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The impact of antibiotic pre‐treatment on diagnostic yield of CT‐guided biopsy for spondylodiscitis: A multi‐centre retrospective study and meta‐analysis
Author(s) -
Wong Hayley,
Tarr Gregory P,
Rajpal Kunaal,
Sweetman Lara,
Doyle Anthony
Publication year - 2021
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.13118
Subject(s) - spondylodiscitis , medicine , antibiotics , biopsy , discitis , retrospective cohort study , tuberculosis , linezolid , surgery , radiology , staphylococcus aureus , vancomycin , pathology , bacteria , microbiology and biotechnology , genetics , magnetic resonance imaging , biology
Patients with suspected spondylodiscitis often undergo CT‐guided biopsy to identify a causative microbiological organism. Antibiotic pre‐treatment has been postulated as a cause for a negative biopsy, although previous clinical studies have been heterogenous with a meta‐analysis suggesting no effect. The aim of this study was to assess the impact of antibiotic pre‐treatment on microbiological yield. Methods Retrospective review of consecutive adult patients undergoing CT‐guided biopsy for suspected spondylodiscitis in two tertiary centres between 2010 and 2016. Demographic, procedural and clinical data were collected. Antibiotic pre‐treatment was ascertained from patient drug charts. Results Over the 6‐year period, 104 biopsies in 104 patients were included. 51% had a positive microbiological yield at CT‐guided biopsy, with the most common isolated organism being Staphylococcus aureus (10.6%). Over two thirds of patients (69.3%) were off antibiotics at time of biopsy. There was no significant difference in microbiological yield in those patients on versus off antibiotics (48.2% vs 54.2%, P = 0.55). 10.6% patients had a final diagnosis of Mycobacterium tuberculosis spondylodiscitis, and this organism was significantly associated with a positive microbiological yield (90.9% vs 46.2%, P = 0.01). There was an inverse association between the presence of fever and sepsis with positive microbiological yield. Conclusions CT‐guided biopsy in suspected spondylodiscitis obtains a positive microbiological yield in about half of patients. This was significantly higher in patients diagnosed with tuberculosis spondylodiscitis, but there was no significant difference with antibiotic pre‐treatment. Therefore, antibiotic pre‐treatment should not preclude clinicians from pursuing a microbiological sample through CT‐guided biopsy.