ARRS 2022 Abstracts

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1559. Impact of Image-Guided Bone Biopsies on Antibiotic Management of Osteomyelitis in Adults
Authors * Denotes Presenting Author
  1. Seth Woods *; University of Nebraska Medical Center
  2. Ran Jing; University of Michigan
  3. Timothy Donovan; University of Nebraska Medical Center
Objective:
Osteomyelitis is an intraosseous inflammatory disease that is usually the result of an infection. If left untreated, osteomyelitis can lead to osteonecrosis, sepsis, or even death. Bone biopsy is the gold standard for the diagnosis of osteomyelitis; however, the yield of bone biopsies and their utility in helping to guide antibiotic therapy remain unclear. This retrospective study aims to assess the impact of image-guided bone biopsy on antibiotic management of osteomyelitis in adults.

Materials and Methods:
Out of 1835 documented bone biopsies performed on adults (age 19 years and above) at Nebraska Medicine between August 2012 to July 2020, 222 cases were screened for clinical suspicion of osteomyelitis, from which 97 bone biopsies in 88 patients were randomly selected for further evaluation. Information including subjects’ basic demographic information, pertinent medical histories, sites of biopsy, pathological, microbiological, and radiographic results, and the use of antibiotics was gathered and analyzed.

Results:
The overall yield of bone biopsy is low at 37.1%, with poor concordance between histopathological and microbiological findings. The yield is highest in vertebral bone biopsies at 41.3%. Overall, 59.1% of patients received empiric antibiotics in the 7-day period prior to bone biopsies, whereas patients who underwent vertebral bone biopsies were the least likely to have received empiric antibiotic treatment prior to the procedure at 50.0%. The association between antibiotic use prior to biopsies and the yield of bone culture was found not to be statistically significant. Osteomyelitis was radiologically diagnosed in 72.2% of the cases. The utility of bone biopsies in guiding antibiotic management in radiographically apparent osteomyelitis is limited in our study at 17.1%.

Conclusion:
Our study suggested that the overall yield of bone biopsy in suspected osteomyelitis cases is low, especially in non-vertebral bone biopsies, and the results of bone biopsies rarely change the clinical antibiotic management.