Nicholas Said MD, MBA, Presenter: Nothing to Disclose

Nicholas Cole Nacey MD, Abstract Co-Author: Nothing to Disclose

Managing osteomyelitis is a complex clinical challenge in patients who typically have many comorbid conditions. Image guided percutaneous biopsy is occasionally requested to guide antibiotic therapy. The purpose of the study is to determine the utility of bone biopsy in guiding the management of patients with osteomyelitis diagnosed by imaging and clinical evaluation.

After IRB approval, a retrospective chart review was performed inclusive of patients with a diagnosis of osteomyelitis based on clinical evaluation and imaging findings who underwent image guided biopsy, with the exclusion of spinal osteomyelitis. Histologic and microbiologic lab analysis were reviewed to determine the number of culture positive bone biopsies. A management decision was considered significantly altered by the biopsy results if the patient subsequently received antibiotic therapy targeted towards the cultured bacteria and the grown bacteria had not previously been cultured from other sites.

A total of 63 attempted bone biopsies for osteomyelitis were reviewed. The majority of these cases were either of the foot (28 biopsies) or pelvis (31 biopsies). Positive cultures were obtained in 8/63 cases (12.7%), 4 of which were foot biopsies and 4 of which were pelvic biopsies. Management decisions were altered by the culture findings in 3/8 (37.5%) patients with positive cultures, or 3/63 (4.8%) of all reviewed patients. Two biopsy associated complications were recorded, one needle fracture and one incident of analgesia related respiratory suppression resulting in cardiac arrest.

There is limited utility for bone biopsy in guiding the management of patients with imaging evidence of osteomyelitis given the low yield of culture positive results and the finding that antibiotic management is often unaltered despite a culture positive bone biopsy. The results represent a positive culture rate that is similar but slightly lower to those quoted in prior published studies. While the management of osteomyelitis is a complex issue, the finding of a similar rate of management alterations and immediate complications suggests that the procedure should best be reserved for difficult cases after careful consideration.

There is limited utility for bone biopsy in patients with imaging evidence of osteomyelitis given a similar rate post procedure management alterations and immediate complications.

Said, N, Nacey, N, Percutaneous Image Guided Biopsy of Osteomyelitis Has Low Impact on Guiding Antibiotic Management: A Retrospective Analysis of 63 Bone Biopsies.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015852.html