*:ab,ti,kw OR (muconomycin NEXT a):ab,ti,kw OR mupirocin*:ab,ti,kw OR mycobacillin*:ab,ti,kw OR nadifloxacin*:ab,ti,kw OR nafcillin*:ab,ti,kw OR (nalidixic NEXT acid*):ab,ti,kw OR narasin*:ab,ti,kw OR natamycin*:ab,ti,kw OR nebacetin*:ab,ti,kw OR nebramycin*:ab,ti,kw OR nebularin*:ab,ti,kw OR neomycin*:ab,ti,kw OR netilmicin*:ab,ti,kw OR netropsin*:ab,ti,kw OR nigericin*:ab,ti,kw OR nisin:ab,ti,kw OR nitrofurantoin*:ab,ti,kw OR nojirimycin*:ab,ti,kw OR norfloxacin*:ab,ti,kw OR novobiocin*:ab,ti,kw OR nystatin*:ab,ti,kw OR ofloxacin*:ab,ti,kw OR oleandomycin*:ab,ti,kw OR oligomycin*:ab,ti,kw OR oxacillin*:ab,ti,kw OR oxetanocin*:ab,ti,kw OR (oxolinic NEXT acid*):ab,ti,kw OR oxytetracyclin*:ab,ti,kw OR (panipenem NEXT betamipron*):ab,ti,kw OR paromomycin*:ab,ti,kw OR pazufloxacin*:ab,ti,kw OR pediocin*:ab,ti,kw OR pefloxacin*:ab,ti,kw OR penicill*:ab,ti,kw OR penimepicyclin*:ab,ti,kw OR phenethicillin*:ab,ti,kw OR phosphoramidon*:ab,ti,kw OR (piericidin NEXT a):ab,ti,kw OR (pipemidic NEXT acid*):ab,ti,kw OR piperacillin*:ab,ti,kw OR pivampicillin*:ab,ti,kw OR plazomycin*:ab,ti,kw OR pluracidomycin*:ab,ti,kw OR polymyxins*:ab,ti,kw OR polyoxorim*:ab,ti,kw OR pristinamycin*:ab,ti,kw OR prodigiosin*:ab,ti,kw OR propicillin*:ab,ti,kw OR prothionamid*:ab,ti,kw OR prulifloxacin*:ab,ti,kw OR pyrazinamid*:ab,ti,kw OR pyrazofurin*:ab,ti,kw OR quinupristin*:ab,ti,kw OR radezolid*:ab,ti,kw OR ramoplanin*:ab,ti,kw OR ribostamycin*:ab,ti,kw OR rifabutin*:ab,ti,kw OR rifamexil*:ab,ti,kw OR rifampin*:ab,ti,kw OR rifamycins*:ab,ti,kw OR rifapentin*:ab,ti,kw OR rifaximin*:ab,ti,kw OR ristocetin*:ab,ti,kw OR rolitetracyclin*:ab,ti,kw OR roxarson*:ab,ti,kw OR roxithromycin*:ab,ti,kw OR rutamycin*:ab,ti,kw OR (saframycin NEXT a):ab,ti,kw OR salinomycin*:ab,ti,kw OR sangivamycin*:ab,ti,kw OR sirolimus:ab,ti,kw OR sisomicin*:ab,ti,kw OR sitafloxacin*:ab,ti,kw OR (sodium NEXT thiosulfat*):ab,ti,kw OR sparfloxacin*:ab,ti,kw OR spectinomycin*:ab,ti,kw OR spiramycin*:ab,ti,kw OR squalamin*:ab,ti,kw OR staphylococcin*:ab,ti,kw OR stigmatellin*:ab,ti,kw OR streptogramin*:ab,ti,kw OR streptomycin*:ab,ti,kw OR streptovaricin*:ab,ti,kw OR sulbactam*:ab,ti,kw OR sulbenicillin*:ab,ti,kw OR sulfadiazin*:ab,ti,kw OR sulfaguanol*:ab,ti,kw OR sulfamerazin*:ab,ti,kw OR sulfameter*:ab,ti,kw OR sulfamethoxazol*:ab,ti,kw OR sulfamethoxypyridazin*:ab,ti,kw OR sulfanilamid*:ab,ti,kw OR sultamicillin*:ab,ti,kw OR suncillin*:ab,ti,kw OR syringomycin*:ab,ti,kw OR talampicillin*:ab,ti,kw OR tazobactam*:ab,ti,kw OR tedizolid*:ab,ti,kw OR teicoplanin*:ab,ti,kw OR telavancin*:ab,ti,kw OR telithromycin*:ab,ti,kw OR temafloxacin*:ab,ti,kw OR temocillin*:ab,ti,kw OR tetarimycin*:ab,ti,kw OR tetracenomycin*:ab,ti,kw OR tetracyclin*:ab,ti,kw OR thalidomid*:ab,ti,kw OR thiamphenicol*:ab,ti,kw OR thienamycin*:ab,ti,kw OR thienamycin*:ab,ti,kw OR thioacetazon*:ab,ti,kw OR thiobenzamid*:ab,ti,kw OR thiocarlid*:ab,ti,kw OR thiolactomycin*:ab,ti,kw OR (thiomandelic NEXT acid*):ab,ti,kw OR thiostrepton*:ab,ti,kw OR thymopoietin*:ab,ti,kw OR tiamulin*:ab,ti,kw OR ticarcillin*:ab,ti,kw OR tigecyclin*:ab,ti,kw OR tilmicosin*:ab,ti,kw OR tobramycin*:ab,ti,kw OR tomaymycin*:ab,ti,kw OR torezolid*:ab,ti,kw OR trimethoprim*:ab,ti,kw OR (triostin NEXT a):ab,ti,kw OR troleandomycin*:ab,ti,kw OR tunicamycin*:ab,ti,kw OR tylosin*:ab,ti,kw OR tyrocidin*:ab,ti,kw OR tyrothricin*:ab,ti,kw OR ubenimex:ab,ti,kw OR ulifloxacin*:ab,ti,kw OR undecylprodigiosin*:ab,ti,kw OR vaborbactam*:ab,ti,kw OR valinomycin*:ab,ti,kw OR vancomycin*:ab,ti,kw OR (vernamycin NEXT b):ab,ti,kw OR viomycin*:ab,ti,kw OR virginiamycin*:ab,ti,kw | 86,838 |
| #7 | #3 OR #4 OR #5 OR #6 | 4470 |
| #6 | ((diabet* next foot) OR (diabet* next feet) OR (diabet* next ulcer*) OR (diabet* next wound*)):ti,ab,kw | 3665 |
| #5 | [mh “Diabetic Foot”] | 1472 |
| #4 | (([mh “Foot Bones”] OR metatarsal:ab,ti,kw OR tarsal:ab,ti,kw OR cuneiform:ab,ti,kw OR cuboid:ab,ti,kw OR navicular*:ab,ti,kw OR calcaneus:ab,ti,kw OR talus:ab,ti,kw) AND ([mh osteomyelitis] OR [mh Osteitis] OR osteomyelit*:ab,ti,kw OR osteitis:ab,ti,kw OR ostitis:ab,ti,kw OR [mh ^Infections] OR [mh ^Inflammation] OR infect*:ab,ti,kw OR inflam*:ab,ti,kw)) | 240 |
| #3 | #1 AND #2 | 903 |
| #2 | [mh Foot] OR [mh “Amputation Stumps”] OR foot:ab,ti,kw OR feet:ab,ti,kw OR forefoot:ab,ti,kw OR metatarsus:ab,ti,kw OR toe:ab,ti,kw OR toes:ab,ti,kw OR hallux:ab,ti,kw OR tarsus:ab,ti,kw OR heel:ab,ti,kw OR (lower NEXT extremit*):ab,ti,kw OR ankle:ab,ti,kw OR ankles:ab,ti,kw OR (amputation NEXT stump*):ab,ti,kw | 40,893 |
| #1 | [mh osteomyelitis] OR [mh Osteitis] OR osteomyelit*:ab,ti,kw OR osteitis:ab,ti,kw OR ostitis:ab,ti,kw OR (( [mh ^” Bone and Bones”] OR [mh “Bones of Lower Extremity”] OR bone:ab,ti,kw OR bones:ab,ti,kw OR osseous:ab,ti,kw OR osseus:ab,ti,kw) AND ([mh ^Infections] OR [mh ^Inflammation] OR infect*:ab,ti,kw OR inflam*:ab,ti,kw)) | 11,612 |
| Ebsco/CINAHL Session Results (19 January 2024) | ||
| Search | Query | Items Found |
| S12 | S10 AND S11 | 131 |
| S11 | (MH randomized controlled trials OR MH double-blind studies OR MH single-blind studies OR MH random assignment OR MH pretest-posttest design OR MH cluster sample OR TI (randomised OR randomized) OR AB (random*) OR TI (trial) OR (MH (sample size) AND AB (assigned OR allocated OR control)) OR MH (placebos) OR PT (randomized controlled trial) OR AB (control W5 group) OR MH (crossover design) OR MH (comparative studies) OR AB (cluster W3 RCT)) NOT ((MH animals+ OR MH animal studies OR TI animal model*) NOT MH human) | 988,125 |
| S10 | S7 AND S8 AND S9 | 1213 |
| S9 | (MH “Diabetes Mellitus+”) OR TI (diabetes OR diabetic* OR dm2 OR niddm OR dm-2 OR t2d* OR dm-type-2 OR dm-type-II OR dm1 OR iddm OR dm-1 OR t1d* OR dm-type-1 OR dm-type-I) OR AB (diabetes OR diabetic* OR dm2 OR niddm OR dm-2 OR t2d* OR dm-type-2 OR dm-type-II OR dm1 OR iddm OR dm-1 OR t1d* OR dm-type-1 OR dm-type-I) OR KW (diabetes OR diabetic* OR dm2 OR niddm OR dm-2 OR t2d* OR dm-type-2 OR dm-type-II OR dm1 OR iddm OR dm-1 OR t1d* OR dm-type-1 OR dm-type-I) | 282,441 |
| S8 | (MH “Antiinfective Agents”) OR (MH “Antibiotics+”) OR (MH “Penicillins+”) OR (MH “Trimethoprim+”) OR (MH “Sulfamethoxazole+”) OR TI (antibacterial* OR anti-bacterial* OR antibiotic* OR acedapson* OR aconiazide* OR actinonin* OR actinorhodin* OR alamethicin* OR albomycin* OR amdinocillin* OR amifloxacin* OR amikacin* OR aminosalicylic acid* OR amoxicillin* OR amphomycin* OR amphotericin-B* OR ampicillin* OR amprenavir* OR angustmycin* OR anisomycin* OR antimycin* OR antofloxacin* OR apramycin* OR arsphenamin* OR aurodox OR avibactam* OR avilamycin* OR azithromycin* OR azlocillin* OR aztreonam* OR bacampicillin* OR bacitracin* OR bacteriocins* OR balofloxacin* OR bambermycins* OR bedaquilin* OR bekanamycin* OR benzathine cloxacillin* OR berythromycin* OR beta-lactam* OR bialaphos* OR bicozamycin* OR blasticidin* OR bongkrekic-Acid* OR bredinin* OR brefeldin* OR broadcillin* OR brobactam* OR butirosin-sulfate* OR cactinomycin* OR calcimycin* OR candicidin* OR capreomycin* OR carbenicillin* OR carfecillin* OR cefaclor* OR cefadroxil* OR cefamandol* OR cefatrizin* OR cefazedon* OR cefazolin* OR cefdinir* OR cefditoren* OR cefepim* OR cefetamet* OR cefiderocol* OR cefixim* OR cefmenoxim* OR cefmetazole* OR cefminox* OR cefodizim* OR cefonicid* OR cefoperazon* OR ceforanide* OR cefoselis* OR cefotaxim* OR cefotetan* OR cefotiam* OR cefoxitin* OR cefpimizol* OR cefpiramid* OR cefpirom* OR cefpodoxim* OR cefprozil* OR cefsulodin* OR ceftarolin* OR ceftazidim* OR cefteram-pivoxil* OR ceftezol* OR ceftibuten* OR ceftiofur* OR ceftizoxim* OR ceftobiprole* OR ceftolozan* OR ceftriaxon* OR cefuroxim* OR cefuroxime-axetil* OR cephacetrile* OR cephalexin* OR cephaloglycin* OR cephaloridin* OR cephalosporin* OR cephalothin* OR cephamycin* OR cephapirin* OR cephradin* OR cethromycin* OR chelerythrin* OR chloramphenicol* OR chloroxin* OR chlortetracyclin* OR ciprofloxacin* OR citrinin* OR clarithromycin* OR clavulanic-acid* OR clinafloxacin* OR clindamycin* OR clofazimin* OR cloxacillin* OR colistin* OR cotrim* OR cyclacillin* OR cycloserin* OR dactinomycin* OR dalbavancin* OR dalfopristin* OR dapson* OR daptomycin* OR decamethoxin* OR demeclocyclin* OR desoxyfructo-serotonin* OR diarylquinolin* OR dibekacin* OR dicloxacillin* OR dihydrostreptomycin-sulfate* OR diketopiperazin* OR dirithromycin* OR distamycin* OR diucifon* OR doripenem* OR doxycyclin* OR dynemicin-a OR echinomycin* OR edein* OR efrotomycin* OR emiglitate* OR enoxacin* OR enviomycin* OR epicillin* OR eravacyclin* OR ertapenem* OR erythromycin* OR ethambutol* OR ethionamid* OR fidaxomicin* OR filipin* OR florfenicol* OR floxacillin* OR flucloxacillin* OR fluoroquinolon* OR forphenicinol* OR fosfomycin* OR framycetin* OR fumagillin* OR fusafungin* OR fusidic-acid* OR gamithromycin* OR garenoxacin* OR gatifloxacin* OR gemifloxacin* OR gentamicin* OR gramicidin* OR grepafloxacin* OR herbimycin* OR hygromycin b OR imipenem* OR immunomycin* OR isatoic-anhydride* OR isepamicin* OR isoniazid* OR izumenolid* OR josamycin* OR kanamycin* OR kitasamycin* OR lactacystin* OR lactam* OR lacticin-481 OR lactoferricin-b OR lasalocid* OR leucomycin* OR levofloxacin* OR lincomycin* OR lincosamid* OR linezolid* OR lomefloxacin* OR loracarbef* OR lucensomycin* OR lydiamycin-a OR lymecyclin* OR maduramicin* OR maltotetraos* OR manoalid* OR manumycin* OR marbofloxacin* OR meclocyclin* OR mepartricin* OR meropenem* OR methacyclin* OR methampicillin* OR methicillin* OR metronidazol* OR mevastatin* OR mezlocillin* OR micronomicin* OR midecamycin* OR mikamycin* OR minocyclin* OR miocamycin* OR mirincamycin* OR mocimycin* OR moxalactam* OR moxifloxacin* OR muconomycin-a OR mupirocin* OR mycobacillin* OR nadifloxacin* OR nafcillin* OR nalidixic-acid* OR narasin* OR natamycin* OR nebacetin* OR nebramycin* OR nebularin* OR neomycin* OR netilmicin* OR netropsin* OR nigericin* OR nisin OR nitrofurantoin* OR nojirimycin* OR norfloxacin* OR novobiocin* OR nystatin* OR ofloxacin* OR oleandomycin* OR oligomycin* OR oxacillin* OR oxetanocin* OR oxolinic acid* OR oxytetracyclin* OR panipenem-betamipron* OR paromomycin* OR pazufloxacin* OR pediocin* OR pefloxacin* OR penicill* OR penimepicyclin* OR phenethicillin* OR phosphoramidon* OR piericidin-a OR pipemidic-acid* OR piperacillin* OR pivampicillin* OR plazomycin* OR pluracidomycin* OR polymyxins* OR polyoxorim* OR pristinamycin* OR prodigiosin* OR propicillin* OR prothionamid* OR prulifloxacin* OR pyrazinamid* OR pyrazofurin* OR quinupristin* OR radezolid* OR ramoplanin* OR ribostamycin* OR rifabutin* OR rifamexil* OR rifampin* OR rifamycins* OR rifapentin* OR rifaximin* OR ristocetin* OR rolitetracyclin* OR roxarson* OR roxithromycin* OR rutamycin* OR saframycin-a OR salinomycin* OR sangivamycin* OR sirolimus OR sisomicin* OR sitafloxacin* OR sodium-thiosulfat* OR sparfloxacin* OR spectinomycin* OR spiramycin* OR squalamin* OR staphylococcin* OR stigmatellin* OR streptogramin* OR streptomycin* OR streptovaricin* OR sulbactam* OR sulbenicillin* OR sulfadiazin* OR sulfaguanol* OR sulfamerazin* OR sulfameter* OR sulfamethoxazol* OR sulfamethoxypyridazin* OR sulfanilamid* OR sultamicillin* OR suncillin* OR syringomycin* OR talampicillin* OR tazobactam* OR tedizolid* OR teicoplanin* OR telavancin* OR telithromycin* OR temafloxacin* OR temocillin* OR tetarimycin* OR tetracenomycin* OR tetracyclin* OR thalidomid* OR thiamphenicol* OR thienamycin* OR thienamycin* OR thioacetazon* OR thiobenzamid* OR thiocarlid* OR thiolactomycin* OR thiomandelic-acid* OR thiostrepton* OR thymopoietin* OR tiamulin* OR ticarcillin* OR tigecyclin* OR tilmicosin* OR tobramycin* OR tomaymycin* OR torezolid* OR trimethoprim* OR triostin-a OR troleandomycin* OR tunicamycin* OR tylosin* OR tyrocidin* OR tyrothricin* OR ubenimex OR ulifloxacin* OR undecylprodigiosin* OR vaborbactam* OR valinomycin* OR vancomycin* OR vernamycin-b OR viomycin* OR virginiamycin*) OR AB (antibacterial* OR anti-bacterial* OR antibiotic* OR acedapson* OR aconiazide* OR actinonin* OR actinorhodin* OR alamethicin* OR albomycin* OR amdinocillin* OR amifloxacin* OR amikacin* OR aminosalicylic acid* OR amoxicillin* OR amphomycin* OR amphotericin-B* OR ampicillin* OR amprenavir* OR angustmycin* OR anisomycin* OR antimycin* OR antofloxacin* OR apramycin* OR arsphenamin* OR aurodox OR avibactam* OR avilamycin* OR azithromycin* OR azlocillin* OR aztreonam* OR bacampicillin* OR bacitracin* OR bacteriocins* OR balofloxacin* OR bambermycins* OR bedaquilin* OR bekanamycin* OR benzathine cloxacillin* OR berythromycin* OR beta-lactam* OR bialaphos* OR bicozamycin* OR blasticidin* OR bongkrekic-Acid* OR bredinin* OR brefeldin* OR broadcillin* OR brobactam* OR butirosin-sulfate* OR cactinomycin* OR calcimycin* OR candicidin* OR capreomycin* OR carbenicillin* OR carfecillin* OR cefaclor* OR cefadroxil* OR cefamandol* OR cefatrizin* OR cefazedon* OR cefazolin* OR cefdinir* OR cefditoren* OR cefepim* OR cefetamet* OR cefiderocol* OR cefixim* OR cefmenoxim* OR cefmetazole* OR cefminox* OR cefodizim* OR cefonicid* OR cefoperazon* OR ceforanide* OR cefoselis* OR cefotaxim* OR cefotetan* OR cefotiam* OR cefoxitin* OR cefpimizol* OR cefpiramid* OR cefpirom* OR cefpodoxim* OR cefprozil* OR cefsulodin* OR ceftarolin* OR ceftazidim* OR cefteram-pivoxil* OR ceftezol* OR ceftibuten* OR ceftiofur* OR ceftizoxim* OR ceftobiprole* OR ceftolozan* OR ceftriaxon* OR cefuroxim* OR cefuroxime-axetil* OR cephacetrile* OR cephalexin* OR cephaloglycin* OR cephaloridin* OR cephalosporin* OR cephalothin* OR cephamycin* OR cephapirin* OR cephradin* OR cethromycin* OR chelerythrin* OR chloramphenicol* OR chloroxin* OR chlortetracyclin* OR ciprofloxacin* OR citrinin* OR clarithromycin* OR clavulanic-acid* OR clinafloxacin* OR clindamycin* OR clofazimin* OR cloxacillin* OR colistin* OR cotrim* OR cyclacillin* OR cycloserin* OR dactinomycin* OR dalbavancin* OR dalfopristin* OR dapson* OR daptomycin* OR decamethoxin* OR demeclocyclin* OR desoxyfructo-serotonin* OR diarylquinolin* OR dibekacin* OR dicloxacillin* OR dihydrostreptomycin-sulfate* OR diketopiperazin* OR dirithromycin* OR distamycin* OR diucifon* OR doripenem* OR doxycyclin* OR dynemicin-a OR echinomycin* OR edein* OR efrotomycin* OR emiglitate* OR enoxacin* OR enviomycin* OR epicillin* OR eravacyclin* OR ertapenem* OR erythromycin* OR ethambutol* OR ethionamid* OR fidaxomicin* OR filipin* OR florfenicol* OR floxacillin* OR flucloxacillin* OR fluoroquinolon* OR forphenicinol* OR fosfomycin* OR framycetin* OR fumagillin* OR fusafungin* OR fusidic-acid* OR gamithromycin* OR garenoxacin* OR gatifloxacin* OR gemifloxacin* OR gentamicin* OR gramicidin* OR grepafloxacin* OR herbimycin* OR hygromycin b OR imipenem* OR immunomycin* OR isatoic-anhydride* OR isepamicin* OR isoniazid* OR izumenolid* OR josamycin* OR kanamycin* OR kitasamycin* OR lactacystin* OR lactam* OR lacticin-481 OR lactoferricin-b OR lasalocid* OR leucomycin* OR levofloxacin* OR lincomycin* OR lincosamid* OR linezolid* OR lomefloxacin* OR loracarbef* OR lucensomycin* OR lydiamycin-a OR lymecyclin* OR maduramicin* OR maltotetraos* OR manoalid* OR manumycin* OR marbofloxacin* OR meclocyclin* OR mepartricin* OR meropenem* OR methacyclin* OR methampicillin* OR methicillin* OR metronidazol* OR mevastatin* OR mezlocillin* OR micronomicin* OR midecamycin* OR mikamycin* OR minocyclin* OR miocamycin* OR mirincamycin* OR mocimycin* OR moxalactam* OR moxifloxacin* OR muconomycin-a OR mupirocin* OR mycobacillin* OR nadifloxacin* OR nafcillin* OR nalidixic-acid* OR narasin* OR natamycin* OR nebacetin* OR nebramycin* OR nebularin* OR neomycin* OR netilmicin* OR netropsin* OR nigericin* OR nisin OR nitrofurantoin* OR nojirimycin* OR norfloxacin* OR novobiocin* OR nystatin* OR ofloxacin* OR oleandomycin* OR oligomycin* OR oxacillin* OR oxetanocin* OR oxolinic acid* OR oxytetracyclin* OR panipenem-betamipron* OR paromomycin* OR pazufloxacin* OR pediocin* OR pefloxacin* OR penicill* OR penimepicyclin* OR phenethicillin* OR phosphoramidon* OR piericidin-a OR pipemidic-acid* OR piperacillin* OR pivampicillin* OR plazomycin* OR pluracidomycin* OR polymyxins* OR polyoxorim* OR pristinamycin* OR prodigiosin* OR propicillin* OR prothionamid* OR prulifloxacin* OR pyrazinamid* OR pyrazofurin* OR quinupristin* OR radezolid* OR ramoplanin* OR ribostamycin* OR rifabutin* OR rifamexil* OR rifampin* OR rifamycins* OR rifapentin* OR rifaximin* OR ristocetin* OR rolitetracyclin* OR roxarson* OR roxithromycin* OR rutamycin* OR saframycin-a OR salinomycin* OR sangivamycin* OR sirolimus OR sisomicin* OR sitafloxacin* OR sodium-thiosulfat* OR sparfloxacin* OR spectinomycin* OR spiramycin* OR squalamin* OR staphylococcin* OR stigmatellin* OR streptogramin* OR streptomycin* OR streptovaricin* OR sulbactam* OR sulbenicillin* OR sulfadiazin* OR sulfaguanol* OR sulfamerazin* OR sulfameter* OR sulfamethoxazol* OR sulfamethoxypyridazin* OR sulfanilamid* OR sultamicillin* OR suncillin* OR syringomycin* OR talampicillin* OR tazobactam* OR tedizolid* OR teicoplanin* OR telavancin* OR telithromycin* OR temafloxacin* OR temocillin* OR tetarimycin* OR tetracenomycin* OR tetracyclin* OR thalidomid* OR thiamphenicol* OR thienamycin* OR thienamycin* OR thioacetazon* OR thiobenzamid* OR thiocarlid* OR thiolactomycin* OR thiomandelic-acid* OR thiostrepton* OR thymopoietin* OR tiamulin* OR ticarcillin* OR tigecyclin* OR tilmicosin* OR tobramycin* OR tomaymycin* OR torezolid* OR trimethoprim* OR triostin-a OR troleandomycin* OR tunicamycin* OR tylosin* OR tyrocidin* OR tyrothricin* OR ubenimex OR ulifloxacin* OR undecylprodigiosin* OR vaborbactam* OR valinomycin* OR vancomycin* OR vernamycin-b OR viomycin* OR virginiamycin*) OR KW (antibacterial* OR anti-bacterial* OR antibiotic* OR acedapson* OR aconiazide* OR actinonin* OR actinorhodin* OR alamethicin* OR albomycin* OR amdinocillin* OR amifloxacin* OR amikacin* OR aminosalicylic acid* OR amoxicillin* OR amphomycin* OR amphotericin-B* OR ampicillin* OR amprenavir* OR angustmycin* OR anisomycin* OR antimycin* OR antofloxacin* OR apramycin* OR arsphenamin* OR aurodox OR avibactam* OR avilamycin* OR azithromycin* OR azlocillin* OR aztreonam* OR bacampicillin* OR bacitracin* OR bacteriocins* OR balofloxacin* OR bambermycins* OR bedaquilin* OR bekanamycin* OR benzathine cloxacillin* OR berythromycin* OR beta-lactam* OR bialaphos* OR bicozamycin* OR blasticidin* OR bongkrekic-Acid* OR bredinin* OR brefeldin* OR broadcillin* OR brobactam* OR butirosin-sulfate* OR cactinomycin* OR calcimycin* OR candicidin* OR capreomycin* OR carbenicillin* OR carfecillin* OR cefaclor* OR cefadroxil* OR cefamandol* OR cefatrizin* OR cefazedon* OR cefazolin* OR cefdinir* OR cefditoren* OR cefepim* OR cefetamet* OR cefiderocol* OR cefixim* OR cefmenoxim* OR cefmetazole* OR cefminox* OR cefodizim* OR cefonicid* OR cefoperazon* OR ceforanide* OR cefoselis* OR cefotaxim* OR cefotetan* OR cefotiam* OR cefoxitin* OR cefpimizol* OR cefpiramid* OR cefpirom* OR cefpodoxim* OR cefprozil* OR cefsulodin* OR ceftarolin* OR ceftazidim* OR cefteram-pivoxil* OR ceftezol* OR ceftibuten* OR ceftiofur* OR ceftizoxim* OR ceftobiprole* OR ceftolozan* OR ceftriaxon* OR cefuroxim* OR cefuroxime-axetil* OR cephacetrile* OR cephalexin* OR cephaloglycin* OR cephaloridin* OR cephalosporin* OR cephalothin* OR cephamycin* OR cephapirin* OR cephradin* OR cethromycin* OR chelerythrin* OR chloramphenicol* OR chloroxin* OR chlortetracyclin* OR ciprofloxacin* OR citrinin* OR clarithromycin* OR clavulanic-acid* OR clinafloxacin* OR clindamycin* OR clofazimin* OR cloxacillin* OR colistin* OR cotrim* OR cyclacillin* OR cycloserin* OR dactinomycin* OR dalbavancin* OR dalfopristin* OR dapson* OR daptomycin* OR decamethoxin* OR demeclocyclin* OR desoxyfructo-serotonin* OR diarylquinolin* OR dibekacin* OR dicloxacillin* OR dihydrostreptomycin-sulfate* OR diketopiperazin* OR dirithromycin* OR distamycin* OR diucifon* OR doripenem* OR doxycyclin* OR dynemicin-a OR echinomycin* OR edein* OR efrotomycin* OR emiglitate* OR enoxacin* OR enviomycin* OR epicillin* OR eravacyclin* OR ertapenem* OR erythromycin* OR ethambutol* OR ethionamid* OR fidaxomicin* OR filipin* OR florfenicol* OR floxacillin* OR flucloxacillin* OR fluoroquinolon* OR forphenicinol* OR fosfomycin* OR framycetin* OR fumagillin* OR fusafungin* OR fusidic-acid* OR gamithromycin* OR garenoxacin* OR gatifloxacin* OR gemifloxacin* OR gentamicin* OR gramicidin* OR grepafloxacin* OR herbimycin* OR hygromycin b OR imipenem* OR immunomycin* OR isatoic-anhydride* OR isepamicin* OR isoniazid* OR izumenolid* OR josamycin* OR kanamycin* OR kitasamycin* OR lactacystin* OR lactam* OR lacticin-481 OR lactoferricin-b OR lasalocid* OR leucomycin* OR levofloxacin* OR lincomycin* OR lincosamid* OR linezolid* OR lomefloxacin* OR loracarbef* OR lucensomycin* OR lydiamycin-a OR lymecyclin* OR maduramicin* OR maltotetraos* OR manoalid* OR manumycin* OR marbofloxacin* OR meclocyclin* OR mepartricin* OR meropenem* OR methacyclin* OR methampicillin* OR methicillin* OR metronidazol* OR mevastatin* OR mezlocillin* OR micronomicin* OR midecamycin* OR mikamycin* OR minocyclin* OR miocamycin* OR mirincamycin* OR mocimycin* OR moxalactam* OR moxifloxacin* OR muconomycin-a OR mupirocin* OR mycobacillin* OR nadifloxacin* OR nafcillin* OR nalidixic-acid* OR narasin* OR natamycin* OR nebacetin* OR nebramycin* OR nebularin* OR neomycin* OR netilmicin* OR netropsin* OR nigericin* OR nisin OR nitrofurantoin* OR nojirimycin* OR norfloxacin* OR novobiocin* OR nystatin* OR ofloxacin* OR oleandomycin* OR oligomycin* OR oxacillin* OR oxetanocin* OR oxolinic acid* OR oxytetracyclin* OR panipenem-betamipron* OR paromomycin* OR pazufloxacin* OR pediocin* OR pefloxacin* OR penicill* OR penimepicyclin* OR phenethicillin* OR phosphoramidon* OR piericidin-a OR pipemidic-acid* OR piperacillin* OR pivampicillin* OR plazomycin* OR pluracidomycin* OR polymyxins* OR polyoxorim* OR pristinamycin* OR prodigiosin* OR propicillin* OR prothionamid* OR prulifloxacin* OR pyrazinamid* OR pyrazofurin* OR quinupristin* OR radezolid* OR ramoplanin* OR ribostamycin* OR rifabutin* OR rifamexil* OR rifampin* OR rifamycins* OR rifapentin* OR rifaximin* OR ristocetin* OR rolitetracyclin* OR roxarson* OR roxithromycin* OR rutamycin* OR saframycin-a OR salinomycin* OR sangivamycin* OR sirolimus OR sisomicin* OR sitafloxacin* OR sodium-thiosulfat* OR sparfloxacin* OR spectinomycin* OR spiramycin* OR squalamin* OR staphylococcin* OR stigmatellin* OR streptogramin* OR streptomycin* OR streptovaricin* OR sulbactam* OR sulbenicillin* OR sulfadiazin* OR sulfaguanol* OR sulfamerazin* OR sulfameter* OR sulfamethoxazol* OR sulfamethoxypyridazin* OR sulfanilamid* OR sultamicillin* OR suncillin* OR syringomycin* OR talampicillin* OR tazobactam* OR tedizolid* OR teicoplanin* OR telavancin* OR telithromycin* OR temafloxacin* OR temocillin* OR tetarimycin* OR tetracenomycin* OR tetracyclin* OR thalidomid* OR thiamphenicol* OR thienamycin* OR thienamycin* OR thioacetazon* OR thiobenzamid* OR thiocarlid* OR thiolactomycin* OR thiomandelic-acid* OR thiostrepton* OR thymopoietin* OR tiamulin* OR ticarcillin* OR tigecyclin* OR tilmicosin* OR tobramycin* OR tomaymycin* OR torezolid* OR trimethoprim* OR triostin-a OR troleandomycin* OR tunicamycin* OR tylosin* OR tyrocidin* OR tyrothricin* OR ubenimex OR ulifloxacin* OR undecylprodigiosin* OR vaborbactam* OR valinomycin* OR vancomycin* OR vernamycin-b OR viomycin* OR virginiamycin*) | 157,339 |
| S7 | S3 OR S4 OR S5 OR S6 | 14,715 |
| S6 | TI (“diabet* foot” OR “diabet* feet” OR “diabet* ulcer*” OR “diabet* wound*”) OR AB (“diabet* foot” OR “diabet* feet” OR “diabet* ulcer*” OR “diabet* wound*”) OR KW (“diabet* foot” OR “diabet* feet” OR “diabet* ulcer*” OR “diabet* wound*”) | 7,937 |
| S5 | (MH “Diabetic Foot”) | 10,516 |
| S4 | (((MH “Foot Bones+”) OR TI (metatarsal OR tarsal OR cuneiform OR cuboid OR navicular* OR calcaneus OR talus) OR AB (metatarsal OR tarsal OR cuneiform OR cuboid OR navicular* OR calcaneus OR talus) OR KW (metatarsal OR tarsal OR cuneiform OR cuboid OR navicular* OR calcaneus OR talus)) AND ((MH “Osteomyelitis”) OR (MH “Osteitis”) OR TI (osteomyelit* OR osteitis OR ostitis OR infect* OR inflam*) OR AB (osteomyelit* OR osteitis OR ostitis OR infect* OR inflam*) OR KW (osteomyelit* OR osteitis OR ostitis OR infect* OR inflam*) OR (MH “Infection”) OR (MH “Inflammation”))) | 1,082 |
| S3 | S1 AND S2 | 2827 |
| S2 | (MH “Foot+”) OR (MH “Amputation Stumps”) OR TI (foot OR feet OR forefoot OR metatarsus OR toe OR toes OR hallux OR tarsus OR heel OR “lower-extremit*” OR ankle OR ankles OR amputation-stump*) OR AB (foot OR feet OR forefoot OR metatarsus OR toe OR toes OR hallux OR tarsus OR heel OR “lower-extremit*” OR ankle OR ankles OR amputation-stump*) OR KW (foot OR feet OR forefoot OR metatarsus OR toe OR toes OR hallux OR tarsus OR heel OR “lower-extremit*” OR ankle OR ankles OR amputation-stump*) | 100,834 |
| S1 | (MH “Osteomyelitis”) OR (MH “Osteitis”) OR TI (osteomyelit* OR osteitis OR ostitis) OR AB (osteomyelit* OR osteitis OR ostitis) OR KW (osteomyelit* OR osteitis OR ostitis) OR (((MH “Bone and Bones”) OR (MH “Foot Bones+”) OR (MH “Leg Bones+”) OR (MH “Pelvic Bones+”) OR TI (bone OR bones OR osseous OR osseus) OR AB (bone OR bones OR osseous OR osseus) OR KW (bone OR bones OR osseous OR osseus)) AND ((MH “Infection”) OR (MH “Inflammation”) OR TI (infect* OR inflam*) OR AB (infect* OR inflam*) OR KW (infect* OR inflam*))) | 25,050 |
| CT.gov Session Results (19 January 2024) | ||
| Search | Query | Items Found |
| #1 | Active, not recruiting Studies | Interventional Studies | diabetic foot ulcer* | 26 |
| ICTRP Session Results (19 January 2024) | ||
| Search | Query | Items Found |
| #1 | Active, not recruiting Studies | Interventional Studies | diabetic foot ulcer* | 63 |
Appendix C
Risk of Bias Assessment.
| Study | Bias in the Randomization Process | Bias from the Intended Intervention (Assignment) | Bias due to Missing Data | Bias in Measurement of Outcomes | Bias in Selection of the Reported Result | Overall Risk of Bias |
|---|---|---|---|---|---|---|
| Tone 2015 [ | Low | Some Concern | Low | Low | Some Concern | Some Concern |
| Rationale for judgement | A computerized random number generator was used to generate random allocation sequences. | No information was provided about deviations from the intended intervention due to the trial context. Participants and caregivers knew the treatment arms, receiving antibiotics for 6 or 12 weeks. The authors did not disclose if the data was analyzed by intention to treat or per protocol and used a superiority design, although the conclusions suggest non-inferiority. | No missing data. | Assessment of the outcomes could have differed between outcome accessors, nevertheless the outcome measures were very well specified, therefore the risk of bias introduced by possible different outcome assessments was deemed low. | There was no prespecified analyses plan. | The overall risk of bias was judged to raise some concerns due to the combination low risk and some concern of bias |
| Gariani 2021 [ | Low | Low | Low | SOME CONCERN | Low | Some Concern |
| Rationale for judgement | The allocation sequence was generated using pre- fabricated sealed envelopes. | Participants and caregivers knew the treatment arms, with participants receiving antibiotics for 3 or 6 weeks. Data are presented for both intention-to-treat and per-protocol analyses. | No missing data. | Obtaining the outcome only two months after treatment may be too soon for all outcomes, such as late clinical failure, need for amputation, and mortality, to become apparent. | There is an analyses section in the protocol. | The overall risk of bias was judged to raise some concerns due to the combination low risk and some concern of bias. |
Low: The study is judged to be at low risk of bias for all domains for this result. Some concern:The study is judged to have some concerns regarding this result in at least one domain. High:The study is judged to be at high risk of bias in at least one domain for this result.
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Abstract
Background: The optimal antimicrobial treatment duration for diabetes-related foot osteomyelitis (DFO) currently needs to be determined. We systematically reviewed the effects of short and long treatment durations on outcomes of DFO. Methods: We performed a systematic review searching Cochrane, CENTRAL, MEDLINE, Embase, and CINAHL Plus from inception up to 19 January 2024. Two independent reviewers screened the titles and abstracts of the studies. Studies comparing short (<6 weeks) and long (>6 weeks) treatment durations for DFO were included. The primary outcome was amputation; the secondary outcomes were remission, mortality, costs, quality of life, and adverse events. Risk of bias and GRADE were assessed. Results: We identified 2708 references, of which 2173 remained after removing duplicates. Two studies were included. Differences in methodology precluded a meta-analysis. The primary outcome, major amputation, was reported in one study, with a rate of 10% in both the intervention and comparison groups (p = 1.00), regardless of treatment duration. For the secondary outcome, remission rates, the first study reported 60% in the intervention group versus 70% in the comparison group (p = 0.50). In the second study, remission rates were 84% in the intervention group versus 78% in the comparison group (p = 0.55). Data for the outcomes mortality, costs, and quality of life were not available. Short treatment duration may lead to fewer adverse events. The risk of bias was assessed as low to moderate, and the level of evidence ranged from very low to moderate. Conclusions: Our findings suggest that for DFO, there is no difference between a shorter and more prolonged duration of antimicrobial treatment regarding amputation and remission, with potentially fewer adverse events with shorter treatment durations. However, the uncertainty stems from limited, heterogeneous studies and generally low-quality evidence marred by moderate biases, imprecision, and indirectness. More high-quality studies are needed to substantiate these findings.
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Details
; Torensma, Bart 2
; Suzanne van Asten 3 ; Sieswerda, Elske 4
; Louise Willy Elizabeth Sabelis 5 ; Martin den Heijer 6 ; de Vries, Ralph 7
; de Groot, Vincent 5 ; Edgar Josephus Gerardus Peters 8
1 Division of Infectious Diseases, Department Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, 1081 HV Amsterdam, The Netherlands; Amsterdam Infection & Immunity, Infectious Diseases, 1081 HV Amsterdam, The Netherlands; Amsterdam UMC Center for Diabetic Foot Complications (ACDC), 1081 HV Amsterdam, The Netherlands
2 Clinical Epidemiologist, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
3 Department of Medical Microbiology, Medical Microbiology, Radboud UMC, 6525 GA Nijmegen, The Netherlands
4 Julius Center for Health Sciences and Primary Care, UMC Utrecht, 3584 CX Utrecht, The Netherlands; Department of Medical Microbiology, UMC Utrecht, 3584 CX Utrecht, The Netherlands
5 Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, 1081 HV Amsterdam, The Netherlands; Amsterdam UMC Center for Diabetic Foot Complications (ACDC), 1081 HV Amsterdam, The Netherlands
6 Division of Endocrinology, Department of Internal Medicine, Academisch Medisch Centrum, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
7 University Library, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
8 Division of Infectious Diseases, Department Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, 1081 HV Amsterdam, The Netherlands; Amsterdam Infection & Immunity, Infectious Diseases, 1081 HV Amsterdam, The Netherlands; Amsterdam UMC Center for Diabetic Foot Complications (ACDC), 1081 HV Amsterdam, The Netherlands