Abstract
In management of patients with pyogenic vertebral osteomyelitis, organism isolation by biopsy is generally considered to be of primary importance when constructing a treatment plan. In our clinical practice, however, patients can be successfully treated even without identifying the organisms. The objective of this study is to review our clinical experiences and clarify the therapeutic impact of organism isolation. Forty patients who were conservatively managed in our institution constituted the base of this study. The average follow-up period was 16.7 months. Among the study subjects, 13 patients underwent percutaneous needle biopsy and the organism was identified in 6 patients. Additionally, the organism was isolated from the sample obtained from blood and possible foci in 10 patients. In total, the causative organism was identified in 15 of the 40 patients (37.5%). Patients were divided into two groups based on whether the organism was identified by culture (Groups A and B, with and without organism isolation respectively). The duration of antibiotic therapy was not significantly different between the groups (Group A: 4.8 ± 1.6 months, Group B: 4.3 ± 2.1 months), while subsequent mortalities in Group A and B were 13.3% and 8% without significant intergroup difference. Organism isolation did not productively help select the effective antibiotics and reduce the treatment period or mortality rate in treatment of patients with pyogenic vertebral osteomyelitis. Therefore, current strategic antibiotic therapy may be effective in eradicating infection even without identification of the causative organism in treatment of patients with pyogenic vertebral osteomyelitis.
Highlights
In management of pyogenic vertebral osteomyelitis (PVO), isolation of the causative organism is generally considered to be a key to constitution of an effective treatment regimen
Among the 13 patients who underwent percutaneous needle biopsy, organisms were identified in 7 patients (53.8%)
Organisms were identified in 15 patients (Group A); the antibiotics that were already administered at the corresponding time period were found to be effective in 14 of these
Summary
In management of pyogenic vertebral osteomyelitis (PVO), isolation of the causative organism is generally considered to be a key to constitution of an effective treatment regimen. A culture of the sample obtained from the percutaneous spinal biopsy is primarily performed to find out the antibiotics to which the identified organism is sensitive (Currier et al 2006; Grados et al 2007; Mylona et al 2008). In addition to the biopsied specimen, other samples from blood and other possible foci are subjected to culturing to survey for the potential source of infection (Carragee 1997; Weinberg and Silber 2004). Regarding the significance of bacteriological examination of the biopsied specimen, it has been reported that the frequency of organism isolation by biopsy is consistently feasible and
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