Physicians do not trust bone biopsy culture data
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
As I approach the end of my summer research project, my team and I have reflected on what we’ve learned from both the research itself and the experience of working on the project.
Cole Hirschfeld
First, I am completely finished with the research and analysis portion of the project. In the last week, I’ve mostly been working on the abstract which we plan to submit to the Society of Hospital Medicine 2018 conference. While I would have liked to make more progress on the manuscript, I realize that writing almost always takes longer than I anticipate, and that I will need to continue working on the manuscript in the fall semester.
As work-life balance is important to me, I would usually I would balk at the idea of sacrificing my personal time, but in this case, I am driven by a sense of ownership and pride over the project that I haven’t felt with past projects. I truly believe the results of this research have the potential to change the way physicians think about and manage patients with osteomyelitis, and I am eager to publish our results and attend conferences where I can present and discuss the findings with the medical community.
We hypothesized that the use of image-guided bone biopsies in patients with non-vertebral osteomyelitis would not have a significant impact on antibiotic management. Our results showed that physicians usually do not trust culture data provided by bone biopsy results. Negative bone cultures almost never lead physicians to discontinue antibiotics due to the low yield and reliability of bone biopsy culture data. Similarly, positive cultures almost never lead physicians to prescribe targeted antibiotics. 75% of the patients in our study had contiguous osteomyelitis caused by an overlying ulcer (e.g., diabetic foot ulcers or sacral decubitus ulcers). Exposure of the wound to the outside world often results in polymicrobial infections, and as such physicians rarely narrowed antibiotic coverage when a single organism was cultured. We also found that empiric antibiotic therapy adequately treated cultured micro-organisms in 95% of cases.
While many questions remained unanswered by this study, our results are an important contribution to the body of evidence that image-guided bone biopsies have low utility in the management of contiguous non-vertebral osteomyelitis. I look forward to seeing how the results of future research will compare with our findings. I am grateful to have had the opportunity to work in such an exciting area of research and I hope to continue participating in research projects throughout my medical career.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
