CT-guided biopsy in suspected spondylodiscitis: microbiological yield, impact on antimicrobial treatment, and relationship with outcome

Abstract

PurposeTo investigate the clinical impact of CT-guided biopsy, as performed in routine clinical practice, in patients with suspected spondylodiscitis on MRI in terms of culture yield, impact on antimicrobial treatment, and outcome.MethodsThis study included 64 patients with MRI findings compatible with spondylodiscitis who underwent CT-guided biopsy.ResultsInitial CT-guided biopsies were culture-positive in 20/64 (31.3%, 95% confidence interval [CI] 21.2–43.3%). Repeat CT-guided biopsies (after initial negative biopsy) were culture-positive in an additional 5/15 (33.3%, 95% CI 15.2–58.3%). Serum leukocytes, C-reactive protein, pre-biopsy use of antibiotics, neurological symptoms, MRI findings, vertebral height loss, and hyperkyphosis were not significantly different between culture-positive and culture-negative cases (P = 0.214–1.000); 75% (15/20) of initial CT-guided biopsies that were culture-positive provided additional information to clinicians for guiding antibiotic treatment. Sixty-two of 64 patients (96.9%, 95% CI 89.3–99.1%) would have been adequately treated if a strategy was followed that would subject all patients without clinical findings suspicious for “atypical” microorganisms and negative blood cultures to empirical antibiotics (i.e., clindamycin for coverage of Gram-positive bacteria) without using biopsy results to determine the optimal antibiotic regimen. Outcome within 6 months (development of neurologic or orthopedic complications, surgery, and death) was not significantly different (P = 0.751) between culture-positive and culture-negative patients.ConclusionsAlthough CT-guided biopsies are culture-positive in a minority of cases, the majority of positive cultures are useful to tailor antibiotic treatment. Empirical treatment with clindamycin may cover almost all micro-organisms in positive biopsy specimens, provided patients are not immunocompromised. Outcome appears similar between culture-positive and culture-negative patients.

Computed-tomography-guided biopsy in suspected spondylodiscitis: Single-center experience including 201 biopsy procedures

“…As our results demonstrate, none of the tested parameters independently predicted a positive finding of microbiological analysis. Kasalak et al 1 analyzed different clinical, radiological and laboratory parameters including leucocytes and C-reactive protein in order to find differences between culture positive and culture negative CT biopsy specimen. None of their analyzed parameters was significantly different between both groups.…”

“…Infectious spondylodiscitis is a relatively rare disease with an estimated incidence of about 0.4 to 2.4. per 100.000 in Europe. 1 Over the past years an increasing incidence has been described, 2 which might be attributable to earlier and more sensitive diagnostic procedures as well as a rising proportion of immunocompromised patients in hospitals. 3-5 Early diagnosis and treatment are mandatory, as the disease might be lethal in up to 17% of cases.…”

Imaging-guided percutaneous vertebral and paravertebral lesion biopsy: A single center experience

“…In the study of Gul et al [10], the success rate was found to be 80% and the only factor that had a significant relationship with success was reported as lesion histopathology. In a recent study by Kasalak et al [11], which included 64 patients with suspected spondylodiscitis, only 31.3% had culture positivity. However, 96.9% of culture positive patients were treated appropriately.…”

“…However, 96.9% of culture positive patients were treated appropriately. Therefore, the importance of biopsy has been emphasized in guiding the treatment [11]. In the meta-analysis performed by Pupabiool et al [12], the sensitivity and specificity of the imaging-guided biopsies performed for spontaneous vertebral osteomyelitis were reported as 52.2% and 99.9%, respectively.…”

Impact of MRI, CT, and Clinical Characteristics on Microbial Pathogen Detection Using CT-Guided Biopsy for Suspected Spondylodiscitis

“…Endeavors to identify both clinical variables and imaging features predictive of microbiological pathogen detection in spondylodiscitis patients have been undertaken by several studies [6,8,15,16,21]. However, results were, in part conflicting and there still exists no consensus in the issue.…”