Diagnostic contribution of a second percutaneous needle biopsy in patients with spontaneous diskitis and negative blood cultures and first biopsy

ObjectivesThe primary objective was to assess the diagnostic contribution of a second percutaneous needle biopsy in patients with spontaneous diskitis and negative findings from blood cultures and the first biopsy. We also assessed the sensitivity of the first biopsy and the diagnostic contribution of post-biopsy blood cultures.MethodsMulticenter retrospective study of patients managed between 2004 and 2014. We excluded patients with postoperative diskitis.ResultsWe identified 63 patients with spontaneous diskitis, negative blood cultures, and at least one percutaneous needle biopsy during the study period. The first biopsy established the diagnosis in 33 (52%) patients. Of the 30 remaining patients, 10 (33%) had a second biopsy, which was positive in 6 (60%), and 20 (67%) received probabilistic antibiotic therapy. There were 8 positive blood cultures after the first biopsy but, among them, 7 occurred in biopsy-positive patients. Biopsy yield varied with the guidance method (needle guidance software or imaging by computed tomography and/or fluoroscopy) and operators. Antibiotic therapy within the 6 months preceding the first biopsy was significantly associated with having a negative first biopsy (15/30 versus 7/33; odds ratio, 3.13; 95% confidence interval, 1.07-9.13; P < 0.05).ConclusionIn our study, a second needle biopsy was useful, providing the bacteriological diagnosis in 60% of cases of spontaneous diskitis with negative findings from blood cultures and the first biopsy.