Diagnostic yield of repeat CT-guided biopsy for suspected infectious spondylodiscitis

Czuczman, Gregory J.; Marrero, Daniel E.; Huang, Ambrose J.; Mandell, Jacob; Ghazikhanian, Varand; Simeone, F. A.

doi:10.1007/s00256-018-2972-y

Cited by 30 publications

(12 citation statements)

References 33 publications

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“…In addition, although 95% of patients with positive blood culture had S. aureus bacteraemia, none of the patients had a CT guided biopsy. Previous studies suggest that initial biopsy is only positive in minority of the cases and has an even lower yield in patients with prior antibiotic exposure [24]. Contrary, a few other studies shown that the majority of bone biopsies yield S. aureus [22,13].…”

Section: Discussionmentioning

confidence: 95%

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Milošević¹,

Çevik

Urošević³

et al. 2020

J Infect Dev Ctries

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Introduction: Management of pyogenic spinal infections (PSI) after the development of neurological deficit has not been specifically addressed in the literature. We aimed to describe real-life clinical outcomes of PSI in patients admitted to an intensive care unit with neurological deficit and identify factors associated with good prognosis. Methodology: Consecutive patients admitted to ICU with a possible diagnosis of spinal infection over five years’ period were included. Descriptive statistics were performed to examine the demographics and clinical parameters. Results: The majority (71%) of patients were male. The mean age was 57.4 years (27-79), and 71% were > 50 years old. At least one underlying risk factor was identified in 68% of the patients; the most common comorbidity was diabetes mellitus (DM). All patients have presented with fever accompanied by a neurological deficit (86%) and back pain (79%). A complete recovery was achieved in 25% of patients. However, the majority of patients had adverse outcomes with 21.4% mortality, and 43% remaining neurological sequelae. Increased age with a cut-off of 65 years and pre-existing DM were identified as being associated with poor outcome. Conclusion: Mortality among patients admitted to ICU with PSI was significantly higher than reported in the literature. The residual neurological deficit was common, one-third of patients had remaining neurological sequelae, and only one-fourth had complete recovery. Increased age and background DM were the most important determinants of poor clinical outcome. The impact of DM appears to be much more important than currently recognised in this population.

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Section: Discussionmentioning

confidence: 95%

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Milošević¹,

Çevik

Urošević³

et al. 2020

J Infect Dev Ctries

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“…5,6 In patients with negative blood-cultures, CT-guided biopsy might be able to isolate causative agents of spondylodiscitis. 7 The rate of positive microbiological and/or histopathological findings varies considerably in the literature. Definitive factors that might influence or predict a positive microbiological or histopathological finding are not consistently reported.…”

Section: Introductionmentioning

confidence: 99%

“…Definitive factors that might influence or predict a positive microbiological or histopathological finding are not consistently reported. 7,8 The goal of our retrospective study was to evaluate a series of CT-guided biopsies in suspected spondylodiscitis in order to document rates of positive microbiological or histopathological findings in correlation to the site of CT-guided biopsy ( i.e . intervertebral disc or paravertebral soft tissue) and to identify possible factors that might predict a positive microbiological result.…”

Section: Introductionmentioning

confidence: 99%

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

Özmen¹,

Özkan

Guberina³

et al. 2019

Orthop Rev (Pavia)

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Our propose is to evaluate CT-guided biopsies in suspected spondylodiscitis with respect to puncture site, microbiology findings, histopathology findings and impact on antibiotic therapy. 86 CT-guided spine interventions in suspected spondylodiscitis comprising 201 biopsy procedures were analyzed. Medical records of all patients were screened for microbiology and histopathology reports as well as date, duration and kind of antibiotic therapy. Statistical analyses included calculation of Chi2-tests and logistic regression analyses. Locations of biopsies were intervertebral disc (48.3%), paravertebral soft-tissue (38.3%) and vertebral body (10.9%). Positive microbiological findings were found altogether in 33.8% of cases, positive histopathological findings in 53.6%. Significant associations between positive microbiological findings, positive histopathological findings and antibiotic therapy, respectively, were found. Location of biopsies did not significantly influence rate of positive findings. From the variables age, white blood cell count, serum creatinine and puncture site, none were found to be an independent predictor for a positive microbiological result. We concluded that CT-guided biopsy of intervertebral disc and paravertebral soft tissue yields positive microbiologic findings in a significant proportion of cases. Puncture site is not associated with positive results of microbiology or histopathology.

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“…Traditional bone cultures theoretically could be affected by systemic antibiotic treatment before cultures are obtained and there is a concern that this could reduce culture yield. The common perception to hold antibiotics prior to bone biopsy; however, does not have convincing evidence (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Pathogen directed therapy has been reported to have a higher rate of success, so regardless, cultures are needed to plan therapy.…”

Section: Discussionmentioning

confidence: 99%

Are We Misdiagnosing Diabetic Foot Osteomyelitis? Is the Gold Standard Gold?

Lavery

Crisologo

Fontaine

et al. 2019

The Journal of Foot and Ankle Surgery

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To compare the incidence of osteomyelitis based on different operational definitions using the gold standard of bone biopsy, we prospectively enrolled 35 consecutive patients who met the criteria of ≥21 years of age and a moderate or severe infection based on the Infectious Diseases Society of America classification. Bone samples were obtained from all patients either by percutaneous bone biopsy, or by intraoperative culture if the patient required surgery. Bone samples were analyzed for conventional culture, histology, and 16S rRNA genetic sequencing. We evaluated five definitions for osteomyelitis: 1. traditional culture 2. histology 3. genetic sequencing 4. traditional culture and histology 5. genetic sequencing and histology. There was variability in the incidence of osteomyelitis based on the diagnostic criteria. Traditional cultures identified more cases of osteomyelitis than histology (68.6% vs. 45.7%, p=0.06, OR 2.59, 95% CI 0.98-6.87) but not significant. In every case that histology reported osteomyelitis, bone culture was positive using traditional culture or genetic sequencing. 16S rRNA testing identified significantly more cases of osteomyelitis compared to histology (82.9% vs. 45.7%, p=0.002, OR 5.74, 95% CI 1.91-17.28) and more compared to traditional cultures but not significant (82.9% vs. 68.6%, p=0.17, OR 2.22, 95% CI 0.71-6.87). When both histology and traditional culture (68.6%) or histology and genetic sequencing cultures (82.9%) were used to define osteomyelitis, the incidence of osteomyelitis did not change. There is variability in the incidence of osteomyelitis based on how the gold standard of bone biopsy is defined in diabetic foot infections.

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Diagnostic yield of repeat CT-guided biopsy for suspected infectious spondylodiscitis

Abstract: Overall microbiologic yield of repeat CT-guided biopsy for patients with suspected infectious spondylodiscitis was low at 14.3%; however, a higher yield was identified in patients who were younger in age and not exposed to pre-biopsy antibiotics.

Cited by 30 publications

References 33 publications

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

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

Are We Misdiagnosing Diabetic Foot Osteomyelitis? Is the Gold Standard Gold?

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