Microbiological diagnosis of suspected vertebral osteomyelitis with a focus on the yield of percutaneous needle biopsy:
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ORIGINAL ARTICLE
Microbiological diagnosis of suspected vertebral osteomyelitis with a focus on the yield of percutaneous needle biopsy: a 10-year cohort study Gilles Avenel 1 & Pauline Guyader 2 & Elise Fiaux 3 & Didier Alcaix 4 & Charles Zarnitsky 4 & Sophie Pouplin-Jardin 1 & Marie Kozyreff-Meurice 1 & Thierry Lequerré 1 & Olivier Vittecoq 1 Received: 18 March 2020 / Accepted: 26 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract This study aims to evaluate in patients hospitalized for vertebral osteomyelitis (VO) the effectiveness of bacteriological diagnosis and the yield of percutaneous needle biopsy (PNB) and to identify factors associated with the result of PNB. This retrospective, two-centre study was conducted between 2000 and 2009. Data on patients with VO were retrieved from the diagnosis database and confirmed by checking medical records. A total of 300 patients with VO were identified; 31 received antibiotics without bacteriological diagnosis, and 269 patients with spondylodiscitis imaging were included. Eighty-three (30.9%) and 18 (6.7%) infections were documented by blood cultures and by bacteriological samples other than PNB, respectively; 168 patients with no bacteriological diagnosis had PNB. Of these, 92 (54.8%) were positive and identified the pathogen and 76 (45.2%) were negative. The most common bacteria were Staphylococcus aureus (34.3%), Streptococcus spp. (20.6%) and coagulase-negative staphylococcus (14.8%). After multivariate analysis, the only factor associated with negative PNB was previous antibiotic intake (OR: 2.31 [1.07–5.00]). When VO was suspected on imaging, bacteriological investigation identified the microorganism in 209/300 (70%) of the cases. The yield of PNB was 54.8%. The only predictor of PNB negativity was previous antibiotic intake. Therefore, we believe that a second PNB should be done after a sufficient delay withdrawal of antibiotics if the first sample was negative. The study was retrospectively registered by the local ethics committee (N°E2019-61). Keywords Vertebral osteomyelitis . Biopsy . Blood culture . Antibiotic
Background Vertebral osteomyelitis (VO) is a rare bacterial infection, with an incidence in France of 2.4/100,000 inhabitants per year
* Gilles Avenel [email protected] 1
Department of Rheumatology, Rouen University Hospital, F-76000 Rouen, France
2
Clinique du Ter, Ploemeur, France
3
Department of Infectious Diseases, Rouen University Hospital, F-76000 Rouen, France
4
Department of Rheumatology, Centre Hospitalier Jacques Monod, Montivilliers, France
between 2002 and 2003 [1]. This incidence is constantly increasing [1, 2]. Bacteriological diagnosis is crucial because VO needs a long antibiotic treatment of 6 to 12 weeks. A French study showed that a short antibiotic treatment, of less than 6 weeks, was not inferior to a prolonged treatment of 3 months [3]. This result remains controversial; indeed, Park et al. showed that in a subgroup of patients at high risk of relapse, prolonged treatment was su
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