Abstract
Objective
Image-guided percutaneous bone biopsy may be requested by clinicians to guide antibiotics management decisions in patients with extremity osteomyelitis. Much of the clinical literature describes a high rate of bone biopsy culture positivity in patients with osteomyelitis, but anecdotally biopsy is felt to be fairly low yield in many musculoskeletal radiology practices. The objective of the study is to determine the culture positivity rate and clinical utility of bone biopsy in guiding the management of patients with osteomyelitis.
Materials and methods
All image-guided bone biopsy procedures of the pelvis or foot performed at a single institution were identified by a retrospective report search, and only those with a clinical suspicion for infection were included. Cases were included based on convincing imaging findings of osteomyelitis on retrospective review. Microbiology results were reviewed in the clinical chart, as were antibiotics management decisions and response to antibiotics therapy.
Results
A total of 60 bone biopsies met the inclusion criteria, 25 within the foot and 35 biopsies of the pelvis. Overall, 11 out of 60 core biopsies (18%) yielded positive cultures. Antibiotics management was altered in only 27% patients with a positive culture; thus, only 5% of patients with MRI findings of osteomyelitis undergoing biopsy had an impact on management.
Conclusion
Percutaneous bone biopsies may have a low rate of culture positivity, and even when positive, frequently do not have an impact on antibiotics choice. These data differ from much of the clinical literature, which describes a very high rate of culture positivity.
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References
Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJG, Armstrong DG, et al. 2012 infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54:132–73.
Livesley NJ, Chow AW. Infected pressure ulcers in elderly individuals. Clin Infect Dis. 2002;35:1390–6.
Larson JD, Altman AM, Bentz ML, Larson DL. Pressure ulcers and perineal reconstruction. Plast Reconstr Surg. 2014;133:39e–48e.
Larson DL, Hudak KA, Waring WP, Orr MR, Simonelic K. Protocol management of late-stage pressure ulcers. Plast Reconstr Surg. 2012;129:897–904.
Game FL. Osteomyelitis in the diabetic foot: diagnosis and management. Med Clin N Am. 2013;97:947–56.
Jeffcoate WJ, Lipsky BA. Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. Clin Infect Dis. 2004;39(Suppl 2):S115–22.
Wu JS, Gorbachova T, Morrison WB, Haims AH. Imaging-guided bone biopsy for osteomyelitis: are there factors associated with positive or negative cultures? Am J Roentgenol. 2007;188:1529–34.
Rankine JJ, Barron DA, Robinson P, Millner PA, Dickson RA. Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J. 2004;80:607–9.
Chew FS, Kline MJ. Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology. 2001;218:211–4.
Collins MS, Schaar MM, Wenger DE, Mandrekar JN. T1 weighted MRI characteristics of pedal osteomyelitis. Am J Roentgenol. 2005;185:386–93.
Donovan A, Schweitzer ME. Use of MR imaging in diagnosing diabetes-related pedal osteomyelitis. Radiographics. 2010;30:723–36.
Donovan A, Schweitzer ME. Current concepts in imaging diabetic pedal osteomyelitis. Radiol Clin N Am. 2008;46:1105–24.
Morrison WB, Schweitzer ME, Batte WG, Radack DP, Russel KM. Osteomyelitis of the foot: relative importance of primary and secondary MR imaging signs. Radiology. 1998;207:625–32.
Yuh WT, Corson JD, Baraniewski HM, Rezai K, Shamma AR, Kathol MH, et al. Osteomyelitis of the foot in diabetic patients: evaluation with plain film, 99mTc-MDP bone scintigraphy, and MR imaging. AJR Am J Roentgenol. 1989;152:795–800.
Khatri G, Wagner DK, Sohnle PG. Effect of bone biopsy in guiding antimicrobial therapy for osteomyelitis complicating open wounds. Am J Med Sci. 2001;321:367–71.
Ertugrul MB, Baktiroglu S, Salman S, Unal S, Aksoy M, Berberoglu K, et al. The diagnosis of osteomyelitis of the foot in diabetes: microbiological examination vs. magnetic resonance imaging and labelled leucocyte scanning. Diabet Med. 2006;23:649–53.
Elamurugan TP, Jagdish S, Kate V, Chandra Parija S. Role of bone biopsy specimen culture in the management of diabetic foot osteomyelitis. Int J Surg. 2011;9:214–6.
Marschall J, Bhavan KP, Olsen MA, Fraser VJ, Wright NM, Warren DK. The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. Clin Infect Dis. 2011;52:867–72.
Schweitzer ME, Deely DM, Beavis K, Gannon F. Does the use of lidocaine affect the culture of percutaneous bone biopsy specimens obtained to diagnose osteomyelitis?: an in vitro and in vivo study. Am J Roentgenol. 1995;164:1201–3.
White M, Schweitzer E, Deely M, Gannon F. Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples. Radiology. 1995;197:840–2.
Senneville E, Lombart A, Beltrand E, Valette M, Legout L, Cazubiel M, et al. Outcome of diabetic foot osteomyelitis treated nonsurgically. Diabetes Care. 2008;31:637–42.
Senneville E, Gaworowska D, Topolinski H, Devemy F, Nguyen S, Singer B, et al. Outcome of patients with diabetes with negative percutaneous bone biopsy performed for suspicion of osteomyelitis of the foot. Diabet Med. 2012;29:56–61.
Senneville E, Melliez H, Beltrand E, Legout L, Valette M, Cazaubiel M, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis. 2006;42:57–62.
Senneville E, Morant H, Descamps D, Dekeyser S, Beltrand E, Singer B, et al. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin Infect Dis. 2009;48:888–93.
McNamara AL, Dickerson EC, Gomez-Hassan DM, Cinti SK, Srinivasan A. Yield of image-guided needle biopsy for infectious discitis: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2017;38:2021–7.
Agarwal V, Wo S, Lagemann GM, Tsay J, Delfyett WT. Image-guided percutaneous disc sampling: impact of antecedent antibiotics on yield. Clin Radiol. 2016;71:228–34.
Saravolatz LD, Labalo V, Fishbain J, Szpunar S, Johnson LB. Lack of effect of antibiotics on biopsy culture results in vertebral osteomyelitis. Diagn Microbiol Infect Dis. 2018;91(3):273-4. Elsevier Inc.
Lesens O, Desbiez F, Vidal M, Robin F, Descamps S, Beytout J, et al. Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis. Clin Microbiol Infect. 2011;17:285–91.
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Said, N., Chalian, M., Fox, M.G. et al. Percutaneous image-guided bone biopsy of osteomyelitis in the foot and pelvis has a low impact on guiding antibiotics management: a retrospective analysis of 60 bone biopsies. Skeletal Radiol 48, 1385–1391 (2019). https://doi.org/10.1007/s00256-019-3152-4
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DOI: https://doi.org/10.1007/s00256-019-3152-4