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Microbiological diagnosis of vertebral osteomyelitis: relevance of second percutaneous biopsy following initial negative biopsy and limited yield of post-biopsy blood cultures

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Abstract

The purpose of this investigation was to evaluate the microbiological diagnosis yield of post-biopsy blood cultures (PBBCs) and second percutaneous needle biopsy (PNB) following an initial negative biopsy in vertebral osteomyelitis (VO) without bacteremia. A retrospective multicenter study was performed. Patients with VO, pre-biopsy negative blood culture(s), ≥1 PNB, and ≥1 PBBC (0–4 h) were included. One hundred and sixty-nine PNBs (136 first and 33 following initial negative biopsy) were performed for 136 patients (median age = 58 years, sex ratio M/F = 1.9). First and second PNBs had a similar yield: 43.4 % (59/136) versus 39.4 % (13/33), respectively. Only two PBBCs (1.1 %) led to a microbiological diagnosis. The strategy with positive first PNB and second PNB following an initial negative result led to microbiological diagnosis in 79.6 % (74/93) of cases versus 44.1 % (60/136) for the strategy with only one biopsy. In the multivariate analysis, young age (odds ratio, OR [95 % confidence interval (CI)] = 0.98 [0.97; 0.99] per 1 year increase, p = 0.02) and >1 sample (OR = 2.4 ([1.3; 4.4], p = 0.007)) were independently associated with positive PNB. To optimize microbiological diagnosis in vertebral osteomyelitis, performing a second PNB (after an initial negative biopsy) could lead to a microbiological diagnosis in nearly 80 % of patients. PBBC appears to be limited in microbiological diagnosis.

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Acknowledgments

We thank Eve Haguenoer, Anne Sophie Domelier, Roland Leclercq, Karine Fevre, and Renaud Verdon for the research support and helpful discussions.

We thank Cécile Eclache and Penelope Hodges for proofreading the manuscript.

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None.

Conflict of interest

None.

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Authors and Affiliations

  1. Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Tours, 2, bd Tonnellé, 37044, Tours, France

    G. Gras, R. Buzele & L. Bernard

  2. Service de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire, Caen, France

    J. J. Parienti

  3. Service de Rhumatologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France

    F. Debiais

  4. Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Garches, Garches, France

    A. Dinh

  5. Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    M. Dupon

  6. Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, Poitiers, France

    F. Roblot

  7. Service de Rhumatologie, Centre Hospitalier Universitaire de Tours, Tours, France

    D. Mulleman

  8. Service de Rhumatologie, Centre Hospitalier Universitaire de Caen, Caen, France

    C. Marcelli

  9. Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Caen, Caen, France

    J. Michon

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  1. G. Gras
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  2. R. Buzele
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  3. J. J. Parienti
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  4. F. Debiais
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  5. A. Dinh
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  6. M. Dupon
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  8. D. Mulleman
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  9. C. Marcelli
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  10. J. Michon
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  11. L. Bernard
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Correspondence to G. Gras.

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This study was performed in accordance with the French ethical committee and the principles of the Helsinki declaration.

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Gras, G., Buzele, R., Parienti, J.J. et al. Microbiological diagnosis of vertebral osteomyelitis: relevance of second percutaneous biopsy following initial negative biopsy and limited yield of post-biopsy blood cultures. Eur J Clin Microbiol Infect Dis 33, 371–375 (2014). https://doi.org/10.1007/s10096-013-1965-y

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  • DOI: https://doi.org/10.1007/s10096-013-1965-y

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