Can procalcitonin predict bone infection in people with diabetes with infected foot ulcers? A pilot study

Aims: The diagnosis of osteomyelitis is a key step of diabetic foot management. Previous studies showed that procalcitonin (PCT), a novel infection marker, is superior to conventional infection markers in the diagnosis of diabetic foot infection. This study aimed to investigate the serum levels of PCT and other conventional infection markers in diabetic persons with and without osteomyelitis. Methods: Twenty-four patients (18 male, mean age: 61.9 +/- 10.8 years) with infected foot ulcers were prospectively enrolled. Clinical characteristics of the wounds were noted. Blood samples were obtained for biochemical analysis. Magnetic resonance imaging of the foot was performed in all patients to diagnose osteomyelitis. Results: Osteomyelitis was found in 13 of 24 (54%) patients. PCT levels were 66.7 +/- 43.5 pg/ml in patients with osteomyelitis and 58.6 +/- 35.5 pg/ml in patients without osteomyelitis. The difference did not reach statistical significance (p = 0.627). Erythrocyte sedimentation rate, but not C-reactive protein and white blood cell count, was found significantly higher in patients with osteomyelitis. Conclusion: In this group of patients, PCT failed to discriminate patients with bone infection. Erythrocyte sedimentation rate can be used as a marker of osteomyelitis in diabetic persons. (C) 2011 Elsevier Ireland Ltd. All rights reserved.