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- Title
CT-guided biopsy in suspected spondylodiscitis: microbiological yield, impact on antimicrobial treatment, and relationship with outcome.
- Authors
Kasalak, Ömer; Wouthuyzen-Bakker, Marjan; Adams, Hugo J. A.; Overbosch, Jelle; Dierckx, Rudi A. J. O.; Jutte, Paul C.; Kwee, Thomas C.
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>This study included 64 patients with MRI findings compatible with spondylodiscitis who underwent CT-guided biopsy.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
BIOPSY; SPONDYLODISCITIS; SPINE diseases diagnosis; ANTI-infective agents; BLOOD serum analysis
- Publication
Skeletal Radiology, 2018, Vol 47, Issue 10, p1383
- ISSN
0364-2348
- Publication type
Academic Journal
- DOI
10.1007/s00256-018-2944-2