Does Antibiotic Treatment Before Bone Biopsy Affects the Identification of Bacterial Pathogens From Bone Culture in Diabetic Foot Osteomyelitis? A Systematic Review and Meta Analysis
Abstract
Our aim was to evaluate the effect of pre-biopsy antibiotics and bacterial pathogen recovery after bone biopsy in patients suspected of having diabetic foot osteomyelitis. A meta-analysis following PRISMA guidelines was conducted. Pubmed, EMBASE, and Cochrane Library were searched for comparative studies reporting positive culture outcomes stratified by antibiotic exposure prior to bone biopsy. Eligible studies included adult patients undergoing bone biopsy with extractable data on pre-biopsy antibiotic use and culture positivity. Pooled odds ratios were calculated using a random-effects model with the Mantel-Haenszel method. Statistical heterogeneity was assessed using the I2 statistic and Cochran's Q test. Four studies met inclusion criteria. The cumulative findings showed an odds ratio of 0.78, CI [0.31, 1.98], p = 0.60, suggesting no significant difference in bacterial culture yield between groups that had antibiotic exposure and patients naïve to antibiotics before biopsy. Heterogeneity: τ2 (REMLb) = 0.42; χ2= 6.11, p = 0.11; I2 = 50%. Withholding antibiotics before bone biopsy in DFO patients does not appear to affect bacterial culture yield.
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