3:38 PM Abstract No. 53 - The role of bone biopsy in osteomyelitis—utility or futility?

Abstract

Purpose To examine the usefulness of bone biopsy in diagnosis of osteomyelitis and its role in management. Materials and Methods We retrospectively reviewed cases of 42 bone biopsies performed by interventional radiology for suspected osteomyelitis. Data collected and analyzed from these cases included extent of associated soft tissue infection/ulceration; results from bone, wound, and fluid cultures; antibiotic therapy; radiologic findings; and clinical impression. Results Of 42 bone cultures, 12 (28.6%) were positive and 30 (71.4%) were negative. Of the 12 positive cases, 8 yielded bone culture results congruent with wound and/or fluid cultures, with no observed change in antibiotic therapy based on bone culture results. In 4 of the 12 culture-positive cases, different organisms were cultured from the bone than were cultured from the wound or fluid. No change in long-term broad-spectrum antibiotic therapy was observed in 3 of these 4 cases. The bone culture of the remaining case yielded mycobacterium tuberculosis, and the patient was subsequently treated with long-term multi-drug therapy. 6 of the 30 cases with negative bone cultures had positive wound cultures. 5 of these 6 cases involved patients with radiologic findings consistent with osteomyelitis. These cases were treated with long-term antibiotic therapy despite negative bone culture. The majority of cases (24 of 42, 57.1%) had congruently negative soft tissue and bone culture results, and treatment varied according to clinical impression and radiologic findings. Conclusion Our retrospective, observational study suggests that bone biopsy is a low-yield procedure playing a minor role in the diagnosis and treatment of osteomyelitis. A minority of bone cultures were positive. Additionally, we found only 1 case where bone biopsy results significantly altered antibiotic treatment. Negative bone culture results had no diagnostic utility, with the length and type of antibiotic treatment in these cases predicated solely on radiologic and clinical findings. Based on these results, we recommend bone biopsy only in highly selected cases, such as poor response to standard therapy or incongruent clinical and radiologic findings.