CT-Guided Needle Biopsy in Vertebral Osteomyelitis: Study of Factors That Could Influence in Culture Yield

array:23 ["pii" => "S1699258X20301996" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2020.08.002" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1465" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2022;18:20-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S1699258X20301947" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2020.07.010" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1460" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2022;18:25-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Estudio prospectivo multicéntrico de experiencia en práctica clínica real en el control de medidas de desenlace reportadas por el paciente (PRO) diagnosticado de artritis psoriásica y/o espondiloartritis y que inicia tratamiento con secukinumab" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "25" "paginaFinal" => "29" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Prospective multicentre study of experience in real-world clinical practice in monitoring reported outcome measures (PROMs) of patient with a diagnosis of psoriatic and/or spondyloarthritis and initiating treatment with secukinumab" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1023 "Ancho" => 2167 "Tamanyo" => 95058 ] ] "descripcion" => array:1 [ "es" => "Tamaño del efecto del tratamiento en las distintas medidas de desenlace reportadas por el paciente (PRO)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan José Lerma Garrido, Antonio Gracia Pérez, Antonio Pérez Torres, Amalia Rueda Cid, Clara Molina Almela, María Dolores Pastor Cubillo, Cristina Campos Fernández, Isabel Balaguer Trull, Loreto Carmona, Javier Calvo Catalá" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Juan José" "apellidos" => "Lerma Garrido" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Gracia Pérez" ] 2 => array:2 [ "nombre" => "Antonio" "apellidos" => "Pérez Torres" ] 3 => array:2 [ "nombre" => "Amalia" "apellidos" => "Rueda Cid" ] 4 => array:2 [ "nombre" => "Clara" "apellidos" => "Molina Almela" ] 5 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Pastor Cubillo" ] 6 => array:2 [ "nombre" => "Cristina" "apellidos" => "Campos Fernández" ] 7 => array:2 [ "nombre" => "Isabel" "apellidos" => "Balaguer Trull" ] 8 => array:2 [ "nombre" => "Loreto" "apellidos" => "Carmona" ] 9 => array:2 [ "nombre" => "Javier" "apellidos" => "Calvo Catalá" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574321000721" "doi" => "10.1016/j.reumae.2020.07.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321000721?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20301947?idApp=UINPBA00004M" "url" => "/1699258X/0000001800000001/v1_202201120658/S1699258X20301947/v1_202201120658/es/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S1699258X20302023" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2020.08.005" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1468" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2022;18:15-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Laboratory Diagnosis of ANCA-Associated Vasculitis (AAV) Using a Combination of Immunofluorescence Test (IIFT) and Line Immunoassay (LIA): Single-Centre Report From India" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "15" "paginaFinal" => "19" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico de laboratorio de vasculitis asociada a ANCA (VAA), utilizando conjuntamente test de inmunofluorescencia (IIFT) e inmunoensayo lineal (LIA): Reporte de un único centro de la India" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1281 "Ancho" => 2500 "Tamanyo" => 176873 ] ] "descripcion" => array:1 [ "en" => "Summary of immunoassays in total patients (n=1289)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rajni Chauhan, Dharmendra Jain, Aseem Kumar Tiwari, Pranav Dorwal, Vimarsh Raina, Shoma Paul Nandi" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Rajni" "apellidos" => "Chauhan" ] 1 => array:2 [ "nombre" => "Dharmendra" "apellidos" => "Jain" ] 2 => array:2 [ "nombre" => "Aseem Kumar" "apellidos" => "Tiwari" ] 3 => array:2 [ "nombre" => "Pranav" "apellidos" => "Dorwal" ] 4 => array:2 [ "nombre" => "Vimarsh" "apellidos" => "Raina" ] 5 => array:2 [ "nombre" => "Shoma Paul" "apellidos" => "Nandi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20302023?idApp=UINPBA00004M" "url" => "/1699258X/0000001800000001/v1_202201120658/S1699258X20302023/v1_202201120658/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "CT-Guided Needle Biopsy in Vertebral Osteomyelitis: Study of Factors That Could Influence in Culture Yield" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "20" "paginaFinal" => "24" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jorge Juan Fragío Gil, Roxana González Mazarío, José Ivorra Cortés, Antonio José Cañada Martínez, Miguel Salavert Lleti, José Andrés Román Ivorra" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Jorge Juan" "apellidos" => "Fragío Gil" "email" => array:1 [ 0 => "jorgefragio@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Roxana" "apellidos" => "González Mazarío" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "José" "apellidos" => "Ivorra Cortés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Antonio José" "apellidos" => "Cañada Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Miguel" "apellidos" => "Salavert Lleti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "José Andrés" "apellidos" => "Román Ivorra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Rheumatology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Infectious Diseases Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Punción asistida por TC en pacientes con osteomielitis vertebral: análisis de los factores que condicionan su rentabilidad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1484 "Ancho" => 1500 "Tamanyo" => 125607 ] ] "descripcion" => array:1 [ "en" => "General study procedure. From a total of 122 cases of VO at our centre, 45 were excluded and 77 included in the study. In 43 patients the CT guided needle biopsy yield the microbiological diagnosis." ] ] ] "textoCompleto" => "IntroductionVertebral Osteomyelitis (VO) is an infectious disease of the vertebral body which can involve the intervertebral disc space.<a class="elsevierStyleCrossRef" href="#bib0110">1</a> The clinical manifestations, laboratory markers and radiological findings may be sometimes unspecific, thus its diagnosis turns frequently into a challenge.<a class="elsevierStyleCrossRefs" href="#bib0115">2,3</a> Therefore, current ISDA (Infectious Diseases Society of America) guidelines suggest that a proper evaluation of a patient should include a thorough neurological examination, baseline CRP and ESR determination, a spine imaging technique (preferred MRI) and bacterial blood cultures. Moreover it is recommended, if possible, to withhold the antibiotic therapy until a microbiological diagnosis could be established. However, if blood cultures do not yield the causative microorganism, an image-guided aspiration biopsy is encouraged.<a class="elsevierStyleCrossRef" href="#bib0120">3</a> The most frequent microorganism involved is Staphylococcus aureus in more than half of the cases but other causes could be seen such as other bacteria species or even fungi or mycobacteria.<a class="elsevierStyleCrossRefs" href="#bib0125">4,5</a>Biopsy material could be obtained via open procedure (open biopsy) or by percutaneous access (usually assisted by CT or fluoroscope). There are several studies reporting both techniques yield, which had shown a wide range of results. Some of them had shown low positivity rates with CT guided biopsy (30–50%) and higher with open biopsy,<a class="elsevierStyleCrossRefs" href="#bib0135">6–8</a> however other groups highlighted the importance of withholding antibiotics prior to the procedure,<a class="elsevierStyleCrossRefs" href="#bib0150">9–12</a> fact that needs to be further explored because other studies have failed in finding any relationship between the antibiotic exposure and the technique result. Regardless, though open biopsy seems to be more reliable, percutaneous procedures such as CT guided biopsy are preferred<a class="elsevierStyleCrossRef" href="#bib0110">1</a> because they are safer, less invasive, require shorter hospital stays and in most cases, general anesthesia is not required.<a class="elsevierStyleCrossRef" href="#bib0170">13</a>Since there is still controversy around this topic,<a class="elsevierStyleCrossRef" href="#bib0135">6</a> the aim of this study was to analyze which are the main factors that could influence in the result of a CT guided biopsy in vertebral osteomyelitis patients.Patients and methodsStudy design and populationA single center retrospective observational study was performed. Inclusion criteria was adult patients who had been diagnosed with VO from January 2010 to January 2020. Diagnosis of VO, according to other studies was established based on the combination of the clinical presentation with either a definitive bacteriologic diagnosis or pathological and/or imaging studies.<a class="elsevierStyleCrossRefs" href="#bib0115">2–12</a> Patients were admitted to different wards, so medical and surgical approach was not standardized. Patients who did not undergone CT guided biopsy or had a postsurgical infection were excluded. Coagulase-negative staphylococcus was considered a true pathogen when it was isolated from biopsy or when it was detected in two or more blood cultures.Clinical cases were search through the clinical history management software (Orion Clinic, Everis Group). Terms searched were “vertebral osteomyelitis”, “discitis” and “spondylodiscitis”.Demographical features, concurrent diseases, laboratory findings, microbiological diagnosis, radiological data, medical complications, antibiotic exposure were compiled.Variable definitionImmunosuppressed patients were considered those who had a rheumatic or inflammatory bowel disease undertaking immunomodulatory drugs, solid organ transplantation receptors, or in Human Immunodeficiency Virus (HIV) patients. Neurological deficit included paresthesia, limb weakness, radiculopathy, sensory loss and/or paraparesis. Clinical and radiological history of lumbar stenosis or disc herniation was considered as prior spine pathology. Chronic Kidney Disease was considered when glomerular filtration rate (GFR) was below 30mL/min, thus, pertaining to groups 4 and 5 of the CKD classification.Radiological presence of epidural abscess, paravertebral abscess, cord compression and vertebral destruction was determined by a musculoskeletal specialized radiologist. Infection location was defined by the most superior segment involved.Procedure descriptionStandard procedure at our center is performed by Musculoskeletal Specialized Radiologist under local anesthesia and CT control. Abscess sample is collected with Acecut® needle (18G) with coaxial technique, trying to obtain at least 3 samples. For discal space, Ostycut® needle (13.5G–15G) is used. For detection of mycobacteria, culture and real time PCR was performed (Seegene kit). If possible, samples were sent for histopathology, anaerobic, aerobic, mycobacteria and fungal cultures.<a class="elsevierStyleCrossRef" href="#bib0130">5</a>Statistical analysisContinuous variables were summarized using mean (SD, standard deviation) and median (1st, 3rd quartiles). Categorical variables were summarized using absolute and relative frequencies (%). To assess the association between risk factors a logistic regression was adjusted including CRP at admission, the presence of fever, back pain span and antibiotic exposure comparing the patients depending on the culture result. All statistical analyses were performed using software R (version 3.5.0). P values were set based on number of analyses.ResultsStudy patientsOverall, from a total of 122 vertebral osteomyelitis cases found, 77 (63%) were included in the study (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Patients were divided into groups depending on the culture result. Baseline characteristics are shown below (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Most patients were diagnosed with MRI (65% and 85% respectively between groups), followed by CT (33% and 15% respectively). In 1 case in the biopsy positive group, 18F-FDG PET/CT was the diagnosis imaging tool.InterventionDelay in the procedure, antibiotic exposure and blood culture positivity were similar among both groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Sample culture was positive in 43 cases (56%) as seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Microorganism isolated included gram+(72%), gram−(14%), mycobacteria (7%) and fungi (7%). Detailed data of microbiological findings are provided in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Seventeen patients had a positive result on the biopsy and blood cultures. In 14 of these 17 cases (83%) it was isolated the same organism on the blood and biopsy culture (see notations below <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Microbiological diagnosis in biopsy negative group was established according to blood cultures and was possible in 16 patients (47% of the biopsy negative group).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Multivariate analysis was performed with a logistic regression including CRP at admission, fever, back pain span and recent antibiotic treatment. The biopsy cultures were not influenced by the CRP value (CI 95% [0.994–1.006] p=0.927), the presence of fever (CI 95% [0.518–5.533] p=0.41) nor antibiotic exposure (CI 95% [0.116–1.355] p=0.155). The longer duration of the back pain was associated to a lower probability of a positive biopsy (CI 95% [0.977–0.998] p=0.042).Patients received antibiotic treatment during the next 84 (56, 112) days in biopsy positive group and 84 (56, 120) days in negative group. Fifteen patients required surgery (6 in positive group and 9 in the negative group, 14% and 26% respectively). Sixteen patients were readmitted after discharge (16 in positive group and 10 in the negative group, 37% and 29% respectively). Six patients died due to the infection (4 cases) or related complications (2 cases) (3 in positive group and 3 in the negative group, 7% and 9% respectively).Immunosuppresed patientsA total of 17 patients were immunosuppressed. Results of these population are commented separately due to its special characteristics. Immunosuppressed patients represented the 22% of the total sample and were balanced between both groups, whom exhibited similar baseline characteristics than non-immunosuppressed patients (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Acute phase markers seemed to be slightly inferior in negative biopsy group. Positive biopsy group may have more abscess formation (100% of the positive group and 87% on the negative group, but epidural abscess was detected in 100% of the patients of the positive group and in the 50% of the negative group). Delay in procedure performance was slightly inferior in immunosuppressed patients (mean 5.2 days). Gram positive predominated on cultures (8 cases) and in the other case, C. auris was detected. In 4 cases (44%), blood and biopsy cultures isolated the same microorganism. Two patients were splenectomized and in one case Staphylococcus epidermidis was isolated on the blood culture (during a febrile episode) and in the other no potential causative organism was detected (the biopsy was performed under antibiotic exposure). On both cases, the biopsy was negative with a delay of 3 and 4 days respectively.DiscussionIn this study including VO patients, the focus has been placed on the biopsy that is needed in many patients, in an attempt of elucidating the causative microorganism so as to provide a targeted antibiotherapy, and thus, reducing side effects and improving the efficacy.<a class="elsevierStyleCrossRefs" href="#bib0110">1,7</a> In particular CT guided needle biopsy had been analyzed in a population with demographic and clinical comorbidities distribution similar to other studies.<a class="elsevierStyleCrossRefs" href="#bib0115">2,6,7</a> The population of the study had been split in two groups attending to the result of the culture of the sample obtained from de biopsy.In this cohort a higher presence of immunosuppressed patients could be noted, due to the characteristics of the center, which is a university hospital. The results of that subset of patients have been displayed separately. In general, the distribution of cardiovascular risk factors and other clinical variables has been fair between both groups. Although there are some differences on the radiological variables (more prevalence of epidural abscess and cord compression) and also, the acute phase markers were slightly greater on the positive result group. In any case, extravertebral extension could not act as a factor of poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0125">4</a> This fact would be explored on further studies but seems to be logical due to a presumed more aggressiveness of the infection on immunocompromised host. Moreover, other studies found correlation between higher CRP value and greater chance of a positive result.<a class="elsevierStyleCrossRefs" href="#bib0140">7–9</a>The signs and symptoms collected seems to be in agreement with other series<a class="elsevierStyleCrossRefs" href="#bib0120">3,4,7</a> with the expected high prevalence of back pain, presented in almost all patients and fever in just 1 out 3 patients, approximately in both groups. As seen in other works, delay in diagnosis is still a problem in VO patients<a class="elsevierStyleCrossRefs" href="#bib0115">2,4</a> who usually waits at least a month since the beginning of the pain, until diagnosis. Additionally, in some cases this period is increased dramatically. Further strategies should be set up in order to reduce this term and prevent future complications.<a class="elsevierStyleCrossRef" href="#bib0180">14</a>Infectious endocarditis is a frequent association with VO,<a class="elsevierStyleCrossRefs" href="#bib0185">15,16</a> but in this study were scarcely represented because in those patients the causative microorganism is more frequent detected through the blood cultures.Acute phase markers (CRP and ESR) were elevated in both groups. Numerically, values were higher in biopsy positive groups, as seen in other studies<a class="elsevierStyleCrossRefs" href="#bib0140">7–9</a> but statistical signification was not reach. Radiological variables were comparable in both groups. A slight difference was noted in cord compression (higher in negative group) probably related to a greater presence of patients with acute paraparesis at diagnosis in this group. This result might be linked to the higher presence of further surgical approach detected in the negative culture group.As it has been pointed out in several studies delay in diagnosis is probably the main issue in VO.<a class="elsevierStyleCrossRefs" href="#bib0115">2,17</a> Moreover, since antibiotic withholding is widely recommended,<a class="elsevierStyleCrossRef" href="#bib0110">1</a> these biopsies should be performed as soon as possible. In this study a median delay of 6 days was detected on both groups, with few differences in the interquartile range (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Marschall et al. achieved a 65% of positivity with a median delay of 3 days.<a class="elsevierStyleCrossRef" href="#bib0155">10</a> Better mean values in immunosuppressed patients have been noted, but overall, this should be improved and analyzed (for instance, creating a specific circuit).Microorganisms isolated had a distribution comparable to another studies.<a class="elsevierStyleCrossRefs" href="#bib0115">2,18</a> Antibiotic exposure was registered in half of the cases on the positive group and in the 58% of the negative group. The higher prevalence of patients with acute paraparesis at diagnosis could be a reasonable cause. In addition, more antibiotic exposure is presumed to reduce the culture yield,<a class="elsevierStyleCrossRef" href="#bib0160">11</a> but it was not detected on our study. This is a matter of controversy, but there are other several studies that concluded the same.<a class="elsevierStyleCrossRefs" href="#bib0165">12,17</a> A possible explanation of the lack or the small influence of antibiotic exposure on the culture result could be that intervertebral space is avascular. A high correlation between blood cultures and biopsy had been noted, so as it is had been previously recommended on the guidelines and other works,<a class="elsevierStyleCrossRef" href="#bib0110">1</a> CT-guided biopsy could be avoided in most cases.Overall positivity (56%) was on the average of the studies published which vary from 21% to 89%.<a class="elsevierStyleCrossRefs" href="#bib0125">4,7–9,19–21</a> The biopsy result was not modified by prior CRP values, fever as clinical presentation nor antibiotic exposure. The longer the length of painful period before diagnosis was related to a lower chance of obtaining a positive result on culture. This result could be explained by a greater aggressiveness of pyogenic organisms that perhaps congregate in the lesser time span instead of non-pyogenic agents and seems logical that the delay in diagnosis makes a negative impact on the technique reliability. Other studies has been performed in order to detect predictive factors of positivity, such as a recent study found that using larger diameter biopsy needle increases the likelihood of causative microorganism.<a class="elsevierStyleCrossRef" href="#bib0200">19</a> Other factor detected related to higher chance of positivity has been the attenuation value on CT scan.<a class="elsevierStyleCrossRef" href="#bib0205">20</a>In order to point out the limitations of the study, since this is a retrospective study, clinical cases may be missed during the search process. Moreover, patients were admitted to different wards, and that hence on variability in patient management. Concerning the procedure, adding more variables would provide more information such as areas specifically punctured, specific antimicrobial treatment received prior to the procedure or number of samples taken at each procedure. During statistical analysis some difficulties were found, such a huge variability in days of antimicrobial therapy received prior the procedure, finally solved dichotomizing in “exposure: yes/no” and reducing the statistical power. The inclusion of mycobacteria and fungi might influence the clinical picture and the yield of the CT-guided biopsy.In conclusion our study displays an acceptable reliability of CT guided needle biopsy in VO patients, even in cases under antibiotic treatment. The presence of fever or elevated CRP values did not predict a positive culture in our study. A positive blood culture would provide a microbiological diagnosis in most cases. Delay in diagnosis could impact negatively in culture yield. Therefore, improving diagnostic strategies in general and shortening the span from VO diagnosis to the procedure performance in particular, may enhance not only the culture yield reliability but also the patient prognosis.FundingNone funding source was required.Conflict of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1644844" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1465687" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1644843" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1465686" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design and population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Variable definition" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Procedure description" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Study patients" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Intervention" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Immunosuppresed patients" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack580881" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-25" "fechaAceptado" => "2020-08-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1465687" "palabras" => array:3 [ 0 => "Vertebral osteomyelitis" 1 => "CT guided biopsy" 2 => "Spondylodiscitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1465686" "palabras" => array:3 [ 0 => "Osteomielitis vertebral" 1 => "Punción guiada por TC" 2 => "Espondilodiscitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe aim of this study was to analyze which are the main factors that could influence the result of a CT guided biopsy in vertebral osteomyelitis (VO) patients. MethodsA single center retrospective observational study was performed including adult patients who had been diagnosed with VO and undergone CT guided needle biopsy from January 2010 to January 2020. Demographical features, concurrent diseases, laboratory findings, microbiological diagnosis, radiological data, medical complications, antibiotic exposure were compiled. Multivariate analysis was performed with a logistic regression comparing the patients depending on the culture result. ResultsSeventy-seven patients were included in the study. Baseline characteristics were comparable between groups. Sample culture was positive in 43 cases (56%). Microorganism isolated were gram+(72%), gram−(14%), mycobacteria (7%) and fungi (7%). Delay in the procedure, antibiotic exposure and blood culture positivity were also similar among both groups. The biopsy results were not influenced by the CRP value, the presence of fever nor antibiotic exposure. The longer duration of back pain was associated to a lower probability of a positive culture. ConclusionsIn conclusion, our study displays an acceptable reliability of CT guided needle biopsy in VO patients, even in cases under antibiotic treatment. The presence of fever or CRP values did not predict a positive culture. Delay in diagnosis could impact negatively on culture yield." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEl propósito del presente estudio es analizar qué factores pueden influir en el resultado del cultivo de las muestras obtenidas por punción guiada por TC en pacientes con osteomielitis vertebral. MétodosSe realizó un estudio en un único centro, retrospectivo y observacional en pacientes diagnosticados de osteomielitis vertebral, que fueron subsidiarios de punción-biopsia entre enero de 2010 y enero de 2020. Se recogieron para su análisis, variables demográficas, comorbilidades, resultados de laboratorio, radiología, el tratamiento previo con antibióticos y la demora previa a la realización de la técnica. Se realizó un análisis multivariante mediante regresión logística. ResultadosSe incluyó a un total de 77 pacientes que fueron sometidos a la técnica. Sus características basales fueron similares. El cultivo fue positivo en 43 casos (56%). Los microorganismos aislados fueron gram + (72%), gram – (14%), micobacterias (7%) y hongos (7%). El retraso en la ejecución de la técnica y el tratamiento previo con antibióticos fue similar en ambos grupos. Ni el valor de PCR, la presencia de fiebre ni la antibioterapia tuvieron influencia en el resultado del cultivo. Se observó que una mayor duración del dolor lumbar se relacionó con una menor probabilidad de obtener un resultado positivo en el cultivo. ConclusionesIncluso bajo exposición antibiótica, la punción asistida por TC mostró una rentabilidad aceptable. La presencia de fiebre o valores elevados de PCR no fueron predictivos de positividad del cultivo. El retraso diagnóstico sí podría impactar negativamente en la rentabilidad diagnóstica del cultivo procedente de la biopsia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "All authors have seen and approved the manuscript, contributed significantly to the work, and also that the manuscript has not been previously published nor is not being considered for publication elsewhere." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1484 "Ancho" => 1500 "Tamanyo" => 125607 ] ] "descripcion" => array:1 [ "en" => "General study procedure. From a total of 122 cases of VO at our centre, 45 were excluded and 77 included in the study. In 43 patients the CT guided needle biopsy yield the microbiological diagnosis." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Mean values are expressed: Mean (SD)/n(%). Median values are expressed: Median (1st, 3rd Q.)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Characteristic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Biopsy culture positive (56%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Biopsy culture negative (44%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n=43 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n=34 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age – years (ds) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (14.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male sex – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidities – number (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes Mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic kidney disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver cirrhosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunosuppression– number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prior spine pathology – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (56) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptoms and signs at diagnosis</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Back pain – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time since pain started – median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (20.5, 60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (22.5, 90) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (36) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time since fever started - median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0, 1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0, 6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute paraparesis – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Underlying endocarditis – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute phase reactants</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP – mg/L median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.8 (48.9, 124) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.8 (23.1, 128) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR – mm/h mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.5 (32.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.5 (24.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infection location – number (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cervical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dorsal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (41) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbo-sacral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (94) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paravertebral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (94) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertebral destruction – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (56) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cord compression – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2801202.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and baseline characteristics." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Biopsy culture positive (56%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Biopsy culture negative (44%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n=43 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n=34 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood culture (positive) – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (42%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (41%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time since admission to procedure – median days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (3, 11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 (3, 18.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antibiotic exposure – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (49%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (58%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antibiotic exposure prior procedure – days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0, 6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (0, 11) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2801203.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Procedure related variables." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Microorganism isolated \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n=43 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gram positive species – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Staphylococcus aureus MS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Staphylococcus epidermidis<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Staphylococcus hominis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Streptococcus mitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Streptococcus anginosus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Streptococcus beta hemol grupo B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Streptococcus gallolyticus spp.<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Streptococcus sanguinis<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Corynebacterium spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Staphylococcus capitis<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Enterococcus spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Propionibacterium acnes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gram negative species – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudomona aeruginosa<a class="elsevierStyleCrossRef" href="#tblfn0025">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brevundimonas spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Escherichia coli<a class="elsevierStyleCrossRef" href="#tblfn0030">f</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fungi – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Candida auris<a class="elsevierStyleCrossRef" href="#tblfn0035">g</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Candida albicans<a class="elsevierStyleCrossRef" href="#tblfn0040">h</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mycobacteria – number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Micobacterium tuberculosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2801204.png" ] ] ] "notaPie" => array:8 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "In 4 cases were also detected on the blood cultures." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Also was isolated on the blood cultures of a patient who was also diagnosed of colorectal cancer." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Also was isolated on the blood cultures of a patient." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "Also was isolated on the blood cultures of a patient." ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "One of them was a multirresistan p. Aeruginosa that also was isolated from blood cultures." ] 5 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "f" "nota" => "On the same culture of a single patient, grown E. coli and Dermatobacter hominis, E. coli was considered the true pathogen. On the other case, E. coli was also isolated on the blood culture." ] 6 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "g" "nota" => "Also was isolated on the blood cultures of a patient." ] 7 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "h" "nota" => "Also was isolated on the blood cultures of a patient." ] ] ] "descripcion" => array:1 [ "en" => "Microorganisms isolated from biopsies." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.F. Berbari" 1 => "S.S. Kanj" 2 => "T.J. Kowalski" 3 => "R.O. Darouchi" 4 => "A.F. Widmer" 5 => "S.K. Schmitt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/civ482" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2015" "volumen" => "61" "paginaInicial" => "e26" "paginaFinal" => "e46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26229122" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0115" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vertebral osteomyelitis: clinical, microbiological and radiological characteristics of 116 patients [published online ahead of print, 2020 May 20]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Fragio Gil" 1 => "R. González Mazarío" 2 => "M. Salavert Lleti" 3 => "J.A. Román Ivorra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2019.12.029" "Revista" => array:3 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2020" "itemHostRev" => array:3 [ "pii" => "S0140673611609938" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0120" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Mylona" 1 => "M. Samarkos" 2 => "E. Kakalou" 3 => "P. Fanourgiakis" 4 => "A. Skoutelis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2008.03.002" "Revista" => array:7 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2009" "volumen" => "39" "paginaInicial" => "10" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18550153" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0923753419351002" "estado" => "S300" "issn" => "09237534" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0125" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pyogenic vertebral osteomyelitis in nondrug users" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Nolla" 1 => "J. Ariza" 2 => "C. Gómez-Vaquero" 3 => "J. Fiter" 4 => "J. Bermejo" 5 => "J. Valverde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/sarh.2002.29492" "Revista" => array:7 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2002" "volumen" => "31" "paginaInicial" => "271" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11836660" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0305737215000250" "estado" => "S300" "issn" => "03057372" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0130" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.P. Lew" 1 => "F.A. Waldvogel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(04)16727-5" "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "2004" "volumen" => "364" "paginaInicial" => "369" "paginaFinal" => "379" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0135" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vertebral osteomyelitis in adults: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.K. Nickerson" 1 => "R. Sinha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bmb/ldw003" "Revista" => array:6 [ "tituloSerie" => "Br Med Bull" "fecha" => "2016" "volumen" => "117" "paginaInicial" => "121" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26872859" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0140" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology microbiological diagnosis, and clinical outcomes in pyogenic vertebral osteomyelitis: a 10-year retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.S.W. Chong" 1 => "C.J. Brereton" 2 => "A. Gordon" 3 => "J.S. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ofid/ofy037" "Revista" => array:4 [ "tituloSerie" => "Open Forum Infect Dis" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "ofy037" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0145" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic yield of computed tomography-guided biopsy and aspiration for vertebral osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.T. Ang" 1 => "G.R. Wong" 2 => "D.R. Wong" 3 => "W. Clements" 4 => "T. Joseph" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1754-9485.12923" "Revista" => array:6 [ "tituloSerie" => "J Med Imaging Radiat Oncol" "fecha" => "2019" "volumen" => "63" "paginaInicial" => "589" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31301094" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0150" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Marschall" 1 => "K.P. Bhavan" 2 => "M.A. Olsen" 3 => "V.J. Fraser" 4 => "N.M. Wright" 5 => "D.K. Warren" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cir062" "Revista" => array:5 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2011" "volumen" => "52" "paginaInicial" => "867" "paginaFinal" => "872" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0155" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Change in bone CT attenuation and C-reactive protein are predictors of bone biopsy culture positivity in patients with vertebral discitis/osteomyelitis [published online ahead of print, 2020 Mar 19]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.T. Lee" 1 => "B.A. Pukenas" 2 => "R. Sebro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/BRS.0000000000003504" "Revista" => array:2 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2020" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0160" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microbiologically and clinically diagnosed vertebral osteomyelitis: impact of prior antibiotic exposure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.J. Kim" 1 => "K.H. Song" 2 => "W.B. Park" 3 => "E. Suk Kim" 4 => "S. Won Park" 5 => "H.B. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.05953-11" "Revista" => array:7 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2012" "volumen" => "56" "paginaInicial" => "2122" "paginaFinal" => "2124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22232286" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204514711714" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0165" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of withholding antibiotics prior to bone biopsy in patients with suspected osteomyelitis: a meta-analysis of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.A. Crisologo" 1 => "J. La Fontaine" 2 => "D.K. Wukich" 3 => "P.J. Kim" 4 => "O.K. Oz" 5 => "L.A. Lavery" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Wounds" "fecha" => "2019" "volumen" => "31" "paginaInicial" => "205" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31356178" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673610621101" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0170" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Yield of image-guided needle biopsy for infectious discitis: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.L. McNamara" 1 => "E.C. Dickerson" 2 => "D.M. Gomez-Hassan" 3 => "S.K. Cinti" 4 => "A. Srinivasan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3174/ajnr.A5337" "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2017" "volumen" => "38" "paginaInicial" => "2021" "paginaFinal" => "2027" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28882866" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0180" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Gupta" 1 => "T.J. Kowalski" 2 => "D.R. Osmon" 3 => "M. Enzler" 4 => "J.M. Steckelberg" 5 => "P.M. Huddleston" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ofid/ofu107" "Revista" => array:3 [ "tituloSerie" => "Open Forum Infect Dis" "fecha" => "2014" "volumen" => "1" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0185" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Pigrau" 1 => "B. Almirante" 2 => "X. Flores" 3 => "V. Falcó" 4 => "D. Rodríguez" 5 => "I. Gasser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2005.02.027" "Revista" => array:4 [ "tituloSerie" => "Am J Med" "fecha" => "2005" "volumen" => "118" "paginaInicial" => "1287" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0190" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The unique clinical features and outcome of infectious endocarditis and vertebral osteomyelitis co-infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Koslow" 1 => "R. Kuperstein" 2 => "I. Eshed" 3 => "M. Perelman" 4 => "E. Maor" 5 => "Y. Sidi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2014.02.023" "Revista" => array:5 [ "tituloSerie" => "Am J Med" "fecha" => "2014" "volumen" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25308624" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0923753419313146" "estado" => "S300" "issn" => "09237534" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lack of effect of antibiotics on biopsy culture results in vertebral osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.D. Saravolatz 2nd" 1 => "V. Labalo" 2 => "J. Fishbain" 3 => "S. Szpunar" 4 => "L.B. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2018.02.017" "Revista" => array:7 [ "tituloSerie" => "Diagn Microbiol Infect Dis" "fecha" => "2018" "volumen" => "91" "paginaInicial" => "273" "paginaFinal" => "274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29573841" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673602099622" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0195" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Amsilli M, Epaulard O. How is the microbial diagnosis of bacterial vertebral osteomyelitis performed? An 11-year retrospective study [published online ahead of print, 2020 Jun 26]. Eur J Clin Microbiol Infect Dis. <a target="_blank" href="doi:10.1007/s10096-020-03929-1">doi:10.1007/s10096-020-03929-1</a>." ] ] ] 18 => array:3 [ "identificador" => "bib0200" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CT-guided discitis-osteomyelitis biopsies: needle gauge and microbiology results [published online ahead of print, 2020 Apr 18]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.S. Husseini" 1 => "F.J. Simeone" 2 => "S.B. Nelson" 3 => "C.Y. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00256-020-03439-3" "Revista" => array:3 [ "tituloSerie" => "Skeletal Radiol" "fecha" => "2020" "paginaInicial" => "10" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0205" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors predicting positive culture in CT-guided bone biopsy performed for suspected osteomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Beroukhim" 1 => "R. Shah" 2 => "M.D. Bucknor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.18.20125" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2019" "volumen" => "212" "paginaInicial" => "620" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30645166" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0210" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy of computed tomography-guided percutaneous spine biopsies in determining a causative organism in cases of suspected infection: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Sertic" 1 => "L. Parkes" 2 => "S. Mattiassi" 3 => "K. Pritzker" 4 => "M. Gardam" 5 => "K. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.carj.2018.09.003" "Revista" => array:6 [ "tituloSerie" => "Can Assoc Radiol J" "fecha" => "2019" "volumen" => "70" "paginaInicial" => "96" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30691569" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack580881" "titulo" => "Acknowledgements" "texto" => "To our partners from the Rheumatology department, the Infectious disease Unit and the Musculoskeletal Unit of the Radiology department. Also to Mrs. Paula Giménez for her effort and valuable help.The authors are grateful for the collaboration with English language revision to Mr. Paul Godfrey." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000001800000001/v1_202201120658/S1699258X20301996/v1_202201120658/en/main.assets" "Apartado" => array:4 [ "identificador" => "17499" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001800000001/v1_202201120658/S1699258X20301996/v1_202201120658/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20301996?idApp=UINPBA00004M"]

Estadísticas

Original Article

CT-Guided Needle Biopsy in Vertebral Osteomyelitis: Study of Factors That Could Influence in Culture Yield

Punción asistida por TC en pacientes con osteomielitis vertebral: análisis de los factores que condicionan su rentabilidad

Jorge Juan Fragío Gila,b,

Autor para correspondencia

jorgefragio@gmail.com

Corresponding author.

, Roxana González Mazaríoa, José Ivorra Cortésa, Antonio José Cañada Martínezb, Miguel Salavert Lletic, José Andrés Román Ivorraa

a Rheumatology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain

b Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain

c Infectious Diseases Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain

Leído

2066

Veces
se ha leído el artículo

857

Total PDF

1209

Total HTML

Compartir estadísticas

 array:23 [
  "pii" => "S1699258X20301996"
  "issn" => "1699258X"
  "doi" => "10.1016/j.reuma.2020.08.002"
  "estado" => "S300"
  "fechaPublicacion" => "2022-01-01"
  "aid" => "1465"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Reumatol Clin. 2022;18:20-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1699258X20301947"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2020.07.010"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "1460"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2022;18:25-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Estudio prospectivo multic&#233;ntrico de experiencia en pr&#225;ctica cl&#237;nica real en el control de medidas de desenlace reportadas por el paciente &#40;PRO&#41; diagnosticado de artritis psori&#225;sica y&#47;o espondiloartritis y que inicia tratamiento con secukinumab"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "25"
          "paginaFinal" => "29"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Prospective multicentre study of experience in real-world clinical practice in monitoring reported outcome measures &#40;PROMs&#41; of patient with a diagnosis of psoriatic and&#47;or spondyloarthritis and initiating treatment with secukinumab"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1023
              "Ancho" => 2167
              "Tamanyo" => 95058
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tama&#241;o del efecto del tratamiento en las distintas medidas de desenlace reportadas por el paciente &#40;PRO&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Juan Jos&#233; Lerma Garrido, Antonio Gracia P&#233;rez, Antonio P&#233;rez Torres, Amalia Rueda Cid, Clara Molina Almela, Mar&#237;a Dolores Pastor Cubillo, Cristina Campos Fern&#225;ndez, Isabel Balaguer Trull, Loreto Carmona, Javier Calvo Catal&#225;"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Juan Jos&#233;"
              "apellidos" => "Lerma Garrido"
            ]
            1 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Gracia P&#233;rez"
            ]
            2 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "P&#233;rez Torres"
            ]
            3 => array:2 [
              "nombre" => "Amalia"
              "apellidos" => "Rueda Cid"
            ]
            4 => array:2 [
              "nombre" => "Clara"
              "apellidos" => "Molina Almela"
            ]
            5 => array:2 [
              "nombre" => "Mar&#237;a Dolores"
              "apellidos" => "Pastor Cubillo"
            ]
            6 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Campos Fern&#225;ndez"
            ]
            7 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Balaguer Trull"
            ]
            8 => array:2 [
              "nombre" => "Loreto"
              "apellidos" => "Carmona"
            ]
            9 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Calvo Catal&#225;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574321000721"
        "doi" => "10.1016/j.reumae.2020.07.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321000721?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20301947?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001800000001/v1_202201120658/S1699258X20301947/v1_202201120658/es/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "S1699258X20302023"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2020.08.005"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "1468"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2022;18:15-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Laboratory Diagnosis of ANCA-Associated Vasculitis &#40;AAV&#41; Using a Combination of Immunofluorescence Test &#40;IIFT&#41; and Line Immunoassay &#40;LIA&#41;&#58; Single-Centre Report From India"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "15"
          "paginaFinal" => "19"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Diagn&#243;stico de laboratorio de vasculitis asociada a ANCA &#40;VAA&#41;&#44; utilizando conjuntamente test de inmunofluorescencia &#40;IIFT&#41; e inmunoensayo lineal &#40;LIA&#41;&#58; Reporte de un &#250;nico centro de la India"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1281
              "Ancho" => 2500
              "Tamanyo" => 176873
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Summary of immunoassays in total patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1289&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Rajni Chauhan, Dharmendra Jain, Aseem Kumar Tiwari, Pranav Dorwal, Vimarsh Raina, Shoma Paul Nandi"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Rajni"
              "apellidos" => "Chauhan"
            ]
            1 => array:2 [
              "nombre" => "Dharmendra"
              "apellidos" => "Jain"
            ]
            2 => array:2 [
              "nombre" => "Aseem Kumar"
              "apellidos" => "Tiwari"
            ]
            3 => array:2 [
              "nombre" => "Pranav"
              "apellidos" => "Dorwal"
            ]
            4 => array:2 [
              "nombre" => "Vimarsh"
              "apellidos" => "Raina"
            ]
            5 => array:2 [
              "nombre" => "Shoma Paul"
              "apellidos" => "Nandi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20302023?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001800000001/v1_202201120658/S1699258X20302023/v1_202201120658/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "CT-Guided Needle Biopsy in Vertebral Osteomyelitis&#58; Study of Factors That Could Influence in Culture Yield"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "20"
        "paginaFinal" => "24"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Jorge Juan Frag&#237;o Gil, Roxana Gonz&#225;lez Mazar&#237;o, Jos&#233; Ivorra Cort&#233;s, Antonio Jos&#233; Ca&#241;ada Mart&#237;nez, Miguel Salavert Lleti, Jos&#233; Andr&#233;s Rom&#225;n Ivorra"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Jorge Juan"
            "apellidos" => "Frag&#237;o Gil"
            "email" => array:1 [
              0 => "jorgefragio@gmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Roxana"
            "apellidos" => "Gonz&#225;lez Mazar&#237;o"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Ivorra Cort&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Antonio Jos&#233;"
            "apellidos" => "Ca&#241;ada Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Miguel"
            "apellidos" => "Salavert Lleti"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Jos&#233; Andr&#233;s"
            "apellidos" => "Rom&#225;n Ivorra"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Rheumatology Department&#44; Hospital Universitari i Polit&#232;cnic La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de Investigaci&#243;n Sanitaria La Fe &#40;IIS La Fe&#41;&#44; Valencia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Infectious Diseases Unit&#44; Hospital Universitari i Polit&#232;cnic La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Punci&#243;n asistida por TC en pacientes con osteomielitis vertebral&#58; an&#225;lisis de los factores que condicionan su rentabilidad"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1484
            "Ancho" => 1500
            "Tamanyo" => 125607
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">General study procedure&#46; From a total of 122 cases of VO at our centre&#44; 45 were excluded and 77 included in the study&#46; In 43 patients the CT guided needle biopsy yield the microbiological diagnosis&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vertebral Osteomyelitis &#40;VO&#41; is an infectious disease of the vertebral body which can involve the intervertebral disc space&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> The clinical manifestations&#44; laboratory markers and radiological findings may be sometimes unspecific&#44; thus its diagnosis turns frequently into a challenge&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;3</span></a> Therefore&#44; current ISDA &#40;Infectious Diseases Society of America&#41; guidelines suggest that a proper evaluation of a patient should include a thorough neurological examination&#44; baseline CRP and ESR determination&#44; a spine imaging technique &#40;preferred MRI&#41; and bacterial blood cultures&#46; Moreover it is recommended&#44; if possible&#44; to withhold the antibiotic therapy until a microbiological diagnosis could be established&#46; However&#44; if blood cultures do not yield the causative microorganism&#44; an image-guided aspiration biopsy is encouraged&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> The most frequent microorganism involved is <span class="elsevierStyleItalic">Staphylococcus aureus</span> in more than half of the cases but other causes could be seen such as other bacteria species or even fungi or mycobacteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Biopsy material could be obtained via open procedure &#40;open biopsy&#41; or by percutaneous access &#40;usually assisted by CT or fluoroscope&#41;&#46; There are several studies reporting both techniques yield&#44; which had shown a wide range of results&#46; Some of them had shown low positivity rates with CT guided biopsy &#40;30&#8211;50&#37;&#41; and higher with open biopsy&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#8211;8</span></a> however other groups highlighted the importance of withholding antibiotics prior to the procedure&#44;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#8211;12</span></a> fact that needs to be further explored because other studies have failed in finding any relationship between the antibiotic exposure and the technique result&#46; Regardless&#44; though open biopsy seems to be more reliable&#44; percutaneous procedures such as CT guided biopsy are preferred<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> because they are safer&#44; less invasive&#44; require shorter hospital stays and in most cases&#44; general anesthesia is not required&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Since there is still controversy around this topic&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> the aim of this study was to analyze which are the main factors that could influence in the result of a CT guided biopsy in vertebral osteomyelitis patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design and population</span><p id="par0020" class="elsevierStylePara elsevierViewall">A single center retrospective observational study was performed&#46; Inclusion criteria was adult patients who had been diagnosed with VO from January 2010 to January 2020&#46; Diagnosis of VO&#44; according to other studies was established based on the combination of the clinical presentation with either a definitive bacteriologic diagnosis or pathological and&#47;or imaging studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#8211;12</span></a> Patients were admitted to different wards&#44; so medical and surgical approach was not standardized&#46; Patients who did not undergone CT guided biopsy or had a postsurgical infection were excluded&#46; Coagulase-negative staphylococcus was considered a true pathogen when it was isolated from biopsy or when it was detected in two or more blood cultures&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical cases were search through the clinical history management software &#40;Orion Clinic&#44; Everis Group&#41;&#46; Terms searched were &#8220;vertebral osteomyelitis&#8221;&#44; &#8220;discitis&#8221; and &#8220;spondylodiscitis&#8221;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Demographical features&#44; concurrent diseases&#44; laboratory findings&#44; microbiological diagnosis&#44; radiological data&#44; medical complications&#44; antibiotic exposure were compiled&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variable definition</span><p id="par0035" class="elsevierStylePara elsevierViewall">Immunosuppressed patients were considered those who had a rheumatic or inflammatory bowel disease undertaking immunomodulatory drugs&#44; solid organ transplantation receptors&#44; or in Human Immunodeficiency Virus &#40;HIV&#41; patients&#46; Neurological deficit included paresthesia&#44; limb weakness&#44; radiculopathy&#44; sensory loss and&#47;or paraparesis&#46; Clinical and radiological history of lumbar stenosis or disc herniation was considered as prior spine pathology&#46; Chronic Kidney Disease was considered when glomerular filtration rate &#40;GFR&#41; was below 30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; thus&#44; pertaining to groups 4 and 5 of the CKD classification&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Radiological presence of epidural abscess&#44; paravertebral abscess&#44; cord compression and vertebral destruction was determined by a musculoskeletal specialized radiologist&#46; Infection location was defined by the most superior segment involved&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedure description</span><p id="par0045" class="elsevierStylePara elsevierViewall">Standard procedure at our center is performed by Musculoskeletal Specialized Radiologist under local anesthesia and CT control&#46; Abscess sample is collected with Acecut&#174; needle &#40;18G&#41; with coaxial technique&#44; trying to obtain at least 3 samples&#46; For discal space&#44; Ostycut&#174; needle &#40;13&#46;5G&#8211;15G&#41; is used&#46; For detection of mycobacteria&#44; culture and real time PCR was performed &#40;Seegene kit&#41;&#46; If possible&#44; samples were sent for histopathology&#44; anaerobic&#44; aerobic&#44; mycobacteria and fungal cultures&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Continuous variables were summarized using mean &#40;SD&#44; standard deviation&#41; and median &#40;1st&#44; 3rd quartiles&#41;&#46; Categorical variables were summarized using absolute and relative frequencies &#40;&#37;&#41;&#46; To assess the association between risk factors a logistic regression was adjusted including CRP at admission&#44; the presence of fever&#44; back pain span and antibiotic exposure comparing the patients depending on the culture result&#46; All statistical analyses were performed using software R &#40;version 3&#46;5&#46;0&#41;&#46; <span class="elsevierStyleItalic">P</span> values were set based on number of analyses&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Study patients</span><p id="par0055" class="elsevierStylePara elsevierViewall">Overall&#44; from a total of 122 vertebral osteomyelitis cases found&#44; 77 &#40;63&#37;&#41; were included in the study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Patients were divided into groups depending on the culture result&#46; Baseline characteristics are shown below &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Most patients were diagnosed with MRI &#40;65&#37; and 85&#37; respectively between groups&#41;&#44; followed by CT &#40;33&#37; and 15&#37; respectively&#41;&#46; In 1 case in the biopsy positive group&#44; 18F-FDG PET&#47;CT was the diagnosis imaging tool&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Intervention</span><p id="par0065" class="elsevierStylePara elsevierViewall">Delay in the procedure&#44; antibiotic exposure and blood culture positivity were similar among both groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Sample culture was positive in 43 cases &#40;56&#37;&#41; as seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Microorganism isolated included gram<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;72&#37;&#41;&#44; gram<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#40;14&#37;&#41;&#44; mycobacteria &#40;7&#37;&#41; and fungi &#40;7&#37;&#41;&#46; Detailed data of microbiological findings are provided in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Seventeen patients had a positive result on the biopsy and blood cultures&#46; In 14 of these 17 cases &#40;83&#37;&#41; it was isolated the same organism on the blood and biopsy culture &#40;see notations below <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Microbiological diagnosis in biopsy negative group was established according to blood cultures and was possible in 16 patients &#40;47&#37; of the biopsy negative group&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Multivariate analysis was performed with a logistic regression including CRP at admission&#44; fever&#44; back pain span and recent antibiotic treatment&#46; The biopsy cultures were not influenced by the CRP value &#40;CI 95&#37; &#91;0&#46;994&#8211;1&#46;006&#93; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;927&#41;&#44; the presence of fever &#40;CI 95&#37; &#91;0&#46;518&#8211;5&#46;533&#93; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;41&#41; nor antibiotic exposure &#40;CI 95&#37; &#91;0&#46;116&#8211;1&#46;355&#93; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;155&#41;&#46; The longer duration of the back pain was associated to a lower probability of a positive biopsy &#40;CI 95&#37; &#91;0&#46;977&#8211;0&#46;998&#93; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Patients received antibiotic treatment during the next 84 &#40;56&#44; 112&#41; days in biopsy positive group and 84 &#40;56&#44; 120&#41; days in negative group&#46; Fifteen patients required surgery &#40;6 in positive group and 9 in the negative group&#44; 14&#37; and 26&#37; respectively&#41;&#46; Sixteen patients were readmitted after discharge &#40;16 in positive group and 10 in the negative group&#44; 37&#37; and 29&#37; respectively&#41;&#46; Six patients died due to the infection &#40;4 cases&#41; or related complications &#40;2 cases&#41; &#40;3 in positive group and 3 in the negative group&#44; 7&#37; and 9&#37; respectively&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Immunosuppresed patients</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 17 patients were immunosuppressed&#46; Results of these population are commented separately due to its special characteristics&#46; Immunosuppressed patients represented the 22&#37; of the total sample and were balanced between both groups&#44; whom exhibited similar baseline characteristics than non-immunosuppressed patients &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Acute phase markers seemed to be slightly inferior in negative biopsy group&#46; Positive biopsy group may have more abscess formation &#40;100&#37; of the positive group and 87&#37; on the negative group&#44; but epidural abscess was detected in 100&#37; of the patients of the positive group and in the 50&#37; of the negative group&#41;&#46; Delay in procedure performance was slightly inferior in immunosuppressed patients &#40;mean 5&#46;2 days&#41;&#46; Gram positive predominated on cultures &#40;8 cases&#41; and in the other case&#44; <span class="elsevierStyleItalic">C&#46; auris</span> was detected&#46; In 4 cases &#40;44&#37;&#41;&#44; blood and biopsy cultures isolated the same microorganism&#46; Two patients were splenectomized and in one case <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> was isolated on the blood culture &#40;during a febrile episode&#41; and in the other no potential causative organism was detected &#40;the biopsy was performed under antibiotic exposure&#41;&#46; On both cases&#44; the biopsy was negative with a delay of 3 and 4 days respectively&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">In this study including VO patients&#44; the focus has been placed on the biopsy that is needed in many patients&#44; in an attempt of elucidating the causative microorganism so as to provide a targeted antibiotherapy&#44; and thus&#44; reducing side effects and improving the efficacy&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#44;7</span></a> In particular CT guided needle biopsy had been analyzed in a population with demographic and clinical comorbidities distribution similar to other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a> The population of the study had been split in two groups attending to the result of the culture of the sample obtained from de biopsy&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In this cohort a higher presence of immunosuppressed patients could be noted&#44; due to the characteristics of the center&#44; which is a university hospital&#46; The results of that subset of patients have been displayed separately&#46; In general&#44; the distribution of cardiovascular risk factors and other clinical variables has been fair between both groups&#46; Although there are some differences on the radiological variables &#40;more prevalence of epidural abscess and cord compression&#41; and also&#44; the acute phase markers were slightly greater on the positive result group&#46; In any case&#44; extravertebral extension could not act as a factor of poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> This fact would be explored on further studies but seems to be logical due to a presumed more aggressiveness of the infection on immunocompromised host&#46; Moreover&#44; other studies found correlation between higher CRP value and greater chance of a positive result&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The signs and symptoms collected seems to be in agreement with other series<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;4&#44;7</span></a> with the expected high prevalence of back pain&#44; presented in almost all patients and fever in just 1 out 3 patients&#44; approximately in both groups&#46; As seen in other works&#44; delay in diagnosis is still a problem in VO patients<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;4</span></a> who usually waits at least a month since the beginning of the pain&#44; until diagnosis&#46; Additionally&#44; in some cases this period is increased dramatically&#46; Further strategies should be set up in order to reduce this term and prevent future complications&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Infectious endocarditis is a frequent association with VO&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">15&#44;16</span></a> but in this study were scarcely represented because in those patients the causative microorganism is more frequent detected through the blood cultures&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Acute phase markers &#40;CRP and ESR&#41; were elevated in both groups&#46; Numerically&#44; values were higher in biopsy positive groups&#44; as seen in other studies<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7&#8211;9</span></a> but statistical signification was not reach&#46; Radiological variables were comparable in both groups&#46; A slight difference was noted in cord compression &#40;higher in negative group&#41; probably related to a greater presence of patients with acute paraparesis at diagnosis in this group&#46; This result might be linked to the higher presence of further surgical approach detected in the negative culture group&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As it has been pointed out in several studies delay in diagnosis is probably the main issue in VO&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;17</span></a> Moreover&#44; since antibiotic withholding is widely recommended&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> these biopsies should be performed as soon as possible&#46; In this study a median delay of 6 days was detected on both groups&#44; with few differences in the interquartile range &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Marschall et al&#46; achieved a 65&#37; of positivity with a median delay of 3 days&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> Better mean values in immunosuppressed patients have been noted&#44; but overall&#44; this should be improved and analyzed &#40;for instance&#44; creating a specific circuit&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Microorganisms isolated had a distribution comparable to another studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;18</span></a> Antibiotic exposure was registered in half of the cases on the positive group and in the 58&#37; of the negative group&#46; The higher prevalence of patients with acute paraparesis at diagnosis could be a reasonable cause&#46; In addition&#44; more antibiotic exposure is presumed to reduce the culture yield&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> but it was not detected on our study&#46; This is a matter of controversy&#44; but there are other several studies that concluded the same&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#44;17</span></a> A possible explanation of the lack or the small influence of antibiotic exposure on the culture result could be that intervertebral space is avascular&#46; A high correlation between blood cultures and biopsy had been noted&#44; so as it is had been previously recommended on the guidelines and other works&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> CT-guided biopsy could be avoided in most cases&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Overall positivity &#40;56&#37;&#41; was on the average of the studies published which vary from 21&#37; to 89&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;7&#8211;9&#44;19&#8211;21</span></a> The biopsy result was not modified by prior CRP values&#44; fever as clinical presentation nor antibiotic exposure&#46; The longer the length of painful period before diagnosis was related to a lower chance of obtaining a positive result on culture&#46; This result could be explained by a greater aggressiveness of pyogenic organisms that perhaps congregate in the lesser time span instead of non-pyogenic agents and seems logical that the delay in diagnosis makes a negative impact on the technique reliability&#46; Other studies has been performed in order to detect predictive factors of positivity&#44; such as a recent study found that using larger diameter biopsy needle increases the likelihood of causative microorganism&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> Other factor detected related to higher chance of positivity has been the attenuation value on CT scan&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In order to point out the limitations of the study&#44; since this is a retrospective study&#44; clinical cases may be missed during the search process&#46; Moreover&#44; patients were admitted to different wards&#44; and that hence on variability in patient management&#46; Concerning the procedure&#44; adding more variables would provide more information such as areas specifically punctured&#44; specific antimicrobial treatment received prior to the procedure or number of samples taken at each procedure&#46; During statistical analysis some difficulties were found&#44; such a huge variability in days of antimicrobial therapy received prior the procedure&#44; finally solved dichotomizing in &#8220;exposure&#58; yes&#47;no&#8221; and reducing the statistical power&#46; The inclusion of mycobacteria and fungi might influence the clinical picture and the yield of the CT-guided biopsy&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion our study displays an acceptable reliability of CT guided needle biopsy in VO patients&#44; even in cases under antibiotic treatment&#46; The presence of fever or elevated CRP values did not predict a positive culture in our study&#46; A positive blood culture would provide a microbiological diagnosis in most cases&#46; Delay in diagnosis could impact negatively in culture yield&#46; Therefore&#44; improving diagnostic strategies in general and shortening the span from VO diagnosis to the procedure performance in particular&#44; may enhance not only the culture yield reliability but also the patient prognosis&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">None funding source was required&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1644844"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1465687"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1644843"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1465686"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design and population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Variable definition"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Procedure description"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Study patients"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Intervention"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Immunosuppresed patients"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Funding"
        ]
        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflict of interest"
        ]
        10 => array:2 [
          "identificador" => "xack580881"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-05-25"
    "fechaAceptado" => "2020-08-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1465687"
          "palabras" => array:3 [
            0 => "Vertebral osteomyelitis"
            1 => "CT guided biopsy"
            2 => "Spondylodiscitis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1465686"
          "palabras" => array:3 [
            0 => "Osteomielitis vertebral"
            1 => "Punci&#243;n guiada por TC"
            2 => "Espondilodiscitis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to analyze which are the main factors that could influence the result of a CT guided biopsy in vertebral osteomyelitis &#40;VO&#41; patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A single center retrospective observational study was performed including adult patients who had been diagnosed with VO and undergone CT guided needle biopsy from January 2010 to January 2020&#46; Demographical features&#44; concurrent diseases&#44; laboratory findings&#44; microbiological diagnosis&#44; radiological data&#44; medical complications&#44; antibiotic exposure were compiled&#46; Multivariate analysis was performed with a logistic regression comparing the patients depending on the culture result&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Seventy-seven patients were included in the study&#46; Baseline characteristics were comparable between groups&#46; Sample culture was positive in 43 cases &#40;56&#37;&#41;&#46; Microorganism isolated were gram<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;72&#37;&#41;&#44; gram<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#40;14&#37;&#41;&#44; mycobacteria &#40;7&#37;&#41; and fungi &#40;7&#37;&#41;&#46; Delay in the procedure&#44; antibiotic exposure and blood culture positivity were also similar among both groups&#46; The biopsy results were not influenced by the CRP value&#44; the presence of fever nor antibiotic exposure&#46; The longer duration of back pain was associated to a lower probability of a positive culture&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In conclusion&#44; our study displays an acceptable reliability of CT guided needle biopsy in VO patients&#44; even in cases under antibiotic treatment&#46; The presence of fever or CRP values did not predict a positive culture&#46; Delay in diagnosis could impact negatively on culture yield&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El prop&#243;sito del presente estudio es analizar qu&#233; factores pueden influir en el resultado del cultivo de las muestras obtenidas por punci&#243;n guiada por TC en pacientes con osteomielitis vertebral&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio en un &#250;nico centro&#44; retrospectivo y observacional en pacientes diagnosticados de osteomielitis vertebral&#44; que fueron subsidiarios de punci&#243;n-biopsia entre enero de 2010 y enero de 2020&#46; Se recogieron para su an&#225;lisis&#44; variables demogr&#225;ficas&#44; comorbilidades&#44; resultados de laboratorio&#44; radiolog&#237;a&#44; el tratamiento previo con antibi&#243;ticos y la demora previa a la realizaci&#243;n de la t&#233;cnica&#46; Se realiz&#243; un an&#225;lisis multivariante mediante regresi&#243;n log&#237;stica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a un total de 77 pacientes que fueron sometidos a la t&#233;cnica&#46; Sus caracter&#237;sticas basales fueron similares&#46; El cultivo fue positivo en 43 casos &#40;56&#37;&#41;&#46; Los microorganismos aislados fueron gram &#43; &#40;72&#37;&#41;&#44; gram &#8211; &#40;14&#37;&#41;&#44; micobacterias &#40;7&#37;&#41; y hongos &#40;7&#37;&#41;&#46; El retraso en la ejecuci&#243;n de la t&#233;cnica y el tratamiento previo con antibi&#243;ticos fue similar en ambos grupos&#46; Ni el valor de PCR&#44; la presencia de fiebre ni la antibioterapia tuvieron influencia en el resultado del cultivo&#46; Se observ&#243; que una mayor duraci&#243;n del dolor lumbar se relacion&#243; con una menor probabilidad de obtener un resultado positivo en el cultivo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Incluso bajo exposici&#243;n antibi&#243;tica&#44; la punci&#243;n asistida por TC mostr&#243; una rentabilidad aceptable&#46; La presencia de fiebre o valores elevados de PCR no fueron predictivos de positividad del cultivo&#46; El retraso diagn&#243;stico s&#237; podr&#237;a impactar negativamente en la rentabilidad diagn&#243;stica del cultivo procedente de la biopsia&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0045">All authors have seen and approved the manuscript&#44; contributed significantly to the work&#44; and also that the manuscript has not been previously published nor is not being considered for publication elsewhere&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1484
            "Ancho" => 1500
            "Tamanyo" => 125607
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">General study procedure&#46; From a total of 122 cases of VO at our centre&#44; 45 were excluded and 77 included in the study&#46; In 43 patients the CT guided needle biopsy yield the microbiological diagnosis&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mean values are expressed&#58; Mean &#40;SD&#41;&#47;<span class="elsevierStyleItalic">n</span>&#40;&#37;&#41;&#46; Median values are expressed&#58; Median &#40;1st&#44; 3rd Q&#46;&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Biopsy culture positive &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Biopsy culture negative &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#8211; years &#40;ds&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Male sex &#8211; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities &#8211; number &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes Mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Liver cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Immunosuppression&#8211; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Prior spine pathology &#8211; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Symptoms and signs at diagnosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Back pain &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Time since pain started &#8211; median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;20&#46;5&#44; 60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;22&#46;5&#44; 90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fever &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Time since fever started - median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44; 1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute paraparesis &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Underlying endocarditis &#8211; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Acute phase reactants</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CRP &#8211; mg&#47;L median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;8 &#40;48&#46;9&#44; 124&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;8 &#40;23&#46;1&#44; 128&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ESR &#8211; mm&#47;h mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;5 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;5 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Infection location &#8211; number &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cervical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dorsal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lumbo-sacral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Abscess &#8211; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Paravertebral</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Epidural</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vertebral destruction &#8211; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cord compression &#8211; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2801202.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic and baseline characteristics&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Biopsy culture positive &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Biopsy culture negative &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood culture &#40;positive&#41; &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time since admission to procedure &#8211; median days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#44; 11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5 &#40;3&#44; 18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antibiotic exposure &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antibiotic exposure prior procedure &#8211; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0&#44; 11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2801203.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Procedure related variables&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Microorganism isolated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gram positive species &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus aureus MS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus hominis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus mitis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus anginosus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus beta hemol grupo B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus gallolyticus</span> spp&#46;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus sanguinis</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Corynebacterium</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus capitis</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enterococcus</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Propionibacterium acnes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gram negative species &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pseudomona aeruginosa</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Brevundimonas</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escherichia coli</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fungi &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Candida auris</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Candida albicans</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">h</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mycobacteria &#8211; number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Micobacterium tuberculosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2801204.png"
              ]
            ]
          ]
          "notaPie" => array:8 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">In 4 cases were also detected on the blood cultures&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Also was isolated on the blood cultures of a patient who was also diagnosed of colorectal cancer&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Also was isolated on the blood cultures of a patient&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Also was isolated on the blood cultures of a patient&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">One of them was a multirresistan <span class="elsevierStyleItalic">p&#46; Aeruginosa</span> that also was isolated from blood cultures&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">On the same culture of a single patient&#44; grown <span class="elsevierStyleItalic">E&#46; coli</span> and <span class="elsevierStyleItalic">Dermatobacter hominis</span>&#44; <span class="elsevierStyleItalic">E&#46; coli</span> was considered the true pathogen&#46; On the other case&#44; <span class="elsevierStyleItalic">E&#46; coli</span> was also isolated on the blood culture&#46;</p>"
            ]
            6 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "g"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Also was isolated on the blood cultures of a patient&#46;</p>"
            ]
            7 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "h"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Also was isolated on the blood cultures of a patient&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Microorganisms isolated from biopsies&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2015 Infectious Diseases Society of America &#40;IDSA&#41; Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;F&#46; Berbari"
                            1 => "S&#46;S&#46; Kanj"
                            2 => "T&#46;J&#46; Kowalski"
                            3 => "R&#46;O&#46; Darouchi"
                            4 => "A&#46;F&#46; Widmer"
                            5 => "S&#46;K&#46; Schmitt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/civ482"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2015"
                        "volumen" => "61"
                        "paginaInicial" => "e26"
                        "paginaFinal" => "e46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26229122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vertebral osteomyelitis&#58; clinical&#44; microbiological and radiological characteristics of 116 patients &#91;published online ahead of print&#44; 2020 May 20&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;J&#46; Fragio Gil"
                            1 => "R&#46; Gonz&#225;lez Mazar&#237;o"
                            2 => "M&#46; Salavert Lleti"
                            3 => "J&#46;A&#46; Rom&#225;n Ivorra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medcli.2019.12.029"
                      "Revista" => array:3 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2020"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611609938"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pyogenic vertebral osteomyelitis&#58; a systematic review of clinical characteristics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Mylona"
                            1 => "M&#46; Samarkos"
                            2 => "E&#46; Kakalou"
                            3 => "P&#46; Fanourgiakis"
                            4 => "A&#46; Skoutelis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2008.03.002"
                      "Revista" => array:7 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2009"
                        "volumen" => "39"
                        "paginaInicial" => "10"
                        "paginaFinal" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18550153"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0923753419351002"
                          "estado" => "S300"
                          "issn" => "09237534"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pyogenic vertebral osteomyelitis in nondrug users"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Nolla"
                            1 => "J&#46; Ariza"
                            2 => "C&#46; G&#243;mez-Vaquero"
                            3 => "J&#46; Fiter"
                            4 => "J&#46; Bermejo"
                            5 => "J&#46; Valverde"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/sarh.2002.29492"
                      "Revista" => array:7 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2002"
                        "volumen" => "31"
                        "paginaInicial" => "271"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11836660"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0305737215000250"
                          "estado" => "S300"
                          "issn" => "03057372"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Osteomyelitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;P&#46; Lew"
                            1 => "F&#46;A&#46; Waldvogel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)16727-5"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "369"
                        "paginaFinal" => "379"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vertebral osteomyelitis in adults&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;K&#46; Nickerson"
                            1 => "R&#46; Sinha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bmb/ldw003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br Med Bull"
                        "fecha" => "2016"
                        "volumen" => "117"
                        "paginaInicial" => "121"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26872859"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology microbiological diagnosis&#44; and clinical outcomes in pyogenic vertebral osteomyelitis&#58; a 10-year retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46;S&#46;W&#46; Chong"
                            1 => "C&#46;J&#46; Brereton"
                            2 => "A&#46; Gordon"
                            3 => "J&#46;S&#46; Davis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ofid/ofy037"
                      "Revista" => array:4 [
                        "tituloSerie" => "Open Forum Infect Dis"
                        "fecha" => "2018"
                        "volumen" => "5"
                        "paginaInicial" => "ofy037"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic yield of computed tomography-guided biopsy and aspiration for vertebral osteomyelitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;T&#46; Ang"
                            1 => "G&#46;R&#46; Wong"
                            2 => "D&#46;R&#46; Wong"
                            3 => "W&#46; Clements"
                            4 => "T&#46; Joseph"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1754-9485.12923"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Imaging Radiat Oncol"
                        "fecha" => "2019"
                        "volumen" => "63"
                        "paginaInicial" => "589"
                        "paginaFinal" => "595"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31301094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Marschall"
                            1 => "K&#46;P&#46; Bhavan"
                            2 => "M&#46;A&#46; Olsen"
                            3 => "V&#46;J&#46; Fraser"
                            4 => "N&#46;M&#46; Wright"
                            5 => "D&#46;K&#46; Warren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/cir062"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2011"
                        "volumen" => "52"
                        "paginaInicial" => "867"
                        "paginaFinal" => "872"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Change in bone CT attenuation and C-reactive protein are predictors of bone biopsy culture positivity in patients with vertebral discitis&#47;osteomyelitis &#91;published online ahead of print&#44; 2020 Mar 19&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;T&#46; Lee"
                            1 => "B&#46;A&#46; Pukenas"
                            2 => "R&#46; Sebro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BRS.0000000000003504"
                      "Revista" => array:2 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microbiologically and clinically diagnosed vertebral osteomyelitis&#58; impact of prior antibiotic exposure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;J&#46; Kim"
                            1 => "K&#46;H&#46; Song"
                            2 => "W&#46;B&#46; Park"
                            3 => "E&#46; Suk Kim"
                            4 => "S&#46; Won Park"
                            5 => "H&#46;B&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.05953-11"
                      "Revista" => array:7 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2012"
                        "volumen" => "56"
                        "paginaInicial" => "2122"
                        "paginaFinal" => "2124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22232286"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204514711714"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of withholding antibiotics prior to bone biopsy in patients with suspected osteomyelitis&#58; a meta-analysis of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;A&#46; Crisologo"
                            1 => "J&#46; La Fontaine"
                            2 => "D&#46;K&#46; Wukich"
                            3 => "P&#46;J&#46; Kim"
                            4 => "O&#46;K&#46; Oz"
                            5 => "L&#46;A&#46; Lavery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Wounds"
                        "fecha" => "2019"
                        "volumen" => "31"
                        "paginaInicial" => "205"
                        "paginaFinal" => "212"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31356178"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673610621101"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Yield of image-guided needle biopsy for infectious discitis&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;L&#46; McNamara"
                            1 => "E&#46;C&#46; Dickerson"
                            2 => "D&#46;M&#46; Gomez-Hassan"
                            3 => "S&#46;K&#46; Cinti"
                            4 => "A&#46; Srinivasan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3174/ajnr.A5337"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2017"
                        "volumen" => "38"
                        "paginaInicial" => "2021"
                        "paginaFinal" => "2027"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28882866"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome of pyogenic vertebral osteomyelitis&#58; a cohort study of 260 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Gupta"
                            1 => "T&#46;J&#46; Kowalski"
                            2 => "D&#46;R&#46; Osmon"
                            3 => "M&#46; Enzler"
                            4 => "J&#46;M&#46; Steckelberg"
                            5 => "P&#46;M&#46; Huddleston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ofid/ofu107"
                      "Revista" => array:3 [
                        "tituloSerie" => "Open Forum Infect Dis"
                        "fecha" => "2014"
                        "volumen" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pyogenic vertebral osteomyelitis and endocarditis&#58; incidence&#44; risk factors&#44; and outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Pigrau"
                            1 => "B&#46; Almirante"
                            2 => "X&#46; Flores"
                            3 => "V&#46; Falc&#243;"
                            4 => "D&#46; Rodr&#237;guez"
                            5 => "I&#46; Gasser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2005.02.027"
                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2005"
                        "volumen" => "118"
                        "paginaInicial" => "1287"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The unique clinical features and outcome of infectious endocarditis and vertebral osteomyelitis co-infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Koslow"
                            1 => "R&#46; Kuperstein"
                            2 => "I&#46; Eshed"
                            3 => "M&#46; Perelman"
                            4 => "E&#46; Maor"
                            5 => "Y&#46; Sidi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2014.02.023"
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2014"
                        "volumen" => "127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25308624"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0923753419313146"
                          "estado" => "S300"
                          "issn" => "09237534"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lack of effect of antibiotics on biopsy culture results in vertebral osteomyelitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46;D&#46; Saravolatz 2nd"
                            1 => "V&#46; Labalo"
                            2 => "J&#46; Fishbain"
                            3 => "S&#46; Szpunar"
                            4 => "L&#46;B&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diagmicrobio.2018.02.017"
                      "Revista" => array:7 [
                        "tituloSerie" => "Diagn Microbiol Infect Dis"
                        "fecha" => "2018"
                        "volumen" => "91"
                        "paginaInicial" => "273"
                        "paginaFinal" => "274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29573841"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673602099622"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Amsilli M&#44; Epaulard O&#46; How is the microbial diagnosis of bacterial vertebral osteomyelitis performed&#63; An 11-year retrospective study &#91;published online ahead of print&#44; 2020 Jun 26&#93;&#46; Eur J Clin Microbiol Infect Dis&#46; <a target="_blank" href="doi:10.1007/s10096-020-03929-1">doi&#58;10&#46;1007&#47;s10096-020-03929-1</a>&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CT-guided discitis-osteomyelitis biopsies&#58; needle gauge and microbiology results &#91;published online ahead of print&#44; 2020 Apr 18&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;S&#46; Husseini"
                            1 => "F&#46;J&#46; Simeone"
                            2 => "S&#46;B&#46; Nelson"
                            3 => "C&#46;Y&#46; Chang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00256-020-03439-3"
                      "Revista" => array:3 [
                        "tituloSerie" => "Skeletal Radiol"
                        "fecha" => "2020"
                        "paginaInicial" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors predicting positive culture in CT-guided bone biopsy performed for suspected osteomyelitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Beroukhim"
                            1 => "R&#46; Shah"
                            2 => "M&#46;D&#46; Bucknor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/AJR.18.20125"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "2019"
                        "volumen" => "212"
                        "paginaInicial" => "620"
                        "paginaFinal" => "624"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30645166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy of computed tomography-guided percutaneous spine biopsies in determining a causative organism in cases of suspected infection&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Sertic"
                            1 => "L&#46; Parkes"
                            2 => "S&#46; Mattiassi"
                            3 => "K&#46; Pritzker"
                            4 => "M&#46; Gardam"
                            5 => "K&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.carj.2018.09.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can Assoc Radiol J"
                        "fecha" => "2019"
                        "volumen" => "70"
                        "paginaInicial" => "96"
                        "paginaFinal" => "103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30691569"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack580881"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0150" class="elsevierStylePara elsevierViewall">To our partners from the Rheumatology department&#44; the Infectious disease Unit and the Musculoskeletal Unit of the Radiology department&#46; Also to Mrs&#46; Paula Gim&#233;nez for her effort and valuable help&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The authors are grateful for the collaboration with English language revision to Mr&#46; Paul Godfrey&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/1699258X/0000001800000001/v1_202201120658/S1699258X20301996/v1_202201120658/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17499"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001800000001/v1_202201120658/S1699258X20301996/v1_202201120658/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20301996?idApp=UINPBA00004M"
]

Información del artículo

ISSN: 1699258X
Idioma original: Inglés

DOI:10.1016/j.reuma.2020.08.002

Datos actualizados diariamente

año/Mes	Html	Pdf	Total

2024 Octubre	32	31	63
2024 Septiembre	43	18	61
2024 Agosto	75	42	117
2024 Julio	48	34	82
2024 Junio	63	54	117
2024 Mayo	36	38	74
2024 Abril	32	34	66
2024 Marzo	30	35	65
2024 Febrero	23	28	51
2024 Enero	27	28	55
2023 Diciembre	58	26	84
2023 Noviembre	44	32	76
2023 Octubre	33	28	61
2023 Septiembre	115	40	155
2023 Agosto	36	14	50
2023 Julio	36	28	64
2023 Junio	25	21	46
2023 Mayo	34	24	58
2023 Abril	14	11	25
2023 Marzo	55	21	76
2023 Febrero	37	24	61
2023 Enero	23	12	35
2022 Diciembre	49	40	89
2022 Noviembre	57	34	91
2022 Octubre	61	30	91
2022 Septiembre	42	36	78
2022 Agosto	37	45	82
2022 Julio	38	43	81
2022 Febrero	3	2	5
2022 Enero	1	0	1
2021 Octubre	1	2	3
2020 Octubre	1	2	3

Mostrar todo

Indexada en:

Síguenos:

Suscribirse:

Estadísticas

Indexada en:

Síguenos:

Suscribirse:

Estadísticas

Suscríbase a la newsletter