Wu Jim S, Gorbachova Tetyana, Morrison William B, Haims Andrew H
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Shapiro 4th Fl., Boston, MA 02215, USA.
AJR Am J Roentgenol. 2007 Jun;188(6):1529-34. doi: 10.2214/AJR.06.1286.
The objective of our study was to identify the clinical and technical factors associated with positive or negative culture results in histologically positive cases of osteomyelitis obtained from imaging-guided bone biopsies.
A retrospective review was performed of 800 consecutive patients undergoing imaging-guided core bone biopsies at two institutions. Seventy-five biopsies were performed for suspected osteomyelitis and 41 patients had histologically proven osteomyelitis. A chart review was performed to determine whether the following factors affected the culture result: histologic type of osteomyelitis, antibiotic therapy before biopsy, fever (temperature > or = 38.0 degrees C), elevated WBC count (> or = 10 x 10(3) microL), elevated erythrocyte sedimentation rate (ESR) (> or = 10 mm/h), elevated C-reactive protein value (CRP) (> or = 6 mg/L), the size of the biopsy needle, and the amount of purulent fluid obtained at biopsy.
Of the 41 cases of osteomyelitis, 14 (34%) had positive cultures. Eighteen (44%) of 41 cases were chronic osteomyelitis. Seventeen (41%) of 41 patients received antibiotics before biopsy, seven (17%) were febrile, five (12%) had an elevated WBC count, 16 (39%) had an elevated ESR, and six (15%) had an elevated CRP value. The biopsy needle size ranged from 11- to 18-gauge. These factors did not have any significant association with positive or negative culture results. Purulent fluid was aspirated in 10 (24%) of the 41 cases. In six (15%) of the cases, > or = 2 mL of purulent fluid was aspirated and five (83%) of the six cases were associated with positive culture (p = 0.02).
The rate of positive culture results in histologically proven cases of osteomyelitis obtained from imaging-guided bone biopsies is low. Aspirating > or = 2 mL of purulent fluid is associated with a significantly higher rate of positive cultures.
我们研究的目的是确定与影像学引导下骨活检组织学确诊为阳性的骨髓炎病例培养结果呈阳性或阴性相关的临床和技术因素。
对两家机构连续800例行影像学引导下骨芯活检的患者进行回顾性研究。对75例疑似骨髓炎患者进行了活检，41例患者经组织学证实患有骨髓炎。查阅病历以确定以下因素是否影响培养结果：骨髓炎的组织学类型、活检前的抗生素治疗、发热（体温≥38.0℃）、白细胞计数升高（≥10×10³/μL）、红细胞沉降率升高（≥10mm/h）、C反应蛋白值升高（≥6mg/L）、活检针大小以及活检时获取的脓性液体量。
41例骨髓炎病例中，14例（34%）培养结果为阳性。41例中有18例（44%）为慢性骨髓炎。41例患者中有17例（41%）在活检前接受了抗生素治疗，7例（17%）发热，5例（12%）白细胞计数升高，16例（39%）红细胞沉降率升高，6例（15%）C反应蛋白值升高。活检针大小为11号至18号。这些因素与培养结果呈阳性或阴性均无显著相关性。41例中有10例（24%）吸出了脓性液体。其中6例（15%）吸出的脓性液体≥2mL，这6例中有5例（83%）培养结果为阳性（p = 0.02）。
影像学引导下骨活检组织学确诊为骨髓炎的病例中，培养结果呈阳性的比例较低。吸出≥2mL脓性液体与培养结果呈阳性的比例显著更高相关。
