Introduction
Materials and methods
Search strategy
Study selection
Study quality
Statistical analysis
Results
Literature search
Study | Country | Data acquisition | Number of patientsa | Age in years (range)a | Gender (male/female)a | Patient spectruma | CRP levels in mg/L (range)a | Leukocyte count ×109 (range)a |
---|---|---|---|---|---|---|---|---|
Ahuja and Sharma [10] | UK | Retrospective | 45 | 62.3b (28–87) | 26/19 | Patients with suspected spinal infection based on clinical and MRI findings Postoperative spinal infections were excluded | 58c (30–90d) | 8.46b (2.4–9) |
Terreaux et al. [11] | France | Retrospective | 63 | 68.2b (NR) | 34/29 | Patients with spontaneous spondylodiscitis and negative blood cultures Patients with postoperative spondylodiscitis, positive blood cultures before the development of spontaneous spondylodiscitis, spontaneous discitis with negative blood cultures investigated by surgical biopsy, tumors, and crystal deposition disease were excluded | NR | NR |
Gras et al. [12] | France | Retrospective | 136 | 58c (47–69d) | 89/47 | Hospitalized patients ≥18 years with spondylodiscitis, pre-biopsy negative blood culture(s), CT-guided biopsy by an interventional radiologist and one or more post-biopsy blood cultures (0–4 h) Patients with continuous osteomyelitis due to decubitus ulcers, a vertebral device, brucellosis, and tuberculous spondylodiscitis were excluded Patients receiving antibiotics within 2 weeks preceding the biopsy were also excluded | NR | NR |
Kim et al. [13] | South Korea | Retrospective | 140 | 65.1b (16–89) | 70/70 | Patients in whom fluoroscopy-guided biopsy was performed to confirm or rule out the clinical or radiological possibility of spondylodiscitis Patients who underwent biopsy for suspected primary bone tumor or metastases were excluded | NR | NR |
Gasbarrini et al. [14] | Italy | Prospective | 69 | 60b (5–85) | 37/32 | Patients in whom CT-guided biopsy was performed in the case of infection indicated on MRI, elevated inflammation markers (ESR, CRP), with a thoracic, lumbar or sacral lesion (cervical lesions were excluded), the absence of bacteriological isolation elsewhere, the absence of indication for emergency surgery, and in whom no antibiotic therapy was initiated or who were outside the therapeutic window of a previously taken antibiotic | NR | NR |
Lora-Tamayo et al. [15] | Spain | Retrospective | 72 | 66 (NR) | 43/29 | Patients with pyogenic spondylodiscitis Postsurgical cases of pyogenic osteomyelitis, cases of facet joint infection with no involvement of the intervertebral disc or vertebral bodies, and cases due to Mycobacterium tuberculosis, Brucella species, and fungus were excluded | NR | NR |
De Lucas et al. [16] | Spain | Retrospective | 40 | 58b (1–88) | 24/16 | Patients with confirmed spondylodiscitis, based on imaging findings, positive cultures from CT-guided or surgical biopsy, or blood samples and satisfactory evolution after antibiotic treatment | NR | NR |
Friedman et al. [17] | USA | Retrospective | 48 | 68.2b (NR) | 26/22 | Adult patients with spontaneous infectious spondylodiscitis who were treated by a single surgeon over a 5-year period and patients with postoperative discitis over the same time period | NR | NR |
Study | Availability of MRI before tissue sampling | MRI criteria for spondylodiscitis | MRI readers | Time between MRI and biopsy | Time between the initial and second biopsies | Type of image guidance for biopsy | Gauge, number of samples | Tissue targeted | Second biopsy of the same area as first biopsy | Physician(s) who performed biopsy |
---|---|---|---|---|---|---|---|---|---|---|
Ahuja and Sharma [10] | Yes | NR | NR | NR | NR | CT | NR, NR | NR | NR | Radiologist |
Terreaux et al. [11] | Yes (in 60/63 [95%]) | NR | NR | NR | 14.4a ± 7.9 | CT or fluoroscopic | 11 to 14, NR | Disc | NR | NR |
Gras et al. [12] | NR | NR | NR | NR | NR | CT | NR, 2.5a | Vertebral corpus | NR | Interventional radiologist |
Kim et al. [13] | NR | NR | NR | NR | NR | Fluoroscopic | 15, >2 | Vertebral corpus/disc/paravertebral abscess | 22/26 same area 4/26 different area | NR |
Gasbarrini et al. [14] | Yes | Hypointense on T1, hyperintense on T2, morphologically consistent with infection | NR | NR | NR | CT | 8 or 11, NR | Bone/disc | NR | Both interventional radiologist and surgeon, whenever possible |
Lora-Tamayo et al. [15] | NR | NR | NR | NR | NR | CT | 13.55 to 22b, NR | Vertebral corpus/disc/abscess/paraspinal phlegmon | NR | Musculoskeletal radiologists |
De Lucas et al. [16] | Yes (in 32/40 [80%]) | NR | Radiologist | NR | NR | CT | 20–22, NAc | Vertebral corpus/disc/paravertebral soft tissue/abscess | NR | NR |
Friedman et al. [17] | NR | NR | NR | NR | NR | NR | NR | Disc | NR | NR |
Methodological quality assessment
Study | Risk of bias | Applicability concerns | |||
---|---|---|---|---|---|
Patient selection | Biopsy | Flow and timing | Patient selection | Biopsy | |
Ahuja and Sharma [10] | High | Low | Unclear | Unclear | Low |
Terreaux et al. [11] | High | Low | Unclear | Unclear | Low |
Gras et al. [12] | High | Low | Unclear | Unclear | Low |
Kim et al. [13] | High | Low | Unclear | Unclear | Low |
Gasbarrini et al. [14] | High | Low | Unclear | Unclear | Low |
Lora-Tamayo et al. [15] | High | Low | Unclear | Unclear | Low |
De Lucas et al. [16] | High | Low | Unclear | Unclear | Low |
Friedman et al. [17] | Low | Unclear | Unclear | Unclear | Unclear |
Culture yield of the repeat biopsy
Study | Number of culture-positive initial biopsies | Cultured micro-organisms of the initial biopsy | Number of culture-positive second biopsies after a negative initial biopsyc | Cultured micro-organisms on repeat biopsyc |
---|---|---|---|---|
Ahuja and Sharma [10] | 19/45 (42.2%) | Escherichia coli (n = 2) Propronibacterium acnes (n = 2) Staphylococcus aureus (n = 2) Candida albicans (n = 1) Coagulase-negative staphylococci (n = 1) Enterococcus faecium (n = 1) Group B hemolytic streptococci (n = 1) Klebsiella oxytoca (n = 1) Methicillin-resistant Staphylococcus aureus (n = 1) Mycobacterium tuberculosis = (n = 1) Pseudomonas aeruginosa = (n = 1) Staphylococcus capitis = (n = 1) Streptococcus sanguinis = (n = 1) Staphylococcus aureus and Propionibacterium acnes (n = 1) Coagulase-negative staphylococci, Propionibacterium acnes, and Streptococcus mutans (n = 1) Nonhemolytic streptococci and Propionibacterium spp. (n = 1) | 1/7 (14.3%) | Staphylococcus epidermidis and Propionibacterium acnes (n = 1) |
Terreaux et al. [11] | 33/63 (52.4%) | Methicillin-susceptible Staphylococcus aureus (n = 9) Staphylococcus epidermidis (n = 8) Mycobacterium tuberculosis (n = 3) Streptococcus constellatus (n = 3) Propionibacterium acnes = (n = 2) Methicillin-resistant Staphylococcus aureus (n = 1) Enterococcus hirae (n = 1) Klebsiella pneumoniae (n = 1) Staphylococcus caprae (n = 1) Streptococcus mutans (n = 1) Streptococcus dysgalactiae (n = 1) Streptococcus milleri type 2 (n = 1) Escherichia coli (n = 1) | 6/10 (60.0%) | Streptococcus (n = 3) Prevotella denticola (n = 1) Pseudomonas aeruginosa (n = 1) Mycobacterium tuberculosis (n = 1) |
Gras et al. [12] | 59/136 (43.4%) | NR | 13/33 (39.4%) | NR |
Kim et al. [13] | 51/170 (30.0%) | Mycobacterium tuberculosis (n = 26) Staphylococcus aureus (n = 13) Streptococcus agalactiae (n = 4) Streptococcus viridans (n = 2) Coagulase-negative Staphylococcus organisms (n = 1) Escherichia coli (n = 1) Enterococcus faecalis (n = 1) Enterobacter cloacae (n = 1) Staphylococcus epididymis (n = 1) Klebsiella (n = 1) | 2/26 (7.7%) | Mycobacterium tuberculosis (n = 1) Staphylococcus aureus (n = 1) |
Gasbarrini et al. [14] | 11/24 (45.8%)a | Mycobacterium tuberculosis (n = 3) Staphylococcus hominis (n = 2) Methicillin-resistant Staphylococcus aureus (n = 1) Methicillin-susceptible Staphylococcus aureus (n = 1) Streptococcus spp. (n = 1) Streptococcus constellatus (n = 1) Pseudomonas aeruginosa (n = 1) Escherichia coli (n = 1) | 0/2 (0.0%) | NA |
Lora-Tamayo et al. [15] | 3/29 (10.3%) | NR | 2/6 (33.3%) | NR |
De Lucas et al. [16] | NRb | NR | 1/4 (25.0%)d | Mycobacterium tuberculosis (n = 1) |
Friedman et al. [17] | 21/40 (52.5%) | NR | 8/19 (42.1%) | NR |