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01-07-2017 | Original Paper

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

Authors: Daniel Pérez-Prieto, María E. Portillo, Lluís Puig-Verdié, Albert Alier, Santos Martínez, Lluisa Sorlí, Juan P. Horcajada, Joan C. Monllau

Published in: International Orthopaedics | Issue 7/2017

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.

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Title: C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections
Authors: Daniel Pérez-Prieto
María E. Portillo
Lluís Puig-Verdié
Albert Alier
Santos Martínez
Lluisa Sorlí
Juan P. Horcajada
Joan C. Monllau
Publication date: 01-07-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 7/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3430-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusions

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