Abstract No. 551 Efficacy of bone biopsy in osteomyelitis

Abstract

Osteomyelitis (OM) is a difficult to treat infection. Treatment is guided by the extent of involvement and the offending pathogen. Several studies have highlighted the need for bone cultures, as they are the only reliable culture source. Percutaneous needle biopsy has traditionally been the method of choice for bone biopsy in OM. However, its efficacy has been recently come into question. In this retrospective observational study, we aimed to identify the impact of needle bone biopsy in the setting of OM. We hypothesized that the biopsy would not have any impact on the diagnosis of OM, but would alter clinical management, namely antibiotic therapy. The RRSB at University of Rochester approved this retrospective cohort study. Bone biopsies when indicated for OM were identified between Jan 2016 and Dec 2016. Several factors were examined including patient age, gender, biopsy needle gauge, target bone, result, imaging, etc. Fisher’s exact test and two-tailed independent t-tests were performed across several variables. A total of 61 biopsies were reviewed, 53 were included in the final analysis. There was no statistical difference across the groups with respect to age, gender, prevalence of diabetes, biopsy needle gauge, or biopsy site. There was a statistically significant difference (p=.0254) between the two groups with respect to positive culture results. Positive cultures were associated with a change in management. Of the 14 patients who had negative culture result, antibiotics were not started or ended on 5 patients, 2 patients had antibiotics held due to clinical improvement, 3 were changed empirically, and the remaining four were not specified. A cost estimate demonstrated a potential savings of $316.32 per patient based on CPT 88307. Bone biopsy is essential tool that has significant clinical impact on OM treatment guiding antibiotic selection and length. Bone biopsy should be focused on obtaining adequate cultures. Pathological testing should be limited to patients with unclear diagnosis, low clinical suspicion of OM or to different acute vs chronic osteomyelitis in select ambiguous cases.