Ulcer Bed Biopsy for Biopsy-Guided Antimicrobial Therapy in Diabetic Foot Osteomyelitis

To the Editor—We thank Larsen-Ramirez and Nuzzolo [1] for their comments on the BeBoP trial [2]. We would like to respond to their observations and concerns. The eligible study participants were characterized in detail in the article describing the protocol of the BeBoP trial [3]. In short, patients presenting with osteomyelitis of the diabetic foot in secondary and tertiary diabetic foot clinics were eligible for inclusion. We used criteria for osteomyelitis that are used in clinical practice by clinicians, that is, a probe to bone test and laboratory and radiology findings according to International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines [3, 4]. Ulcer locations are shown in Table 1 [2]. Complete surgical bone debridement or amputation and noncorrectable chronic limb-threatening ischemia were exclusion criteria, but patients who were likely to undergo surgery within 72 hours after enrollment for peripheral revascularization or for other reasons (eg, abscesses drainage) were not excluded.