Background: Patients with suspected vertebral osteomyelitis routinely undergo a biopsy procedure
early in their admission. Our goal is to assess the utility of surgical pathology
and other clinical factors in guiding treatment of vertebral osteomyelitis. Method(s): This was an IRB-approved retrospective review of CT-guided core biopsies for suspected
vertebral osteomyelitis. 67 patients met our inclusion criteria. A chart review was
performed for the following clinical factors to determine their impact on antibiotic
regimen changes: microbiological cultures, presence of paravertebral abscess/phlegmon,
fever, elevated erythrocyte sedimentation rate (ESR), elevated C-reactive protein,
and an elevated white blood cell count. Results were analyzed using SPSS (version
25, IBM), p-values were obtained using a Chi-squared test. Result(s): Of the 69 biopsied cases of vertebral osteomyelitis, 26 cases (38%) yielded positive
cultures. Among the group of positive cultures, 16 (62%) of the biopsies contributed
new information, isolating either a new or different organism. In the cases with positive
cultures, 15 (58%) had changes in their empiric antibiotics (p < 0.001). A change
in empiric antibiotic coverage was seen in 3 patients with negative biopsy cultures.
24 patients had a paravertebral abscess or phlegmon described in the pre-biopsy MRI.
In this subset of patients with paravertebral abscesses or phlegmon, a positive biopsy
culture was seen in 16 (66%) patients (p < 0.001). 10 patients who had positive cultures
did not have a paravertebral abscess or phlegmonous changes. In addition, no significant
association was noted with changes in antibiotic regimen in the presence of a fever,
leukocytosis, elevated ESR or CRP. Conclusion(s): Although CT-guided vertebral core biopsies are relatively low yield, they often provide
results that are clinically relevant for proper treatment. Positive culture results
contribute pertinent information and aid in identifying the most efficacious antibiotic(s)
for clinicians to formulate a successful treatment plan.
