The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis

Jonas Marschall, Kavita P. Bhavan, Margaret A. Olsen, Victoria J. Fraser, Neill M. Wright, David K. Warren

Research output: Contribution to journalArticle

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Abstract

Background. Biopsy specimens are often obtained in the evaluation of hematogenous vertebral osteomyelitis. The effect of prebiopsy antibiotic exposure on pathogen recovery is unknown. Methods. We conducted a retrospective cohort study of adult inpatients with hematogenous vertebral osteomyelitis at a tertiary care hospital from 1 January 2003 through 31 July 2007. Antibiotic exposure within 14 days before biopsy was evaluated. Results. Of 150 patients with hematogenous vertebral osteomyelitis, 92 (61%) underwent a biopsy (60 [65%] needle and 32 [35%] open biopsies). The median time from admission to biopsy was 3 days (range, 0-69 days). Patients who underwent biopsy were more likely to have weakness (53 [58%] biopsy vs 15 [26%] no biopsy; P <. 001) and sensory loss (27 [29%] vs 6 [10%]; P =. 006), but were less likely to have a positive blood culture result (28 [30%] vs 30 [52%]; P =. 01). Pathogens were recovered in 61 patients (66%). Open biopsy had a higher yield than needle biopsy (29 [91%] of 32 vs 32 [53%] of 60; P <. 001). Sixty patients (65%) who had biopsies performed received antibiotics ≤14 days before the procedure (median duration, 4 days; range, 1-37 days). Open biopsy predicted positive biopsy culture results (adjusted odds ratio, 8.4; 95% confidence interval, 2.2-31.8), but there was no association of prebiopsy antibiotics with culture results (adjusted odds ratio, 2.3; 95% confidence interval, 0.8-6.2). Conclusions. A pathogen was recovered from 61 (66%) of 92 patients who had biopsies performed in this cohort of hematogenous vertebral osteomyelitis. Open biopsies had a higher microbiological yield than did needle biopsies. Antibiotic exposure before biopsy did not negatively impact pathogen recovery and should not be the sole reason for foregoing biopsies.

Original languageEnglish (US)
Pages (from-to)867-872
Number of pages6
JournalClinical Infectious Diseases
Volume52
Issue number7
DOIs
StatePublished - Apr 1 2011

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Osteomyelitis
Anti-Bacterial Agents
Biopsy
Needle Biopsy
Odds Ratio
Confidence Intervals
Tertiary Healthcare
Tertiary Care Centers
Needles
Inpatients

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. / Marschall, Jonas; Bhavan, Kavita P.; Olsen, Margaret A.; Fraser, Victoria J.; Wright, Neill M.; Warren, David K.

In: Clinical Infectious Diseases, Vol. 52, No. 7, 01.04.2011, p. 867-872.

Research output: Contribution to journalArticle

Marschall, Jonas ; Bhavan, Kavita P. ; Olsen, Margaret A. ; Fraser, Victoria J. ; Wright, Neill M. ; Warren, David K. / The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. In: Clinical Infectious Diseases. 2011 ; Vol. 52, No. 7. pp. 867-872.
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abstract = "Background. Biopsy specimens are often obtained in the evaluation of hematogenous vertebral osteomyelitis. The effect of prebiopsy antibiotic exposure on pathogen recovery is unknown. Methods. We conducted a retrospective cohort study of adult inpatients with hematogenous vertebral osteomyelitis at a tertiary care hospital from 1 January 2003 through 31 July 2007. Antibiotic exposure within 14 days before biopsy was evaluated. Results. Of 150 patients with hematogenous vertebral osteomyelitis, 92 (61{\%}) underwent a biopsy (60 [65{\%}] needle and 32 [35{\%}] open biopsies). The median time from admission to biopsy was 3 days (range, 0-69 days). Patients who underwent biopsy were more likely to have weakness (53 [58{\%}] biopsy vs 15 [26{\%}] no biopsy; P <. 001) and sensory loss (27 [29{\%}] vs 6 [10{\%}]; P =. 006), but were less likely to have a positive blood culture result (28 [30{\%}] vs 30 [52{\%}]; P =. 01). Pathogens were recovered in 61 patients (66{\%}). Open biopsy had a higher yield than needle biopsy (29 [91{\%}] of 32 vs 32 [53{\%}] of 60; P <. 001). Sixty patients (65{\%}) who had biopsies performed received antibiotics ≤14 days before the procedure (median duration, 4 days; range, 1-37 days). Open biopsy predicted positive biopsy culture results (adjusted odds ratio, 8.4; 95{\%} confidence interval, 2.2-31.8), but there was no association of prebiopsy antibiotics with culture results (adjusted odds ratio, 2.3; 95{\%} confidence interval, 0.8-6.2). Conclusions. A pathogen was recovered from 61 (66{\%}) of 92 patients who had biopsies performed in this cohort of hematogenous vertebral osteomyelitis. Open biopsies had a higher microbiological yield than did needle biopsies. Antibiotic exposure before biopsy did not negatively impact pathogen recovery and should not be the sole reason for foregoing biopsies.",
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AU - Fraser, Victoria J.

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AU - Warren, David K.

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N2 - Background. Biopsy specimens are often obtained in the evaluation of hematogenous vertebral osteomyelitis. The effect of prebiopsy antibiotic exposure on pathogen recovery is unknown. Methods. We conducted a retrospective cohort study of adult inpatients with hematogenous vertebral osteomyelitis at a tertiary care hospital from 1 January 2003 through 31 July 2007. Antibiotic exposure within 14 days before biopsy was evaluated. Results. Of 150 patients with hematogenous vertebral osteomyelitis, 92 (61%) underwent a biopsy (60 [65%] needle and 32 [35%] open biopsies). The median time from admission to biopsy was 3 days (range, 0-69 days). Patients who underwent biopsy were more likely to have weakness (53 [58%] biopsy vs 15 [26%] no biopsy; P <. 001) and sensory loss (27 [29%] vs 6 [10%]; P =. 006), but were less likely to have a positive blood culture result (28 [30%] vs 30 [52%]; P =. 01). Pathogens were recovered in 61 patients (66%). Open biopsy had a higher yield than needle biopsy (29 [91%] of 32 vs 32 [53%] of 60; P <. 001). Sixty patients (65%) who had biopsies performed received antibiotics ≤14 days before the procedure (median duration, 4 days; range, 1-37 days). Open biopsy predicted positive biopsy culture results (adjusted odds ratio, 8.4; 95% confidence interval, 2.2-31.8), but there was no association of prebiopsy antibiotics with culture results (adjusted odds ratio, 2.3; 95% confidence interval, 0.8-6.2). Conclusions. A pathogen was recovered from 61 (66%) of 92 patients who had biopsies performed in this cohort of hematogenous vertebral osteomyelitis. Open biopsies had a higher microbiological yield than did needle biopsies. Antibiotic exposure before biopsy did not negatively impact pathogen recovery and should not be the sole reason for foregoing biopsies.

AB - Background. Biopsy specimens are often obtained in the evaluation of hematogenous vertebral osteomyelitis. The effect of prebiopsy antibiotic exposure on pathogen recovery is unknown. Methods. We conducted a retrospective cohort study of adult inpatients with hematogenous vertebral osteomyelitis at a tertiary care hospital from 1 January 2003 through 31 July 2007. Antibiotic exposure within 14 days before biopsy was evaluated. Results. Of 150 patients with hematogenous vertebral osteomyelitis, 92 (61%) underwent a biopsy (60 [65%] needle and 32 [35%] open biopsies). The median time from admission to biopsy was 3 days (range, 0-69 days). Patients who underwent biopsy were more likely to have weakness (53 [58%] biopsy vs 15 [26%] no biopsy; P <. 001) and sensory loss (27 [29%] vs 6 [10%]; P =. 006), but were less likely to have a positive blood culture result (28 [30%] vs 30 [52%]; P =. 01). Pathogens were recovered in 61 patients (66%). Open biopsy had a higher yield than needle biopsy (29 [91%] of 32 vs 32 [53%] of 60; P <. 001). Sixty patients (65%) who had biopsies performed received antibiotics ≤14 days before the procedure (median duration, 4 days; range, 1-37 days). Open biopsy predicted positive biopsy culture results (adjusted odds ratio, 8.4; 95% confidence interval, 2.2-31.8), but there was no association of prebiopsy antibiotics with culture results (adjusted odds ratio, 2.3; 95% confidence interval, 0.8-6.2). Conclusions. A pathogen was recovered from 61 (66%) of 92 patients who had biopsies performed in this cohort of hematogenous vertebral osteomyelitis. Open biopsies had a higher microbiological yield than did needle biopsies. Antibiotic exposure before biopsy did not negatively impact pathogen recovery and should not be the sole reason for foregoing biopsies.

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