Are granulocyte colony-stimulating factors beneficial in treating diabetic foot infections?: A meta-analysis.

Abstract

OBJECTIVE:

To assess the value of granulocyte colony-stimulating factor (G-CSF) as adjunctive therapy for diabetic foot infections.

RESEARCH DESIGN AND METHODS:

We systematically searched the medical literature (including Medline, Embase, LookSmart, and the Cochrane Library) for prospective randomized studies that used G-CSF as an adjunct to standard treatment for diabetic foot infections. Using a conventional meta-analysis, we pooled the relative risks (RRs) for outcomes of interest, including resolution of infection, wound healing, duration of antibiotic therapy, and need for various surgical interventions, using a fixed-effects model.

RESULTS:

Five randomized trials, with a total of 167 patients, met our inclusion criteria. The methodological quality of the studies was satisfactory. The investigators administered various G-CSF preparations parenterally for between 3 and 21 days. The meta-analysis revealed that adding G-CSF did not significantly affect the resolution of infection or the healing of the wounds but was associated with a significantly reduced likelihood of lower extremity surgical interventions (RR 0.38 [95% CI 0.20-0.69], number of patients who needed to be treated: 4.5), including amputation (0.41 [0.17-0.95], number of patients who needed to be treated: 8.6). There was no evidence of heterogeneity among the studies or of publication bias, suggesting that these conclusions are reasonably generalizable and robust.

CONCLUSIONS:

Adjunctive G-CSF treatment does not appear to hasten the clinical resolution of diabetic foot infection or ulceration but is associated with a reduced rate of amputation and other surgical procedures. The small number of patients who needed to be treated to gain these benefits suggests that using G-CSF should be considered, especially in patients with limb-threatening infections.

• Authors: Mario Cruciani, Benjamin A Lipsky, Carlo Mengoli, Fausto de Lalla
• Journal: Diabetes care (Diabetes Care) Vol. 28 Issue 2 Pg. 454-60 (Feb 2005) ISSN: 0149-5992 [Print] United States
• PMID: 15677817 (Publication Type: Journal Article, Meta-Analysis)

Chemical References

• Granulocyte Colony-Stimulating Factor

Topics

• Amputation, Surgical
• Bacterial Infections (drug therapy)
• Diabetic Foot (drug therapy, microbiology, surgery)
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Humans
• Limb Salvage
• Randomized Controlled Trials as Topic