{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:40:03Z","timestamp":1763559603401,"version":"3.45.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011912","name":"Washington University School of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011912","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected nonvertebral osteomyelitis in adults is heterogenous in published studies because of small sample size, indicating the need for large cohort studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of ICNBs was performed from 2010 to 2021 for patients with suspected nonvertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. Additionally, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. Multivariate statistical analysis was performed to evaluate the factors associated with yield.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 883 biopsies performed on 787 patients were included. A histopathologic diagnosis of osteomyelitis was made in 51.6% (381\/738) of biopsies, and microbiological cultures were positive in 28.7% (253\/883) of biopsies. Antimicrobial exposure before biopsy was negatively associated with positive cultures from bone core samples (odds ratio [OR] = 0.52; 95% confidence interval [CI], .33\u2013.83; P = .0005). Elevated hemoglobin A1c (continuous variable) (OR = 1.38; 95% CI, 1.03\u20131.86; P = .03), and purulent aspirate (OR = 28.1; 95% CI, 2.67\u20131.86; P = .03) were positively associated with positive cultures from aspirate samples. Clinical management was affected by ICNB in 26.2% (231\/883) of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in more than one fourth of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary Statement<\/jats:title>\n                    <jats:p>In a retrospective study of 883 image-guided biopsies of suspected nonvertebral osteomyelitis, microbiological cultures were positive in 28.7% (253\/883) of biopsies, a histopathologic diagnosis of osteomyelitis was made in 51.6% (197\/381), and 26.2% (231\/883) of biopsies affected clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf665","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T12:58:40Z","timestamp":1761656320000},"source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Efficacy and Clinical Impact of Image-guided Core Needle Biopsy of Suspected Adult Nonvertebral Osteomyelitis"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6795-2597","authenticated-orcid":false,"given":"Winston L","family":"Winkler","sequence":"first","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ige A","family":"Geroge","sequence":"additional","affiliation":[{"name":"John T. Milliken Department of Internal Medicine, Division of Infectious Disease, Washington University in St. Louis School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumanth","family":"Gandra","sequence":"additional","affiliation":[{"name":"John T. Milliken Department of Internal Medicine, Division of Infectious Disease, Washington University in St. Louis School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan C","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anderanik","family":"Tomasian","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, University of Southern California , Los Angeles, California ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0454-8789","authenticated-orcid":false,"given":"Benjamin","family":"Northrup","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5135-9185","authenticated-orcid":false,"given":"Theodore L","family":"Vander Velde","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis J","family":"Hillen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3682-9454","authenticated-orcid":false,"given":"Chongliang","family":"Luo","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Washington University School of Medicine in St. Louis , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4965-4557","authenticated-orcid":false,"given":"Resten","family":"Imaoka","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gino M","family":"Dettorre","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack W","family":"Jennings","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology , St. Louis, Missouri ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"2025111908371014400_ofaf665-B1","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1056\/NEJM199704033361406","article-title":"Osteomyelitis","volume":"336","author":"Lew","year":"1997","journal-title":"N Engl J Med"},{"key":"2025111908371014400_ofaf665-B2","doi-asserted-by":"crossref","first-page":"nihpa116823","DOI":"10.3810\/psm.2008.12.11","article-title":"Osteomyelitis: approach to diagnosis and treatment","volume":"36","author":"Fritz","year":"2008","journal-title":"Phys Sportsmed"},{"key":"2025111908371014400_ofaf665-B3","doi-asserted-by":"crossref","first-page":"e3280","DOI":"10.1002\/dmrr.3280","article-title":"Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Lipsky","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"2025111908371014400_ofaf665-B4","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1093\/cid\/cis346","article-title":"2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2025111908371014400_ofaf665-B5","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/00000441-200106000-00002","article-title":"Effect of bone biopsy in guiding antimicrobial therapy for osteomyelitis complicating open wounds","volume":"321","author":"Khatri","year":"2001","journal-title":"Am J Med Sci"},{"key":"2025111908371014400_ofaf665-B6","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.ijsu.2010.11.011","article-title":"Role of bone biopsy specimen culture in the management of diabetic foot osteomyelitis","volume":"9","author":"Elamurugan","year":"2011","journal-title":"Int J Surg"},{"key":"2025111908371014400_ofaf665-B7","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1086\/498112","article-title":"Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures","volume":"42","author":"Senneville","year":"2006","journal-title":"Clin Infect Dis"},{"key":"2025111908371014400_ofaf665-B8","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1007\/s00270-017-1658-5","article-title":"CIRSE guidelines on percutaneous needle biopsy (PNB)","volume":"40","author":"Veltri","year":"2017","journal-title":"Cardiovasc Intervent Radiol"},{"key":"2025111908371014400_ofaf665-B9","doi-asserted-by":"crossref","first-page":"813","DOI":"10.2214\/ajr.158.4.1546598","article-title":"Percutaneous needle biopsy of musculoskeletal lesions. 2. Cost-effectiveness","volume":"158","author":"Fraser-Hill","year":"1992","journal-title":"AJR Am J Roentgenol"},{"key":"2025111908371014400_ofaf665-B10","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2214\/AJR.20.24313","article-title":"Best practices: CT-guided percutaneous sampling of vertebral discitis-osteomyelitis and technical factors maximizing biopsy yield","volume":"217","author":"Husseini","year":"2021","journal-title":"AJR Am J Roentgenol"},{"key":"2025111908371014400_ofaf665-B11","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1093\/cid\/civ482","article-title":"2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults","volume":"61","author":"Berbari","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2025111908371014400_ofaf665-B12","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1086\/597263","article-title":"Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot","volume":"48","author":"Senneville","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2025111908371014400_ofaf665-B13","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.2214\/AJR.06.1286","article-title":"Imaging-guided bone biopsy for osteomyelitis: are there factors associated with positive or negative cultures?","volume":"188","author":"Wu","year":"2007","journal-title":"AJR Am J Roentgenol"},{"key":"2025111908371014400_ofaf665-B14","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.2214\/ajr.164.5.7717232","article-title":"Does the use of lidocaine affect the culture of percutaneous bone biopsy specimens obtained to diagnose osteomyelitis? An in vitro and in vivo study","volume":"164","author":"Schweitzer","year":"1995","journal-title":"AJR Am J Roentgenol"},{"key":"2025111908371014400_ofaf665-B15","doi-asserted-by":"crossref","first-page":"e16954","DOI":"10.1097\/MD.0000000000016954","article-title":"Impact of diagnostic bone biopsies on the management of non-vertebral osteomyelitis: a retrospective cohort study","volume":"98","author":"Hirschfeld","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2025111908371014400_ofaf665-B16","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s00256-019-3152-4","article-title":"Percutaneous image-guided bone biopsy of osteomyelitis in the foot and pelvis has a low impact on guiding antibiotics management: a retrospective analysis of 60 bone biopsies","volume":"48","author":"Said","year":"2019","journal-title":"Skeletal Radiol"},{"key":"2025111908371014400_ofaf665-B17","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1111\/1753-0407.13377","article-title":"Is fluoroscopy-guided percutaneous bone biopsy of diabetic foot with suspected osteomyelitis worthwhile? A retrospective study","volume":"15","author":"Al-Balas","year":"2023","journal-title":"J Diabetes"},{"key":"2025111908371014400_ofaf665-B18","doi-asserted-by":"crossref","first-page":"620","DOI":"10.2214\/AJR.18.20125","article-title":"Factors predicting positive culture in CT-guided bone biopsy performed for suspected osteomyelitis","volume":"212","author":"Beroukhim","year":"2019","journal-title":"AJR Am J Roentgenol"},{"key":"2025111908371014400_ofaf665-B19","first-page":"277","article-title":"Impact of fluoroscopically guided bone biopsy on antibiotic management of osteomyelitis in the lower extremity","volume":"27","author":"Mammarappallil","year":"2018","journal-title":"J Surg Orthop Adv"},{"key":"2025111908371014400_ofaf665-B20","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s00256-024-04764-7","article-title":"Yield and clinical impact of image-guided bone biopsy in osteomyelitis of the appendicular skeleton: a systematic review and meta-analysis","volume":"54","author":"Smayra","year":"2025","journal-title":"Skeletal Radiol (2024)"},{"key":"2025111908371014400_ofaf665-B21","doi-asserted-by":"crossref","first-page":"107027","DOI":"10.1016\/j.ijid.2024.107027","article-title":"Diagnostic efficacy and clinical impact of image-guided core needle biopsy of suspected vertebral osteomyelitis","volume":"144","author":"Winkler","year":"2024","journal-title":"Int J Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaf665\/65024242\/ofaf665.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/11\/ofaf665\/65024242\/ofaf665.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/11\/ofaf665\/65024242\/ofaf665.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:37:19Z","timestamp":1763559439000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf665\/8305761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":21,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,10,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf665","relation":{},"ISSN":["2328-8957"],"issn-type":[{"type":"electronic","value":"2328-8957"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,10,29]]},"article-number":"ofaf665"}}