Clinical and Radiological Predictors of Positive Microbiological Yield in Vertebral Osteomyelitis: A Retrospective Cohort Study

Ilhan Nahit Mutlu; Ali Dablan; Mehmet Cingoz; Beyza Oncel; Ozgur Kilickesmez

doi:10.58600/eurjther2233

Authors

Ilhan Nahit Mutlu Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Türkiye https://orcid.org/0000-0002-9326-5432
Ali Dablan Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Türkiye https://orcid.org/0000-0003-4198-4416
Mehmet Cingoz Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Türkiye https://orcid.org/0000-0002-6937-2692
Beyza Oncel Department of Medical Microbiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Türkiye https://orcid.org/0000-0002-2857-8635
Ozgur Kilickesmez Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Türkiye https://orcid.org/0000-0003-4658-2192

DOI:

https://doi.org/10.58600/eurjther2233

Keywords:

biopsy, discitis, osteomyelitis, vertebra, spinal infection

Abstract

Objective: To evaluate demographic, laboratory, biopsy, and imaging variables as potential predictors of microbial identification in patients with suspected vertebral osteomyelitis, aiming to enhance diagnostic accuracy and optimize patient care.

Methods: This retrospective cohort study analyzed 83 patients who underwent image-guided percutaneous disc-space sampling between June 2020 and December 2023. Inclusion criteria were adults aged ≥18 years with imaging-based evidence of vertebral osteomyelitis and clinical suspicion of infection. Exclusion criteria were presence of known malignancy and non-infective causes. Demographics, clinical history, imaging, biopsy, and microbiology data were collected. Logistic regression analysis was used to identify predictors of positive microbiological yield.

Results: Microorganisms were identified in 32 of 83 cases (38.6%), with Mycobacterium tuberculosis being the most common pathogen identified (21.9%). Elevated C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and paravertebral signal changes on MRI were associated with a positive culture yield. Multivariate analysis identified CRP as an independent predictor of positive microbiological results. CT-guided percutaneous biopsy was found to be safe, with no major complications reported.

Conclusion: CT-guided percutaneous biopsy is a reliable and safe diagnostic tool for identifying the causative pathogens in vertebral osteomyelitis. Elevated CRP levels were independently associated with positive microbiological yield, highlighting its role as a crucial predictor in clinical practice. These findings underscore the importance of incorporating CRP levels into the diagnostic process, potentially guiding the selection of patients for biopsy to improve the detection of infection.

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References

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