title: Diagnostic contribution of a second percutaneous needle biopsy in patients with spontaneous diskitis and negative blood cultures and first biopsy.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  Multicenter retrospective study of patients managed between 2004 and 2014. We excluded patients with postoperative diskitis.
  
  
  RESULTS
  We 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 6months 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).
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Service de rhumatologie, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France. Electronic address: wterreaux@gmail.com.
authors.forename: William
authors.initials: W
authors.lastname: Terreaux
authors.affiliation: Service de rhumatologie, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Geoffroy
authors.affiliation: Service de chirurgie orthopédique, hôpital Maison-Blanche, CHU de Reims, 51092 Reims, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ohl
authors.affiliation: Service de radiologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Job
authors.affiliation: Service de radiologie, centre hospitalier Charleville-Mézières, 51008 Charleville-Mézières, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cart
authors.affiliation: Service de rhumatologie, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Eschard
authors.affiliation: Service de rhumatologie, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France; EA 3797, Champagne Ardenne, faculté de médecine, université de Reims, 51095 Reims, France.
authors.forename: Jean-Hugues
authors.initials: JH
authors.lastname: Salmon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle / Q000379:methods / Q000706:statistics & numerical data*; D000071997:Blood Culture / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D015299:Discitis / Q000382:microbiology* / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Antibiotic therapy; Blood cultures; Diskitis; Needle guidance software; Percutaneous needle disk biopsy