Microbiologically and Clinically Diagnosed Vertebral Osteomyelitis: Impact of Prior Antibiotic Exposure

Kim, Chung Jong; Song, Kyoung Ho; Park, Wan Beom; Kim, Eu Suk; Kim, Hong Bin; Oh, Myoung Don; Kim, Nam Joong

doi:10.1128/aac.05953-11

Cited by 82 publications

(49 citation statements)

References 16 publications

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“…The prevalence of multidrug-resistant bacteria was low in our population. In fact, only one strain of S. aureus was methicillin resistant, which contrasts with previous studies, in which MRSA has been reported in 19.2 to 53.3% of cases of PVO (20)(21)(22)(23)(24)(25)(26). Similarly, we did not isolate any extended-spectrum ␤-lactamase (ESBL)-producing Enterobacteriaceae, which is inconsistent with recent data showing an increase in resistant strains of Enterobacteriaceae.…”

Section: Discussioncontrasting

confidence: 56%

Susceptibility Pattern of Microorganisms Isolated by Percutaneous Needle Biopsy in Nonbacteremic Pyogenic Vertebral Osteomyelitis

Desoutter

Cottier

Ghout

et al. 2015

Antimicrob Agents Chemother

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Section: Discussioncontrasting

confidence: 56%

Susceptibility Pattern of Microorganisms Isolated by Percutaneous Needle Biopsy in Nonbacteremic Pyogenic Vertebral Osteomyelitis

Desoutter

Cottier

Ghout

et al. 2015

Antimicrob Agents Chemother

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“…In acute hematogenous osteomyelitis, the blood cultures are positive in about 58 % of cases (Mylona et al 2009). Specimens for microbiological analysis should be taken prior to the antibiotic therapy to increase the yield probability (Kim et al 2012). If antibiotic therapy has already been established, the consideration should be made to withhold antibiotics for several days prior to microbiological sampling when feasible (Zimmerli 2010).…”

Section: Clinical Manifestations and Diagnosismentioning

confidence: 99%

Staphylococcus aureus-Associated Musculoskeletal Infections

Idelevich

Kreis

Löffler

et al. 2016

Current Topics in Microbiology and Immunology

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Musculoskeletal infections caused by Staphylococcus aureus are among the most difficult-to-treat infections. S. aureus osteomyelitis is associated with a tremendous disease burden through potential for long-term relapses and functional deficits. Although considerable advances have been achieved in diagnosis and treatment of osteomyelitis, the management remains challenging and impact on quality of life is still enormous. S. aureus acute arthritis is relatively seldom in general population, but the incidence is considerably higher in patients with predisposing conditions, particularly those with rheumatoid arthritis. Rapidly destructive course with high mortality and disability rates makes urgent diagnosis and treatment of acute arthritis essential. S. aureus pyomyositis is a common disease in tropical countries, but it is very seldom in temperate regions. Nevertheless, the cases have been increasingly reported also in non-tropical countries, and the physicians should be able to timely recognize this uncommon condition and initiate appropriate treatment. The optimal management of S. aureus-associated musculoskeletal infections requires a strong interdisciplinary collaboration between all involved specialists.

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“…It is well known that the yield of open surgical biopsy is higher than that of needle biopsy (9-11). Also, a higher CRP level occurs more frequently in patients with culture-positive PVO (3,12,13). One might expect that the longer the antibiotic-free period is, the higher the culture positivity rate is because more antibiotic would be removed from tissue and the negative effect of antibiotic exposure would be lessened.…”

mentioning

confidence: 99%

“…Prior antibiotic exposure has been reported in some studies to have a negative effect on microbiologic diagnosis (2)(3)(4)(5). In view of this, it is recommended that, for clinically stable patients, biopsy be delayed until at least 48 h after the last antibiotic has been administered (6).…”

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confidence: 99%

Factors Influencing Culture Positivity in Pyogenic Vertebral Osteomyelitis Patients with Prior Antibiotic Exposure

Kim

Kang

Yoon

et al. 2015

Antimicrob Agents Chemother

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bWe conducted a retrospective cohort study to evaluate factors influencing tissue culture positivity in patients with pyogenic vertebral osteomyelitis exposed to antibiotics before diagnosis. Tissue culture was positive in 48.3% (28/58) of the patients, and the median antibiotic-free period was 1.5 days (range, 0.7 to 5.7 days). In a multivariate analysis, a higher C-reactive protein (CRP) level (adjusted odds ratio [aOR], 1.18; 95% confidence interval, 1.07 to 1.29) and open surgical biopsy (aOR, 6.33; 95% confidence interval, 1.12 to 35.86) were associated with tissue culture positivity. If pyogenic vertebral osteomyelitis (PVO) is suspected, tissue cultures and/or blood cultures are recommended (1). Prior antibiotic exposure has been reported in some studies to have a negative effect on microbiologic diagnosis (2-5). In view of this, it is recommended that, for clinically stable patients, biopsy be delayed until at least 48 h after the last antibiotic has been administered (6). The aims of this study were to investigate the factors influencing tissue culture positivity in patients with PVO who were exposed to antibiotics prior to biopsy and to establish whether an antibiotic-free period improves culture positivity rates.We conducted a retrospective cohort study at three universityaffiliated teaching hospitals from May 2012 through February 2014. Patients with PVO who had been exposed to antibiotics during the 2 weeks before the acquisition of tissue culture specimens were investigated. Patients who were Ͻ18 years old and patients with infectious spondylitis caused by Mycobacterium tuberculosis or fungi were excluded. PVO was diagnosed when the causative microorganism was isolated from spinal or paraspinal tissues or if there were compatible clinical signs or symptoms and radiologic evidence of vertebral infection as described previously (7). The antibiotic-free period was defined as the time interval between the administration of the latest antibiotic and acquisition of specimens for tissue culture. If the antibiotic administered was not active on the microorganism eventually isolated, the patient was considered not to have been exposed to antibiotics. Tissue culture specimens were acquired by percutaneous biopsy or open surgical biopsy. The latter was performed during surgical treatment of the PVO. The Mann-Whitney U test was used to compare continuous variables, and the chi-square test was used to compare categorical variables. Multivariate analysis was performed with binary logistic regression to investigate the factors influencing tissue culture positivity. All P values were two tailed, and P Ͻ 0.05 was considered statistically significant.During the study period, a total of 58 patients with PVO received antibiotics before the acquisition of tissue culture specimens. Blood cultures were done for 53 patients, and 30.2% (16/ 53) gave positive results. The tissue culture positivity rate was 48.3% (28/58). Tissue culture specimens of 48 patients were obtained by computed-tomography or fluoroscopy-guided percu...

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Microbiologically and Clinically Diagnosed Vertebral Osteomyelitis: Impact of Prior Antibiotic Exposure

Cited by 82 publications

References 16 publications

Susceptibility Pattern of Microorganisms Isolated by Percutaneous Needle Biopsy in Nonbacteremic Pyogenic Vertebral Osteomyelitis

Susceptibility Pattern of Microorganisms Isolated by Percutaneous Needle Biopsy in Nonbacteremic Pyogenic Vertebral Osteomyelitis

Staphylococcus aureus-Associated Musculoskeletal Infections

Factors Influencing Culture Positivity in Pyogenic Vertebral Osteomyelitis Patients with Prior Antibiotic Exposure

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