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C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections

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dc.contributor.author Pérez Prieto, Daniel
dc.contributor.author Portillo, María Eugenia
dc.contributor.author Puig Verdié, Luís
dc.contributor.author Alier Fabrego, Albert
dc.contributor.author Martínez Díaz, Santos
dc.contributor.author Sorli Redó, M. Luisa
dc.contributor.author Horcajada Gallego, Juan Pablo
dc.contributor.author Monllau García, Juan Carlos
dc.date.accessioned 2018-01-19T08:11:43Z
dc.date.issued 2017
dc.identifier.citation Portillo ME, Puig-Verdié L, Alier A, Martínez S, Sorlí L, Horcajada JP. Et al. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop. 2017 Jul;41(7):1315-1319. DOI: 10.1007/s00264-017-3430-5
dc.identifier.issn 0341-2695
dc.identifier.uri http://hdl.handle.net/10230/33693
dc.description.abstract BACKGROUND: Periprosthetic tissue cultures, sonication and synovial fluid cultures remain the gold standard for prosthetic joint infection (PJI) diagnosis. However, some 15-20% culture-negative PJI are still reported. Therefore, there is the need for other diagnostic criteria. One point of concern relative to the different definitions of PJI is as to the inclusion of the c-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) as diagnostic criteria for PJI despite them being non-specific inflammatory blood tests. PURPOSE: The purpose of the present study was to determine the relevance of CRP and the ESR in the diagnosis of PJI. METHODS: All PJI with positive cultures over a two-year period in two hospitals were reviewed. The main variables of the present study were the type of prosthesis and the CRP level. More information was recorded in those patients with normal CRP: radiographs, physical examination records and the ESR. RESULTS: Seventy-three patients were included in study. Pre-operative CRP levels were normal (lower than 0.8 mg/dl) in 23 patients, representing 32% of all PJI with positive cultures. Low virulence micro-organisms, 12 coagulase-negative staphylococci and four P. acnes, grew in most of them. They represented 70% of all PJI with normal CRP levels. In addition, 17 patients (23% of all PJI with positive cultures) had a normal ESR, a normal physical examination (they only presented with pain) and no clear loosening was observed in the radiographs. CONCLUSIONS: Per the American Association of Orthopaedic Surgeons (AAOS) guidelines or the Musculoskeletal Infection Society (MSIS), 23% of the patients in the present study with PJI would never have been identified. Blood inflammatory markers such as the CRP level and ESR may not be accurate as diagnostic tools in PJI, particularly to identify low-grade and chronic PJI.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Springer
dc.rights © Springer The final publication is available at Springer via http://dx.doi.org/10.1007/s00264-017-3430-5”.
dc.subject.other Pròstata
dc.subject.other Infeccions
dc.title C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1007/s00264-017-3430-5
dc.subject.keyword CRP
dc.subject.keyword Chronic PJI
dc.subject.keyword Culture-negative PJI
dc.subject.keyword Low-grade PJI
dc.subject.keyword Prosthetic joint infection
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/acceptedVersion
dc.embargo.liftdate 2018-07-31


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