Does Antibiotic Treatment Before Bone Biopsy Affect the Identification of Bacterial Pathogens From Bone Culture?

Lawrence A. Lavery, DPM, MPH; Peter A. Crisologo, DPM, FFPM RCPS (Glasg); Easton Ryan, MD; David Truong, DPM; Gu Kang, PhD; Mathew J. Johnson, DPM; Matthew Malone, PhD, FFPM RCPS (Glasg)


Wounds. 2023;35(6):E186-E188. 

In This Article

Abstract and Introduction


There is a common belief and practice that any exposure to oral or parenteral antibiotics prior to bone biopsy makes culture results unreliable. The aim of this article was to evaluate the effect of antibiotic exposure on bacterial yield in DFO microbiology specimens. The authors retrospectively evaluated 114 patients with DFO confirmed by histology. The primary outcome measurement was the proportion of bone biopsies with positive bacterial cultures. There was no statistically significant difference in culture yield in patients who received antibiotics (77.9%) and patients who did not (85.7%, P = .58). This study demonstrates that there were no differences in bacterial yield whether antibiotics were withheld or administered before bone cultures were obtained. The duration of antibiotic use prior to bone biopsy did not change the bacterial yield.


There is a common belief that any exposure to antibiotics prior to bone biopsy renders culture results unreliable. In the presence of a negative culture, some physicians disregard the results even if there has been only a single dose of antibiotics, hypothesizing that antibiotic penetration of bone could interfere with recovery and identification of bacteria. Clinically, this is problematic when clinical findings such as "probe to bone" or MRI contradict a negative bone culture. In these cases, the gold standard may be disregarded in favor of less-reliable tests.

The majority of studies that discuss antibiotics and bone culture yield are from patients with hematogenous VO.[1] The results of these studies have been generalized to other types of bone infections that occur from direct extension, such as DFO. The aim of the current study was to evaluate the effect of antibiotic exposure and bacterial pathogen identification in patients with DFO. The null hypothesis was that bacterial culture identification would be the same in patients who did not receive pre-biopsy antibiotics and patients who received pre-biopsy antibiotics.