• Leonor Díaz-Velis, Fabián Álvarez-Echeverría, and Gabino Garrido.
• Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del del Norte, Antofagasta, Chile.
• Rev Med Chil. 2023 Feb 1; 151 (2): 206221206-221.

BackgroundDiabetic foot osteomyelitis (DFO) is a serious complication of infected ulcers in a diabetic patient. The identification of the infecting microorganisms is generally by culture, which causes a bias. Recently, metagenomics has been used for microbial identification.AimTo systematically review the scientific literature related to DFO in the last 10 years to evaluate if culture and metagenomics are complementary.Material And MethodsTo carry out the systematic review, PRISMA and Rayyan were used for the selection of studies, using three databases, using the keywords diabetes, osteomyelitis, culture and microbiome. Articles in English or Spanish were included, containing information related to bacterial identification in DFO. Characteristics of the technique, patients and frequency of bacterial appearance were collected.ResultsTwenty six articles were included, 19 used culture and 7 metagenomics. The patients were predominantly men (68%), with an average age of 61 years, 83% had type 2 diabetes and comorbidities, mainly vascular and neuropathy. The Families with the highest frequency of appearance using the culture technique were Enterobacteriaceae (29.3%) and Staphylococcaceae(28.3%) and with metagenomics Peptoniphilaceae (22.1%) and Staphylococcaceae (9.4%). Peptoniphilaceae were not identified in culture, although they were frequently identified by metagenomics. Methicillin- resistant Staphylococcus aureus, regularly identified by culture, was not identified using metagenomics.ConclusionsComparing results, there is a certain complementarity between microbiological culture and sequencing to identify bacteria present in DFO.

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