1Dept. of Endocrinology pgimer, Chandigarh(India); 2Dept. of Nuclear Medicine*pgimer, Chandigarh(India); 3Dept. of Microbiology **pgimer, Chandigarh(India); 4Dept. of Pathology***pgimer, Chandigarh(India).
Abstract
The diagnosis of osteomyelitis in diabetes mellitus remains a challenge. This study was conducted to evaluate the infection scintigraphy with instantly prepared single vial kit, radio-labelled ciprofloxacin (Diagnobact TM), as a mean to detect bone infection; in comparison with bacterial culture as gold standard. Written consent was taken from all patients including approval from institute ethics committee. Twenty-five patients with diabetic foot ulcers including 6 with superficial ulcers and positive 99mTc-MDP bone scan were subjected to 99mTc-ciprofloxacin scan and subsequent bacteriological culture. 99mTc-ciprofloxacin scan was positive in 13, negative in 12 patients including 6 with superficial ulcers. Bacterial culture was positive in 18 subjects, negative in 7 including 1 with osteomyelitis on bone biopsy only. Therefore 99mTc-ciprofloxacin scan was 'true positive' in 12, 'true negative' in 6, false positive in 1 and false negative in 6. Sensitivity and specificity of the test was 67.7% and 87.7% respectively, with positive, negative predictive values and accuracy of 92.3%, 50% and 72% respectively. Staphylococcus aureus and Escherichia coli were the most frequently isolated organisms. 99mTc-ciprofloxacin is a sensitive and specific marker to diagnose bone infection in diabetics, but care must be taken in case of excessive new bone formation, fastidious organisms and ciprofloxacin resistant bacterial flora where false results may be obtained.
Key Words Ciprofloxacin scan, Diabetic foot, Osteomyelitis
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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