Hosted by Eileen Scully, MD, PhD, and Christopher Hoffmann, MD, MSC, MPH, both HIV specialists at Johns Hopkins, Viremic explores quandaries in adult HIV care. Each case discussion includes medical hi...

AbstractObjectivesThe diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected non-vertebral osteomyelitis in adults is heterogenous in published studies due to small sample size, indicating the need for large cohort studies.MethodsA retrospective analysis of ICNBs was performed from 2010-2021 for patients with suspected non-vertebral 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.ResultsA 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 prior to biopsy was negatively associated with positive cultures from bone core samples (OR=0.52, 95%CI[0.33-0.83], p=0.0005). Elevated hemoglobin A1c (continuous variable) (OR=1.38, 95%CI[1.03-1.86], p=0.03), and purulent aspirate (OR=28.1, 95%CI[2.67-1.86], p=0.03) were positively associated with positive cultures from aspirate samples. Clinical management was affected by ICNB in 26.2% (231/883) of cases.ConclusionIn this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-fourth of patients.

ATLANTA — There is more evidence that shingles vaccination significantly decreases the risk for heart disease, dementia and death among people aged 50 years or older with herpes zoster infection...