The biopsy site is critical for bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis.

Abstract

Backgrounds: Previous studies have found that the positive rate of bacterial culture after percutaneous needle biopsy in patients with suspected pyogenic spondylodiscitis is influenced by a number of factors. At the same time, the choice of puncture site in percutaneous biopsy has been controversial.

Objective: To explore the factors influencing the positive rate of bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis.

Methods: The medical records of 186 patients with suspected spinal infection who underwent C-type arm-guided percutaneous biopsy in Beijing Chest Hospital Affiliated to Capital Medical University from January 2023 to December 2023 were retrospectively analyzed. According to inclusion and exclusion criteria, a total of 116 patients with suspected pyogenic spondylodiscitis were included. The positive rate of bacterial culture was calculated, and the effects of age, gender, course of disease, preoperative fever, preoperative antibiotic use, preoperative white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate and puncture site on the positive rate of culture were discussed. Logistic regression analysis was used to identify the relevant factors affecting the positive rate of culture.

Results: Among the 116 patients, 63 were males and 53 were females. Age ranged from 13 to 87 years, with a median age of 59.5 years. The results of bacterial culture in 42 patients were positive, with a positive rate of 36.2% (42/116), including Staphylococcus aureus in 12 cases, streptococcus in 5 cases, Brucella in 5 cases, Escherichia coli in 4 cases, Staphylococcus epidermidis in 3 cases, Pseudomonas aeruginosa in 2 cases, Enterococcus faecalis in 2 cases, anaerobic bacteria in 2 cases and other bacteria in 7 cases. The positive rate of bacterial culture was 22.6% (14/62) in patients with vertebral body puncture and 51.9% (28/54) in patients with intervertebral disc puncture, and there was a significant difference between the two groups (P=0.001). Logistic regression analysis showed that the course of disease, the increase of C-reactive protein before puncture and the site of puncture were the factors influencing the positive rate of culture.

Conclusion: The course of disease, the elevation of CRP before puncture and the site of puncture were the factors influencing the positive rate of bacterial culture in percutaneous biopsy of pyogenic spondylodiscitis patients. The positive rate of obtaining intervertebral disc in percutaneous puncture was significantly higher than that of vertebral body, suggesting that intervertebral disc is a more critical puncture site.