The utility of image-guided percutaneous needle aspiration biopsy for the diagnosis of spontaneous vertebral osteomyelitis: a systematic review and meta-analysis

Pupaibool, Jakrapun; Vasoo, Shawn; Erwin, Patricia J.; Murad, M. Hassan; Berbari, Elie F.

doi:10.1016/j.spinee.2014.07.003

Cited by 54 publications

(35 citation statements)

References 34 publications

(52 reference statements)

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“…The biopsy yield percentages in this study may be more realistic than previously reported numbers that suffered from methodological flaws [7–9, 14], although local antibiotic resistance could change yields between institutions. The same applies to the investigation on the association of several laboratory, clinical (including the pre-biopsy use of antibiotics), and MRI findings with CT-guided biopsy results, with none of them being statistically associated with a positive culture.…”

Section: Discussionmentioning

confidence: 89%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 89%

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

et al. 2018

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“…Cultures on specific media for Mycobacterium tuberculosis and fungi should be requested as well, especially when there is a suspicion for tuberculosis exposure or indicating imaging signs [7]. A CT-guided percutaneous needle aspiration biopsy is paramount to confirm the diagnosis and isolate the responsible microorganism, provided that prompt surgical treatment is not required such as in cases with progressive neurological symptoms due to spinal cord compression or spinal canal abscesses [48]. However, the sensitivity and specificity of CT-guided needle biopsy is lower than believed; in a recent metanalysis, a sensitivity of 52.2% (95% CI, 45.8-58.5) for CT-guided percutaneous needle aspiration biopsy for the diagnosis of spinal infections was reported [48].…”

Section: Diagnosismentioning

confidence: 99%

“…A CT-guided percutaneous needle aspiration biopsy is paramount to confirm the diagnosis and isolate the responsible microorganism, provided that prompt surgical treatment is not required such as in cases with progressive neurological symptoms due to spinal cord compression or spinal canal abscesses [48]. However, the sensitivity and specificity of CT-guided needle biopsy is lower than believed; in a recent metanalysis, a sensitivity of 52.2% (95% CI, 45.8-58.5) for CT-guided percutaneous needle aspiration biopsy for the diagnosis of spinal infections was reported [48]. Recent studies reported a higher pathogen detection rate of fine-needle aspiration with combined superimposed MR and CT imaging [49,50].…”

Section: Diagnosismentioning

confidence: 99%

Spinal Infections: An Update

et al. 2020

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Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. Infections are usually caused by bacterial microorganisms, although fungal infections can also occur. The most common route for spinal infection is through hematogenous spread of the microorganism from a distant infected area. Most patients with spinal infections diagnosed in early stages can be successfully managed conservatively with antibiotics, bed rest, and spinal braces. In cases of gross or pending instability, progressive neurological deficits, failure of conservative treatment, spinal abscess formation, severe symptoms indicating sepsis, and failure of previous conservative treatment, surgical treatment is required. In either case, close monitoring of the patients with spinal infection with serial neurological examinations and imaging studies is necessary.

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“…However, this strategy could delay the initiation of treatment. Although the microbiologic yield of image-guided biopsy is considered to range from 36% to 91% according to the literature [7,[9][10][11][12], our concurrent biopsy specimen culture might have produced a high yield and provided additional information for 26% of patients in our study. The present study suggests that the concurrent use of blood culture and biopsy specimen culture can produce a high detection rate with an acceptable lead time for the start of the treatment.…”

Section: Discussionmentioning

confidence: 88%

The Etiology of Pyogenic Vertebral Osteomyelitis and Evaluation of Biopsy Specimen Cultures in Hospitalized Patients

Kamono¹,

Kabeya²,

Sohara³

et al. 2017

J Med Microb Diagn

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Identifying the causative pathogens in patients with pyogenic vertebral osteomyelitis is important for optimizing antibiotic therapy. Thus, we examined patient characteristics and investigated the efficacy of the combined use of blood culture and image-guided biopsy culture for identifying the causative pathogens of pyogenic vertebral osteomyelitis. A case series study was conducted in hospitalized patients who were diagnosed with pyogenic vertebral osteomyelitis using electronic medical records. Twenty-three patients who had undergone both blood culture and image-guided biopsy to determine the causative pathogens were identified. Detailed patient characteristics were identified, and the detection rate of a causative pathogen was 57% using either blood or biopsy specimen culture. By combining the results of each culture, the detection rate was increased to 83%. We described the detailed characteristics of patients with pyogenic vertebral osteomyelitis from whom both blood and biopsy specimen cultures were obtained. We found that the combined use of blood culture and biopsy specimen culture is useful for enhancing the detection of causative pathogens in patients with pyogenic vertebral osteomyelitis.

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The utility of image-guided percutaneous needle aspiration biopsy for the diagnosis of spontaneous vertebral osteomyelitis: a systematic review and meta-analysis

Cited by 54 publications

References 34 publications

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

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

Spinal Infections: An Update

The Etiology of Pyogenic Vertebral Osteomyelitis and Evaluation of Biopsy Specimen Cultures in Hospitalized Patients

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