Outcome of culture-negative pyogenic vertebral osteomyelitis: Comparison with microbiologically confirmed pyogenic vertebral osteomyelitis

Kim, Jung Ok; Kim, So Hyun; Peck, Kyong Ran; Kim, Eun-Sang; Cho, Sun Young; Ha, Young Eun; Kang, Cheol-In; Chung, Doo Ryeon; Song, Jae-Hoon

doi:10.1016/j.semarthrit.2014.04.008

Cited by 46 publications

(63 citation statements)

References 19 publications

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“…On the contrary, the recent study by Kim et al showed a more favorable outcome in empirical treated patient versus patients with microbiologically confirmed spondylodiscitis. Kim et al suggest that the patients with culture negative spondylodiscitis often have a less severe infection and therefore a more better outcome [59]. In our review, no difference in outcome is seen between the studies with a low percentage of positive cultures versus studies with a high percentage.…”

Section: Discussioncontrasting

confidence: 47%

“…The percentage of positive cultures ranges from 42-100 % in the current review. The assumption that identification of the causative microorganism leads to more effective treatment is well established; however, there are no studies available to support this hypothesis [2,9,59]. On the contrary, the recent study by Kim et al showed a more favorable outcome in empirical treated patient versus patients with microbiologically confirmed spondylodiscitis.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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Background Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies. Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach. Results 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment. Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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“…However, various reports have shown that the treatment duration, mortality, and recurrence rate do not seem to differ between the patients with identification of the causative organism and those without46,63,89,96). Similarly, the data from the authors’ institute also show that the yield of a second biopsy in patients with negative results from a first fluoroscopy-guided biopsy was only 7.6%(2 out of 26 patients)45).…”

Section: Identification Of Causative Organismsmentioning

confidence: 65%

Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment

et al. 2017

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Pyogenic vertebral osteomyelitis (PVO) may result in neurological deficits and sequelae, so early diagnosis and appropriate treatment are critical. Many previous studies on PVO exist, but our paper has aimed to comprehensively summarize the clinical aspects of PVO. Through review of the vast literature on the clinical research of PVO an overview of the clinical characteristics, diagnostic methods, treatment and prognosis is provided.

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“…Moreover, the present study found no significant difference in outcome between biopsy culture-positive and culture-negative patients. A recent study by Kim et al [15] reported no significant difference ( P = 0.157) in treatment success (defined as survival and absence of signs of infection at the end of the therapy) either between 75 patients with microbiologically confirmed spondylodiscitis (whether by means of blood or biopsy cultures) and 76 patients without microbiologically confirmed spondylodiscitis. Given the above-mentioned numbers, and the fact that (despite being relatively safe, with transient complications in 2% [16]) CT-guided biopsy is costly, invasive, and uses potentially harmful ionizing radiation, the idea has been coined to manage patients without clinical findings suspicious for “atypical” pathogens with a course of empirical antibiotic therapy, without performing CT-guided biopsy [8].…”

Section: Discussionmentioning

confidence: 99%

CT-guided biopsy in suspected spondylodiscitis: microbiological yield, impact on antimicrobial treatment, and relationship with outcome

et al. 2018

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PurposeTo investigate the clinical impact of CT-guided biopsy, as performed in routine clinical practice, in patients with suspected spondylodiscitis on MRI in terms of culture yield, impact on antimicrobial treatment, and outcome.MethodsThis study included 64 patients with MRI findings compatible with spondylodiscitis who underwent CT-guided biopsy.ResultsInitial CT-guided biopsies were culture-positive in 20/64 (31.3%, 95% confidence interval [CI] 21.2–43.3%). Repeat CT-guided biopsies (after initial negative biopsy) were culture-positive in an additional 5/15 (33.3%, 95% CI 15.2–58.3%). Serum leukocytes, C-reactive protein, pre-biopsy use of antibiotics, neurological symptoms, MRI findings, vertebral height loss, and hyperkyphosis were not significantly different between culture-positive and culture-negative cases (P = 0.214–1.000); 75% (15/20) of initial CT-guided biopsies that were culture-positive provided additional information to clinicians for guiding antibiotic treatment. Sixty-two of 64 patients (96.9%, 95% CI 89.3–99.1%) would have been adequately treated if a strategy was followed that would subject all patients without clinical findings suspicious for “atypical” microorganisms and negative blood cultures to empirical antibiotics (i.e., clindamycin for coverage of Gram-positive bacteria) without using biopsy results to determine the optimal antibiotic regimen. Outcome within 6 months (development of neurologic or orthopedic complications, surgery, and death) was not significantly different (P = 0.751) between culture-positive and culture-negative patients.ConclusionsAlthough CT-guided biopsies are culture-positive in a minority of cases, the majority of positive cultures are useful to tailor antibiotic treatment. Empirical treatment with clindamycin may cover almost all micro-organisms in positive biopsy specimens, provided patients are not immunocompromised. Outcome appears similar between culture-positive and culture-negative patients.

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Outcome of culture-negative pyogenic vertebral osteomyelitis: Comparison with microbiologically confirmed pyogenic vertebral osteomyelitis

Cited by 46 publications

References 19 publications

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment

CT-guided biopsy in suspected spondylodiscitis: microbiological yield, impact on antimicrobial treatment, and relationship with outcome

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