Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Chong, Brian; Brereton, Christopher J.; Gordon, Alexander; Davis, Joshua S.

doi:10.1093/ofid/ofy037

Cited by 43 publications

(32 citation statements)

References 17 publications

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“…Furthermore, current clinical guidelines are not entirely clear in regards to recommendations of antimicrobial initiation and duration, particularly given the heterogeneity of clinical presentations and associated neurological morbidity. There is a relative paucity of Australian data on this condition, with only one other single‐centre study in vertebral osteomyelitis . The aim of this study was to further define the yield, predictors of yield and local practices in a study of vertebral biopsies at a tertiary Australian centre.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield of computed tomography‐guided biopsy and aspiration for vertebral osteomyelitis

Ang

Wong

et al. 2019

J Med Imag Rad Onc

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Introduction: The diagnostic yield of and best approaches for imaging-guided percutaneous biopsy for vertebral osteomyelitis is controversial. Early studies suggest yields of up to 90%; however, recent evidence shows lower yields of 30-40%. We aim to determine yield and predictors of yield in percutaneous CT-guided biopsies in vertebral osteomyelitis. Methods: We conducted a retrospective observational single-centre study cohort study of all patients presenting for vertebral biopsy or aspiration between 2014 and 2018. Only patients undergoing biopsy for suspected infection were included. Patients with malignant indications were excluded. Comprehensive review of medical records was performed for clinical presentation, comorbidities, imaging, biomarkers, microbiology and treatment. Results: Overall, 40 out of 88 biopsies were performed for suspected infection, in 36 patients. Mean age was 59 AE 18 years; 29 (81%) were male. Of the 40 samples, an organism was identified in 14 samples (35%). Gram-positive organisms were most commonly identified; Staphylococcus aureus was cultured in 7 (50%) of samples. Mean admission CRP was significantly higher in patients with identified organisms compared to those without (137 AE 106 vs 54 AE 78, P = 0.008). Aspiration was a strong independent predictor of positive microbiological growth on multivariate analysis .02], P = 0.026). Biopsy or aspiration aided clinical decision-making in half of cases. Conclusions: Percutaneous CT-guided biopsy has a modest yield for identifying the culprit organism in suspected cases of vertebral osteomyelitis. Elevated CRP and aspiration of fluid collections are associated with improved microbiological yield and should be considered in deciding when and where to biopsy.

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Section: Introductionmentioning

confidence: 99%

Diagnostic yield of computed tomography‐guided biopsy and aspiration for vertebral osteomyelitis

Ang

Wong

et al. 2019

J Med Imag Rad Onc

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“…In a 10-year retrospective cohort study conducted by Chong et al, it was found that of 129 cases with PVO, no causative organism was identified in 21.7% of the patients, and that open biopsy of vertebral tissue had a higher diagnostic yield than the other ones (7). They reported that only 15% of the patients had complete recovery after receiving a median of six-week intravenous antibiotic therapy.…”

Section: █ Discussionmentioning

confidence: 99%

“…It was also reported that the oral antibiotic treatment continued for a median of 42 days after intravenous therapy. However, they concluded that the clinical outcomes for the patients with PVO were poor despite the empirical antibiotic treatment (7).…”

Section: █ Discussionmentioning

confidence: 99%

“…Identification of the active microorganism is important in determining the appropriate antibiotic treatment option. However, microbiological factors have not yet been determined even though many methods, such as surgical or needle aspiration biopsy, wound swab sampling, and taking a blood culture, have been used (7,14). The ideal diagnostic method is not yet fully evident.…”

Section: Original Investigationmentioning

confidence: 99%

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Evaluation of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis

Doğan

Şimşek²,

Yılmaz³

et al. 2019

Turkish Neurosurgery

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AIM: To investigate the efficacy of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis (PVO) cases. MATERIAL and METHODS: The records of patients with culture-negative PVO who were treated at infectious disease and neurosurgery outpatient clinics in the past four years were examined retrospectively. The control group comprised healthy subjects with similar age, gender, and body mass index but without pathology. In the statistical evaluation of the obtained data, the comparison of the groups was performed by analysis of variance. Statistical significance was accepted as p<0.05. RESULTS: No statistically significant difference in the white blood cell count and erythrocyte sedimentation rate was found between the spondylodiscitis and the healthy subject groups when the blood parameters obtained before and after the treatment (p>0.05). However, a statistical significance was assessed in the results of the comparison for C-reactive protein (p<0.05). CONCLUSION: In the context of evidence-based medicine and the rational use of antibiotics, it is clear that antibiotics should be preferred according to the culture antibiogram results in the treatment of infectious diseases.

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“…We performed a vertebral CT-guided fine needle agobiopsy in 84 patients (47%) with a microbiological diagnosis in less than half the cases, but the usefulness of a second biopsy, if the first one is negative, is a subject of debate [15]. According to the literature, bone biopsy identifies organisms in approximately 40% of the cases, but the yield is reduced if antibiotic therapy had been 8 started [16]. In fact, antibiotics were given before diagnosis to almost half of our patients.…”

Section: Discussionmentioning

confidence: 99%

Pyogenic Vertebral Osteomyelitis in Adults: Ten-year Experience in Two Italian Hospitals

Zoboli

Ripamonti

Carretta

et al. 2019

Preprint

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Background: The incidence of pyogenic vertebral osteomyelitis (PVO) is increasing, but optimal diagnostic strategy and medical management remain controversial. Methods: We conducted a retrospective study of PVO in two Italian hospitals, including all the adults admitted from January 2007 to December 2016. PVO was defined probable or definite according to clinical, radiological and microbiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The outcome measures were cure rate, mortality during index admission and recurrence rate. Results: Most cases were diagnosed with MRI. Biopsy was performed in 47% of patients and was successful only in 49% of them. The microbiological diagnosis (mostly Gram-positive agents) was obtained in 111 patients (62%). Treatment duration did not differ between patients with definite or probable diagnosis (108 and 112 days, respectively). Among the 100 patients (56%) with at least 1-year follow-up, the cure rate, the failure rate and the mortality were 88%, 12% and 3%, respectively. Relapses were uncommon (4%) among patients who completed the follow-up. Among the patients who recovered completely, 47 (59%) had a microbiological diagnosis. Among the 111 patients with a definite diagnosis and 68 with a probable diagnosis, 42% and 49% achieved a full recovery, respectively. Conclusions: Despite influencing the antibiotic selection, the etiological diagnosis did not impact the cure rate and/or duration of treatment. Some open questions remain with regard to the optimal starting regimen, the duration of treatment and the time to switch to oral therapy.

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Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Cited by 43 publications

References 17 publications

Diagnostic yield of computed tomography‐guided biopsy and aspiration for vertebral osteomyelitis

Diagnostic yield of computed tomography‐guided biopsy and aspiration for vertebral osteomyelitis

Evaluation of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis

Pyogenic Vertebral Osteomyelitis in Adults: Ten-year Experience in Two Italian Hospitals

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