Crisologo Peter Andrew, La Fontaine Javier, Wukich Dane K, Kim Paul J, Oz Orhan K, Lavery Lawrence A
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Wounds. 2019 Aug;31(8):205-212.
The aim of this meta-analysis is to evaluate the effect of withholding antibiotics prior to obtaining a bone biopsy in the diagnosis of osteomyelitis.
Literature searches on Scopus, PubMed, and Google Scholar were performed with the input antibiotic, bone, biopsy, osteomyelitis, and prior both separately and together, though initially as a combination, as key words for all study types in the English language published up until July 2018. The initial combination search (and subsequent additional search of the references) yielded 924 related articles, which ultimately resulted in 12 articles with adequate data for analysis. Data were analyzed using an inverse variance method to determine the weight of the studies in a random effects model, pooling the data for odds ratios (OR) and heterogeneity. Bias risk was determined with the Quality Assessment of Diagnostic Accuracy Studies 2 system.
Of the 12 studies, 8 failed to demonstrate that antibiotics administered prior to bone biopsy have an effect on culture yield, while 4 reported a significant effect on culture yield. The total weighted OR for all studies was 2.02 (95% confidence interval [CI], 0.94-4.36; P = .04) and the prediction interval was 0.17-23.63. When vertebral osteomyelitis (VO) and nonvertebral osteomyelitis (NVO) articles were evaluated separately, the VO OR was 2.95 (95% CI, 1.40-6.24) and the prediction interval was 0.40-21.53. The OR for NVO was 0.66 (95% CI, 0.04-12.03) and the prediction interval was 0-114.53.
When all studies as well as when NVO studies only were evaluated, there was no significant difference in bacterial pathogen yield based on antibiotic exposure. When VO studies were evaluated separately, there were fewer pathogens recovered than when antibiotics were administered prior to obtaining bone cultures.
本荟萃分析旨在评估在进行骨活检以诊断骨髓炎之前停用抗生素的效果。
在Scopus、PubMed和谷歌学术上进行文献检索，将“抗生素”“骨”“活检”“骨髓炎”以及“之前”分别和组合作为关键词，检索截至2018年7月发表的所有英文研究类型。最初的组合检索（以及随后对参考文献的额外检索）产生了924篇相关文章，最终得到12篇有足够数据进行分析的文章。使用逆方差法分析数据，以确定随机效应模型中各研究的权重，汇总比值比（OR）和异质性数据。采用诊断准确性研究质量评估2系统确定偏倚风险。
在这12项研究中，8项未能证明在骨活检前使用抗生素对培养结果有影响，而4项报告对培养结果有显著影响。所有研究的总加权OR为2.02（95%置信区间[CI]，0.94 - 4.36；P = 0.04），预测区间为0.17 - 23.63。当分别评估椎体骨髓炎（VO）和非椎体骨髓炎（NVO）的文章时，VO的OR为2.95（95%CI，1.40 - 6.24），预测区间为0.40 - 21.53。NVO的OR为0.66（95%CI，0.04 - 12.03），预测区间为0 - 114.53。
当评估所有研究以及仅评估NVO研究时，基于抗生素暴露的细菌病原体培养结果没有显著差异。当单独评估VO研究时，与在获取骨培养物之前使用抗生素相比，回收的病原体较少。
