A 56-year-old female with thrombocythemia complicated by portal venous system thrombosis presented with recurrent left pleural effusions after failed recanalization via mechanical thrombectomy and stenting at an outside center. With no other cause, splenic vein thrombosis and left-sided portal hypertension was suggested as a possible etiology. Partial splenic embolization was performed with immediate decrease in effusions and resolution by 8 weeks. Portal and splenic venous system thrombosis may cause recurrent pleural effusions from left-sided portal hypertension and fluid leakage across diaphragmatic defects. Upper pole partial splenic embolization may treat recurrent left pleural effusions and offer an alternative to splenectomy.
Purpose
The aim of this study was to evaluate the role of fluoroscopy-guided vertebral biopsy in vertebral osteomyelitis and determine if it results in a change in antimicrobial management based on bone culture yield.
Materials and Methods
This study is a retrospective chart review of 83 patients (49 men, 34 women; age range, 28–92 years; mean age, 56.9 years) with a diagnosis of vertebral osteomyelitis on imaging (computed tomography or magnetic resonance imaging) who underwent a fluoroscopy-guided biopsy from January 2010 to May 2015. Data collection included patient demographic information; etiology/risk factors for vertebral osteomyelitis; antibiotic exposure within 30 days before biopsy; blood, urine, and bone culture results; and any postprocedural change in antibiotic therapy. The primary outcome is culture yield from biopsy, whereas the secondary outcome is to determine if a change in antimicrobial therapy occurred based on biopsy results. A change in antimicrobial management is defined as transitioning from empiric antibiotic coverage to narrow-spectrum antibiotics based on positive bone culture yield or discontinuation of empiric antibiotic coverage based on negative culture yield. Biopsy culture yield was tested against a change in antimicrobial management with statistical analysis including the Fisher exact test.
Results
Positive bone culture yields were obtained in 22 (27%) of the 83 cases. Of the 22 that were positive, only 11 resulted in a change in antimicrobial management where broad empiric coverage was switched to narrow-spectrum organism-specific coverage. Of the remaining 61 negative cultures, only 2 (3%) had a change in management where the empiric antibiotic treatment was discontinued. Whether the culture results were positive or negative, 70 patients (84%) did not have any change in antimicrobial management after biopsy with the results being statistically significant (odds ratio, 27.3; 95% confidence interval, 5.25–141.82; P < 0.0001).
Conclusions
Vertebral biopsies do not cause a significant change in antimicrobial management in the majority of cases.
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