Computed Tomography-Guided Biopsy in Vertebral Osteomyelitis

Background: Patients with suspected vertebral osteomyelitis routinely undergo a biopsy procedure early in their admission. Our goal is to assess the utility of surgical pathology and other clinical factors in guiding treatment of vertebral osteomyelitis. Method(s): This was an IRB-approved retrospective review of CT-guided core biopsies for suspected vertebral osteomyelitis. 67 patients met our inclusion criteria. A chart review was performed for the following clinical factors to determine their impact on antibiotic regimen changes: microbiological cultures, presence of paravertebral abscess/phlegmon, fever, elevated erythrocyte sedimentation rate (ESR), elevated C-reactive protein, and an elevated white blood cell count. Results were analyzed using SPSS (version 25, IBM), p-values were obtained using a Chi-squared test. Result(s): Of the 69 biopsied cases of vertebral osteomyelitis, 26 cases (38%) yielded positive cultures. Among the group of positive cultures, 16 (62%) of the biopsies contributed new information, isolating either a new or different organism. In the cases with positive cultures, 15 (58%) had changes in their empiric antibiotics (p < 0.001). A change in empiric antibiotic coverage was seen in 3 patients with negative biopsy cultures. 24 patients had a paravertebral abscess or phlegmon described in the pre-biopsy MRI. In this subset of patients with paravertebral abscesses or phlegmon, a positive biopsy culture was seen in 16 (66%) patients (p < 0.001). 10 patients who had positive cultures did not have a paravertebral abscess or phlegmonous changes. In addition, no significant association was noted with changes in antibiotic regimen in the presence of a fever, leukocytosis, elevated ESR or CRP. Conclusion(s): Although CT-guided vertebral core biopsies are relatively low yield, they often provide results that are clinically relevant for proper treatment. Positive culture results contribute pertinent information and aid in identifying the most efficacious antibiotic(s) for clinicians to formulate a successful treatment plan.

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Artikel online veröffentlicht:
11. Mai 2021