How is the microbial diagnosis of bacterial vertebral osteomyelitis performed? An 11-year retrospective study
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ORIGINAL ARTICLE
How is the microbial diagnosis of bacterial vertebral osteomyelitis performed? An 11-year retrospective study Marie Amsilli 1,2 & Olivier Epaulard 1,2 Received: 13 April 2020 / Accepted: 12 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Vertebral osteomyelitis (VOM) is often diagnosed with delays, resulting in poorer outcomes. Microbial documentation is particularly challenging and obtained using blood cultures (BCs) and vertebral biopsies (VBs; CT-guided or surgical). We retrospectively analysed VOM cases in a tertiary reference centre between 2004 and 2015, focusing on how and how quickly microbiological diagnosis was performed. Among 220 VOM, 88.2% had documentation, including Gram-positive cocci (GPC) (70.6%), Gram-negative rods (GNR) (9.3%), anaerobes (3.6%), polybacterial infections (6.7%) and tuberculosis (9.8%). BCs were performed in 98.2% and positive in 59.3%, identifying most GPC (80.3%) and half of GNR (54.6%). VBs were performed in fewer cases (37.7%), but were more frequently positive (68.8% for CT-guided and 81.0% for surgical biopsies). They documented all anaerobes (100.0%), most M. tuberculosis (84.2%) and polybacterial infections (76.9%), and GNR (45.4%). Extra-vertebral samples highly contributed to tuberculosis diagnosis (52.6%, and 15.8% as the only positive sample). Documentations most often followed radiological diagnosis (53.4%). They were obtained earlier by BCs than by VB after first clinical symptoms (median of 14 versus 51 days). Antibiotic treatments were mostly initiated after samplings (88.0%). BCs allow the documentation of most VOM and should be performed without delay in case of clinical or radiological suspicion; however, they may miss 1 out of 5 GPC and 1 out of 2 GNR. VBs have a higher positivity rate and should be rapidly performed if negative BCs. It is likely that delayed and missed diagnoses result from the insufficient use of VB. Keywords Vertebral osteomyelitis . Microbiological diagnosis . Blood cultures . Vertebral biopsy . Diagnosis delay
Highlights • Blood cultures (BCs) and vertebral biopsies (VBs) are main VOM diagnosis techniques. • Both must be performed simultaneously, with systematic BCs and second-line VBs. • Microbiological samplings must not be delayed. • BCs allowed most pyogenic documentation, but missed some bacteria identified by VBs. • VBs and extravertebral samples are essential for documentation of M. tuberculosis. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-03929-1) contains supplementary material, which is available to authorized users. * Marie Amsilli [email protected]
1
Infectious and Tropical Diseases Unit, Grenoble-Alpes University Hospital, Grenoble, France
* Olivier Epaulard [email protected]
2
Fédération d’Infectiologie Multidisciplinaire de l’Arc Alpin, Université Grenoble Alpes, Grenoble, France
Eur J Clin Microbiol Infect Dis
Introduction
Definitions
Vertebral osteomyelitis (VOM) is a heterogeneous group of
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