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Diabetic foot osteomyelitis — ABIM Board MCQ

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HardInfectious DiseaseDiabetic foot osteomyelitisABIM Board

A 63-year-old man has a chronic plantar ulcer that probes to bone and MRI findings compatible with calcaneal osteomyelitis. He is afebrile and stable, and no antibiotic has yet been given. Debridement is planned. Which microbiologic approach best guides definitive therapy?

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Correct answer: C — Obtain an aseptic bone specimen for culture during debridement

The best answer is “Obtain an aseptic bone specimen for culture during debridement”. Imaging can support the diagnosis, but an aseptically obtained bone specimen provides the most reliable pathogen identification for diabetic foot osteomyelitis. A superficial swab frequently reflects colonizing flora and cannot substitute for bone culture. Because he is stable and sampling is imminent, microbiologic diagnosis can be obtained before empiric treatment obscures yield.

Reference: IWGDF/IDSA Guideline: Diabetes-Related Foot Infections: https://www.idsociety.org/practice-guideline/diabetic-foot-infections/