TY - JOUR
T1 - CT-guided biopsy in suspected spondylodiscitis
T2 - microbiological yield, impact on antimicrobial treatment, and relationship with outcome
AU - Kasalak, Omer
AU - Wouthuyzen-Bakker, Marjan
AU - Adams, Hugo J. A.
AU - Overbosch, Jelle
AU - Dierckx, Rudi A. J. O.
AU - Jutte, Paul C.
AU - Kwee, Thomas C.
PY - 2018/10
Y1 - 2018/10
N2 - Purpose To 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.Methods This study included 64 patients with MRI findings compatible with spondylodiscitis who underwent CT-guided biopsy.Results Initial 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.Conclusions Although 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.
AB - Purpose To 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.Methods This study included 64 patients with MRI findings compatible with spondylodiscitis who underwent CT-guided biopsy.Results Initial 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.Conclusions Although 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.
KW - Biopsy
KW - CT
KW - Culture yield
KW - Spondylodiscitis
KW - Spine infection
KW - PYOGENIC VERTEBRAL OSTEOMYELITIS
KW - CLINICAL-PRACTICE GUIDELINES
KW - INFECTIOUS-DISEASES SOCIETY
KW - DIAGNOSIS
KW - ADULTS(A)
KW - KYPHOSIS
KW - SPINE
U2 - 10.1007/s00256-018-2944-2
DO - 10.1007/s00256-018-2944-2
M3 - Article
C2 - 29663026
SN - 0364-2348
VL - 47
SP - 1383
EP - 1391
JO - Skeletal Radiology
JF - Skeletal Radiology
IS - 10
ER -