2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adultsa

Abstract

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

Role of Operative or Interventional Radiology-Guided Cultures for Osteomyelitis

“…11 Imaging-guided aspiration/biopsy is being recognized as the standard of care in the diagnosis of vertebral osteomyelitis in adults and is currently endorsed by national guidelines. 35 Previous series in children have largely focused on the overall diagnostic yield of CT-guided musculoskeletal biopsy, including cases in which malignancy is highly suspect. [36][37][38] In 30% to 46% of patients in such series, imagingguided biopsy revealed the diagnosis of osteomyelitis.…”

Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis

“…Another virtue of MDCT is the opportunity to gather minimally invasive core needle biopsies to ensure the microbiological diagnosis for specific antibiotic treatment [5] and to rule out traumatic or degenerative reasons for back pain in the same procedure. Moreover, other infectious foci of the abdomen can be assessed, which is an advantage over spinal MRI.…”

“…It can result from hematogenous spread of pathogens following a distant infection, in continuity from neighboring tissues or after spinal surgery [4]. Elderly patients and those with immunosuppressive diseases, renal failure, or intravenous drug abuse are at particular risk [5]. Diagnosis can be challenging as patients may present with nonspecific symptoms such as back or abdominal pain [6], fever, malaise and/or elevated inflammatory blood values while blood cultures often return negative [5].…”

“…Elderly patients and those with immunosuppressive diseases, renal failure, or intravenous drug abuse are at particular risk [5]. Diagnosis can be challenging as patients may present with nonspecific symptoms such as back or abdominal pain [6], fever, malaise and/or elevated inflammatory blood values while blood cultures often return negative [5]. Moreover, symptoms can be masked by previous (self-) medication, resulting in a delay of correct diagnosis of up to several months [4].…”

“…Magnetic resonance imaging (MRI) is the recommended reference standard for diagnostic evaluation of suspected spondylodiscitis [5,7]. MRI is highly accurate in the diagnosis of spondylodiscitis with a sensitivity and specificity of above 95 % [7 -9].…”