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

Pérez-Prieto, Daniel; Portillo, María Eugenia; Puig-Verdié, Lluís; Alier, Albert; Martínez, Santos; Sorlí, Lluïsa; Horcajada, Juan Pablo; Monllau, Joan Carles

doi:10.1007/s00264-017-3430-5

Cited by 131 publications

(96 citation statements)

References 26 publications

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“…However, CRP and ESR are inflammatory markers with a low sensitivity: levels within the normal range do not rule out infection. Pérez-Prieto et al [23] found that one third of PJI presented normal CRP levels and that approximately two thirds of these also had a normal ESR, and Akgün et al [24] had similar findings. This is the case especially in low-grade infections due to coagulase-negative staphylococci and Cutibacterium spp.…”

Section: Use Of Swab Samplesmentioning

confidence: 86%

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

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Background Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls. Materials and methods Common diagnostic and treatment errors are described, analyzed and interpreted. Results Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results. Conclusion Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.

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Section: Use Of Swab Samplesmentioning

confidence: 86%

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

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“…CRP has been considered as a specific indicator for the diagnosis of PJI, and its diagnostic sensitivity and specificity are similar to that of histopathology [39], which has also been recommended in guidelines [40]. P erez-Prieto et al [41] had revealed that CRP lacks sensitivity in detecting PJI, especially in low-grade and chronic cases. Patients included in this study were diagnosed with chronic PJI, and it was found that CRP had a sensitivity of 81.13% and specificity of 65.67%, indicating the limited diagnostic value of CRP in chronic PJI.…”

Section: Discussionmentioning

confidence: 99%

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

Qin

Gong

et al. 2020

The Journal of Arthroplasty

101

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“…However, CRP is not specific for infection and usually increases due to healing process after intervention. Pérez-Prieto et al18) found that with normal CRP about one-third of chronic, low-grade infections would be missed. So the combination of CRP and ESR is used for diagnose PJI1920), the sensitivity of combined ESR (>30 mm/hr) and CRP (>10 mg/L) was 96%, but low specificity 56%21).…”

Section: Diagnosismentioning

confidence: 99%

Management of Periprosthetic Joint Infection

2018

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Periprosthetic joint infection (PJI) is a serious complication after arthroplasty, which is associated with pain, prolonged hospital stay, multiple surgeries, functional incapacitation, and even mortality. Using scientific and efficient management protocol including modern diagnosis and treatment of PJI and eradication of infection is possible in a high percentage of affected patients. In this article, we review the current knowledge in epidemiology, classification, pathogenesis, diagnosis and treatment of PJI.

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

Cited by 131 publications

References 26 publications

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

Management of Periprosthetic Joint Infection

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