The Efficacy of Computed Tomography-Guided Percutaneous Spine Biopsies in Determining a Causative Organism in Cases of Suspected Infection: A Systematic Review

Abstract

Purpose In suspected spondylodiscitis and vertebral osteomyelitis, computed tomography (CT)-guided biopsies are often performed to determine a causative organism and guide antimicrobial therapy. The aim of this study is to determine the diagnostic culture yield of CT-guided biopsies performed in cases of suspected spinal infections. Methods A literature search of PubMed and MEDLINE up to April 2017 was performed for keywords “CT guided vertebral biopsy infection,” “CT-guided spine biopsy infection,” “CT guided spine biopsy yield,” and “CT guided vertebral biopsy yield.” Inclusion criteria primarily consisted of studies exclusively using CT-guided biopsies in cases of suspected infectious lesions only. After study selection, published articles were analysed to determine diagnostic culture yield. Descriptive statistics were applied. Results 220 search results were screened; 11 met our inclusion criteria and were reviewed. In total, 647 biopsies of suspected infectious spinal lesions were performed. Positive cultures were obtained in 241 cases. Upon excluding one paper's skewed results, the net pooled results culture yield was 33%. Several cultures grew multiple organisms, leading to a total of 244 species identified. Most common isolated organisms include S taphylococcus aureus (n = 83), coagulase-negative S taphylococcus (n = 45), and Mycobacteria (n = 38). Conclusions The diagnostic culture yield of CT-guided biopsies in cases of suspected spinal infection is 33%. In the majority of cases, a causative organism is not identified. This suggests that improvements can be made in biopsy technique and specimen transfer to optimize culture yield and increase the clinical value of the procedure.

Time to Reconsider Routine Percutaneous Biopsy in Spondylodiscitis?

“…4 In another more recent meta-analysis that included 10 studies, the positive culture yield of CT-guided biopsy in suspected spinal infection was 33%. 9 The latter percentage of 33% corroborates both the results of some more recent original studies investigating the microbiological yield of the first biopsy in suspected spondylodiscitis 10,11 and a meta-analysis that included 8 studies on the culture yield of repeat biopsy after an initial biopsy with negative findings. 12 This percentage is also considerably lower than the 30%-74% range that was described in the Infectious Diseases Society of America guidelines.…”

Use of Blood Culture Bottles to Incubate Irrigation Water from the Surgical Site May Improve Detection of Causative Organisms in Pyogenic Vertebral Osteomyelitis

“…To control for the possibility of the test yielding a high number of false positives due to contaminants, we veri ed that organisms grown in culture were consistent with those known to cause PVO. Thus, repeat biopsies may be helpful in clinically challenging cases [24,25].…”

Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis

“…With little more than 30% positive findings, we had a fairly low yield in identifying bacteria in conservatively managed patients, despite the fact that we did not only rely on venous blood cultures but always performed computer tomography (CT)-guided needle aspiration from the infectious area, prior to administration of antibiotics. This well-known problem in conservative management of spondylodiscitis [16][17][18] compounds the administration of targeted antibiotics. Therefore, numerous authors propagate surgical debridement and fusion surgery, when possible.…”