Utility Of Diagnostic Bone Biopsies In The Management Of Osteomyelitis Through Retrospective Analysis: How Golden Is The Gold Standard?

Esquivel, Ernie L.

UTILITY OF DIAGNOSTIC BONE BIOPSIES IN THE MANAGEMENT OF OSTEOMYELITIS THROUGH RETROSPECTIVE ANALYSIS: HOW GOLDEN IS THE GOLD STANDARD?

Cole B. Hirschfeld, BS¹, Shashi Kapadia, MD², Joanna Bryan, MPH², Deanna Jannat-Khah, MSPH, DrPH², Tamir Friedman, MD², Benjamin May, MD², Ole Vielemeyer, MD², Ernie L. Esquivel, MD², ¹Weill Cornell Medical College, New York, NY; ²Weill Cornell Medical College

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract Number: 95

Category: Research

Sub-Category: Other

Keywords: bone biopsy, non-vertebral OM, Osteomyelitis

Background: Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to identify predictors of a positive bone culture.

Methods: We retrospectively reviewed all cases of non-vertebral OM in patients who underwent image-guided bone biopsies between 2009 and 2016. Data on pathologic and microbiologic yield were collected and logistic regression was used to determine potential factors affecting the microbiologic yield. Post-biopsy empiric antibiotics and final antibiotics were compared to determine if there was a change in antibiotic treatment after biopsy results were reported.

Results: We evaluated 203 bone biopsies in 185 patients. Samples from 115 (57%) cases were sent to pathology, of which 33 (29%) confirmed OM. All samples were sent to microbiology and 57 (28%) yielded a positive result. Elevated white blood cell count (RR=1.05, p=0.023) was significantly associated with positive bone cultures in multivariate analyses. There was no association between positive cultures and number of samples cultured, needle size, prior antibiotic use, or antibiotic-free days. Post-biopsy empiric antibiotics were given in 138 (68%) cases. Therapy was narrowed to target specific organisms in 7 cases and changed due to inadequate empiric treatment in 3 cases. Targeted therapy was initiated in 4/65 cases, in which empiric antibiotics had been initially withheld. While final antibiotics were withheld in 38/146 with negative bone cultures, empiric antibiotics were discontinued in only 8 cases.

Conclusions: In patients with non-vertebral OM, bone biopsy cultures rarely yielded results that necessitated changes in antibiotic management. Identified bone organisms were treated by empiric therapy in most patients. While bone biopsy remains the gold standard diagnostic test for OM, further work is needed to identify patients whose management may be impacted by this procedure.

By admin|2020-02-25T16:03:55-05:00February 25th, 2020|

To cite this abstract:

Hirschfeld, C; Kapadia, S; Bryan, J; Jannat-Khah, D; Friedman, T; May, B; Vielemeyer, O; Esquivel, E.