Management Outcomes after Image-Guided Percutaneous Biopsy for Suspected Vertebral Osteomyelitis-Discitis.

Dania G Malik, Mathew V Smith, Gabriel M Swenson, Robert E Grady, Felix E Diehn, Erik H Middlebrooks, Jeffrey S Ross, Tanya J Rath
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Abstract

Background and purpose: Studies show a modest yield for image-guided biopsy of suspected vertebral osteomyelitis-discitis. Many studies evaluate factors to improve diagnostic yield, and few studies assess how biopsy results impact clinical management. We aim to evaluate the impact of biopsy results on clinical management in suspected vertebral osteomyelitis-discitis.

Materials and methods: We performed a retrospective study of patients who underwent image-guided biopsy for suspected vertebral osteomyelitis-discitis. Data collected included risk factors, imaging findings, laboratory values, antibiotics, biopsy procedure details, microbiology and pathology results, and clinical course. Factors assessed for management change included whether biopsy results affected antibiotic type or course, decision to start or stop antibiotics, surgical decisions, or if an alternate diagnosis was determined.

Results: Three hundred ten biopsies were included. Biopsy yield with true-positive culture results was 34% (104/310) and similar for patients on antibiotics (36%, 34/94) and off antibiotics (32%, 66/204). Yield was greater when disc was sampled (36%, 82/228) versus bone only (8%, 2/24) and with aspiration of disc and/or bone (42%, 39/92) versus core only (29%, 56/193). With positive blood cultures before biopsy, biopsy yield was 50% (22/44) with concordance and discordance rates of 75% (18/24) and 17% (4/24), respectively, and 8% (2/24) of positive biopsy results deemed contaminants. Management was affected in 36% (113/310) of all biopsies and in 78% (81/104) of biopsies with a positive culture result. No management change occurred in 57% (177/310) of biopsies. Management change was unclear in 6% (20/310). Biopsy results changed antibiotics in 27% (85/310). Management change occurred in 23% (10/44) of cases with prior positive blood culture compared with 41% (93/233) without a prior culture source (P = .024). Negative culture results influenced management in 16% (32/194).

Conclusions: Image-guided biopsy for vertebral osteomyelitis-discitis has a meaningful impact on management despite modest yield. Greatest management impact is seen with positive culture results, no prior culture source, and patients not on antibiotics at the time of biopsy. Biopsy culture yield is not affected by preceding antibiotics, and yield is greater with disc sampling and aspiration.

影像引导下经皮活检疑似椎体骨髓炎-椎间盘炎后的处理结果。
背景和目的:研究表明,影像引导下对疑似椎体骨髓炎-椎间盘炎的活检成功率适中。许多研究评估提高诊断率的因素,很少有研究评估活检结果如何影响临床管理。我们的目的是评估活检结果对疑似椎体骨髓炎-椎间盘炎临床治疗的影响。材料和方法:我们对疑似椎体骨髓炎-椎间盘炎接受图像引导活检的患者进行了回顾性研究。收集的数据包括危险因素、影像学表现、实验室值、抗生素、活检程序细节、微生物学和病理学结果以及临床过程。评估管理改变的因素包括活检结果是否影响抗生素类型或疗程、开始或停止抗生素的决定、手术决定或是否确定替代诊断。结果:共纳入310例活检。培养真阳性的活检率为34%(104/310),抗生素组(36%,34/94)和非抗生素组(32%,66/204)的活检率相似。抽吸椎间盘(36%,82/228)比只抽吸骨(8%,2/24)和抽吸椎间盘和/或骨(42%,39/92)比只抽吸核心(29%,56/193)的产率更高。活检前血培养阳性,活检率为50%(22/44),一致性和不一致性率分别为75%(18/24)和17%(4/24),8%(2/24)的阳性活检结果被认为是污染物。36%(113/310)的活检组织和78%(81/104)的培养阳性活检组织的管理受到影响。57%(177/310)的活检未发生管理改变。6%(20/310)的管理变动不明确。27%的活检结果改变了抗生素(85/310)。先前血培养阳性的病例中,23%(10/44)发生了管理改变,而没有先前培养源的病例中,这一比例为41% (93/233)(P = 0.024)。16%(32/194)的负面培养结果影响了管理。结论:图像引导下椎体骨髓炎-椎间盘炎的活检对治疗有重要影响,尽管成功率不高。在活检时,培养结果阳性、无培养源、患者未使用抗生素的情况下,对管理的影响最大。活检培养产量不受先前抗生素的影响,而圆盘取样和抽吸的产量更大。缩写:VO =椎体骨髓炎-椎间盘炎;白细胞计数;ESR =红细胞沉降率;c反应蛋白;MC =管理层变动;NMC =管理层无变动;UC =不明确的管理变更;Abx =抗生素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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