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

Nicholas Said, Majid Chalian, Michael Fox, Nicholas C. Nacey

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
JournalSkeletal Radiology
DOIs
StatePublished - Jan 1 2019

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Image-Guided Biopsy
Osteomyelitis
Pelvis
Foot
Anti-Bacterial Agents
Biopsy
Bone and Bones
Microbiology
Radiology
Extremities

Keywords

  • Antibiotics
  • Osteomyelitis
  • Percutaneous bone biopsy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{905c61dd973f4d98a4d6a13e2e58867c,
title = "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",
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.",
keywords = "Antibiotics, Osteomyelitis, Percutaneous bone biopsy",
author = "Nicholas Said and Majid Chalian and Michael Fox and Nacey, {Nicholas C.}",
year = "2019",
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doi = "10.1007/s00256-019-3152-4",
language = "English (US)",
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T1 - Percutaneous image-guided bone biopsy of osteomyelitis in the foot and pelvis has a low impact on guiding antibiotics management

T2 - a retrospective analysis of 60 bone biopsies

AU - Said, Nicholas

AU - Chalian, Majid

AU - Fox, Michael

AU - Nacey, Nicholas C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Antibiotics

KW - Osteomyelitis

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